5:10am BP’s higher the last few hours. Nurse gave him his Labetalol last night, and his “as needed” Hydralazine for BP this morning. In addition, she gave him an extra dose of Dilaudid to see if it was pain related. Nothing seemed to help.
Also this morning, his oxygen saturations are lower. While he’s on ECMO, they are tolerant of him being in the mid 70’s. Right now they are low 70’s to upper 60’s. Output from chest tube drain is down overnight. Usually puts out 250ml-300ml of fluid. Overnight had 125ml. Unsure if it’s related to his oxygen saturations.
Doctor at beside looking at ventilator settings, and nurse suctioned his trach. Nurse said it’s been a “dry suction” every time, meaning that he has minimal secretions. Waiting for xray to come do his routine chest xray. Attending doctor also came in. Thinks that they are going to need to change out his ECMO oxygenator this morning. Due to him not being on blood thinners (other than SQ Heparin) there can be small clots that form in the cartridge and tubing (which have been there is Seth’s case) that can affect how the ECMO circuit runs. They’ve told us to expect this. He’s on a higher sweep setting since yesterday, meaning how much CO2 is being pulled from his lungs. His Lactate is good this morning, so we know that he’s getting enough oxygen to his tissues right now (most importantly). If his tital volumes drop on the ventilator before they change out the ECMO circuit, they may try another broncoscopy to help clear his lungs. Nurse is going to give him his BP meds a little earlier and more Dilaudid for pain before they move him around for his xray and bath.Xray came and did film. Doctor looked at it, and said it is consistent with how it’s been. So now changes there. Waiting still for other doctors to round. Right now, his BP is better 116/46 and his SPO2 sats are 79-81% (also better).To change out his oxygenator, they’d have to disconnect his ECMO tubing and attach new tubing and a new circuit. The process is quick so he’s not off of it very long. No timeline given when it’ll be done.
He has the same nurses today as he did yesterday. The nurses are saying that the intensivist can make their recommendations to change the oxygenator out, but it’ll be up to CTS (cardio thoracic surgery) that manages it and would have to make that final decision. It would be about 15 secs that the Ecmo would be disconnected. It’ll have to be changed out at some point, it’s just a matter of when.
7:43am His internal medicine said from their standpoint, he’s “about the same.” They were happy his sodium levels are stable, his BP and heart rate are being managed off the Esmolol drip, & temps are stable. His WBC count is still elevated, but has been consistently this way. They’d be more concerned if they saw a spike in this, or if his temps went up (but they have been normal). Will be on a 10 day course of antibiotics. Expecting chest tube to come out in the next 2 days. They don’t see an air leak, but want to make sure that the hole is sealed well so his lung doesn’t collapse again. They looked at clots in his ECMO circuit. Said if we have questions today, their office is down the hall and they’d be happy to come. Waiting for CTS to determine what to do about his oxygenator.
7:58am The internal medicine drs this morning called the “hole” in his lung more of a “fistula.” Treatment is the same, but a fistula is more of a passage or tunnel-like connection between his airway and the pleural space. So to me, probably why they are being more conservative and why the lung took longer to heal.
8:24am The CTS nurse practitioner came by and had surgeon on the phone. They will change circuit out this morning after they do some of his morning cares.
-Aunt Kerry
Specific prayer today:
Lungs to be healed
Antibiotics to keep working
Safe ECMO replacement when needed
Trigger warning: Picture is of the ECMO machine. You’ll notice two tubes on the left. The darker is the unoxygenated blood being taken from a vein in his neck which goes through a honeycomb box, called an oxygenator that puts in oxygen. The lighter tube is the oxygenated blood returning to his vein. The technology that God has given us wisdom to figure out is amazing!-Darcy
PS, Hannah, Ben and Seth have always liked the show Phineas and Ferb (pix). Every time someone says “oxygenator”, it reminds me of the character in the show who is always making a machine/invention that ends with -ator. I’m sure Seth would find this humorous too.
Leave a Reply