Hanoi (VNA) – Critically ill with septic shock and multiple organ failure, Mr. David Schmidt, a German tourist, received dedicated treatment from doctors for 15 days despite having no family members by his side.
While traveling in Hanoi, Mr. David developed abdominal pain, repeated vomiting, and diarrhea. Upon examination at Hong Ngoc General Hospital, he was diagnosed with a severe gastrointestinal infection and was advised to be admitted for inpatient treatment. However, he declined admission as he wished to return to his home country.
Just a few hours later, Mr. David was brought back to the Emergency Department in a state of profound exhaustion, impaired consciousness, and an SpO₂ level that had dropped to 88 percent while breathing room air. The patient was immediately resuscitated, while in depth examinations and specialized laboratory tests were performed to determine the cause.
Laboratory results showed that the disease was progressing rapidly and severely. The marker used to assess heart failure was more than 57 times higher than normal, while the infection marker was nearly 900 times above the reference limit. Renal function continued to deteriorate, and arterial blood gas results showed that the patient had developed respiratory failure.
Mr. David was diagnosed with septic shock, severe bloodstream infection, pneumonia complicated by ARDS, severe multiple organ failure, and a very high risk of death. The intensive care team immediately initiated mechanical ventilation, endotracheal intubation, and central venous catheterization, while also coordinating with the German Embassy to contact the patient’s family.
Even before contact could be established with his family, doctors coordinated multidisciplinary care, applied advanced intensive care techniques, and fought minute by minute to save the patient’s life.
After 24 hours of emergency treatment, the patient’s condition remained complex, with cardiac arrhythmias, episodes of tachycardia reaching up to 170 beats per minute, and severe respiratory acidosis. The doctors immediately initiated broad spectrum antibiotics, continuous renal replacement therapy, sedation and neuromuscular blockade, albumin supplementation, ventilator optimisation, and prone position ventilation to improve respiratory function and control the infection.
“To ensure maximum safety for the patient, we organised online consultations with tertiary hospitals. The specialists all agreed with the treatment strategy and intensive care indications being implemented at Hong Ngoc General Hospital” said Dr. Pham Thi Ninh Van, MD, Specialist Level I, Emergency Medicine and Intensive Care Department, Hong Ngoc General Hospital, who directly treated the patient.
As the patient had both heart failure and septic shock, medication administration and fluid resuscitation had to be calculated with great caution. Over the following 48 hours, a PiCCO system was placed for continuous hemodynamic monitoring and fluid management, helping optimize treatment.
“If the medication dose is too strong, the heart may not be able to tolerate it; however, if the dose is insufficient, the infection cannot be brought under control. Therefore, physicians must continuously monitor hemodynamics using PiCCO to adjust medications and intravenous fluids with precision down to the milliliter” Dr. Van explained.
Blood culture results confirmed that the patient had a bloodstream infection caused by Klebsiella pneumoniae originating from the gastrointestinal tract. Based on these findings, doctors optimised the antibiotic regimen, leading to markedly improved treatment outcomes.
After three days of intensive resuscitation, the patient’s clinical indicators began to improve, and he gradually emerged from critical condition. However, he continued to receive continuous renal replacement therapy as his cardiac and renal function had not yet fully recovered. By day 7, his respiratory function had improved markedly. After 15 days of treatment, the endotracheal tube was removed. The patient was able to breathe on his own with oxygen delivered via a nasal cannula, sit up, eat, drink, and call his family in Germany.
After nearly one month of treatment, his inflammatory markers and organ function indicators had almost returned to normal, and he was considered fit to return to his home country.
According to Dr. Van, this was a case of gastrointestinal infection with exceptionally rapid and dangerous progression, leading to septic shock and multiple organ failure within a short period of time. Such cases require early detection and intensive resuscitation from the very first hours to increase the patient’s chance of survival.
Hong Ngoc General Hospital has been awarded the Surgical Education Centre accreditation by the Royal College of Surgeons of England, recognizing its professional expertise, quality of care, and patient safety in accordance with international standards. The hospital has also invested in modern medical equipment, enabling the treatment of many severe and critical cases and supporting clinical specialties in complex emergency situations.
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