Howerver, at the night of 23rd, Ximei experienced a sudden shortness of breath. Her pulse was 140 per minute. She was fatigued and drowsy and was immediately transferred to ICU. The medical monitor showed oxygen saturation level was 85%-92%. End-tidal carbon dioxide concentration (partial pressure) was 120, three times higher than normal and pH was 7.2. In medical term, she was having respiratory acidosis with metabolic alkalosis. According to our respiratory specialist, this was Type II respiratory failure.
Dr. Niu, Dr. Mu and Dr. Li, all highly experienced cardiothoracic surgeons came to help. We analysed and concluded that this was caused by the high intra-abdominal pressure which caused diaphragmatic elevation and compression of lung and heart. The immediate action to take was to drain out the abdominal fluid (ascite) immediately to reduce the abdominal cavity pressure so that the lungs could resume greater activity. There was no technical problem in performing celiocentesis and drawing ascites, but there were some factors to be taken into consideration: firstly, once the therapy was performed, there would be a reduction of intravascular water, proteins and electrolytes in the blood which needed to be supplemented leading to inadequate intravascular volume thus causing shock and renal dysfunction. Secondly, rapid drawing ascites therapy would cause disequilibrium of abdominal cavity pressure causing heart and circulatory dysfunction. Thirdly, as the abdominal cavity was not clearly visible, if ascites were caused by cancerous growth, they would be encapsulated by sacs; piercing the sacs would cause metastasis.
Although weak, Ximei still had a clear mind. Holding my hand, she said, “I know that I am in a critical state. Just proceed with whatever you plan to do. If I survive, I will volunteer myself to serve in your hospital. If I don’t survive, you can use my remains for medical research purpose.”
As doctors, we were often faced with such dilemma. The top most priority now was to correct respiratory failure. I specialized on clinical digestive diseases and had the experience in treating ascites due to liver cirrhosis. As long as the speed and rhythm of liquid flow were under control and protein supplement was given, it would greatly reduce the associated risks.
A needle was inserted into Ximei’s lower right abdomen to reduce the abdominal pressure. Pale yellowish fluid flew out rapidly. 500 ml of the fluid was collected within 5 minutes and a total of 2000ml of fluid was drained. Simultaneously, intravenous injection of albumen was given.
Ximei felt very weak and did not want to talk. Dr. Li Haibo reduced the flow of oxygen by 30%. The drowsiness experienced by the patient was greatly reduced. Too much oxygen intake would suppress the respiratory centre and aggravate respiratory failure. After an hour, the end-tidal carbon dioxide concentration (partial pressure) was 80, pH rose to 7.35. That night, 300ml abdominal fluid was drained out hourly.