Friday, June 6th - The Gauntlet has been delayed

We arrive a bit after 8:00 am. Overall, Kinley's ECMO and vent settings are completely the same as when we left yesterday. The oxygen input is still disconnected from Kinley's ECMO machine and the flow is still at its normal setting. There was a small adjustment to her high frequency ventilator to help her get rid of some excess CO2. During the night, Kinley received 2 extra doses of versed (a sedative) to help her remain calm and relaxed. Kinley's urine output is still going strong, for the past 24 hours she is at about 6.5 cc/kilo/hr.

Not long after we arrive, Bridget (echo technician) comes in with her portable ultrasound machine. Kinley's ECMO flow is turned down and Bridget begins with the heart echo test. It only takes about 10 minutes to complete the test, then Bridget leaves to take the test results to the cardiologist for a final analysis.

Around 10:30 am we get some blood gas test results back. Her CO2 is at 62 (okay, but not great) and her O2 is at 109 (good). We also find out that Kinley's chest x-ray looks good, her lungs are open, and that her head ultrasound came back with no concerns.

At 12:15 pm Dr. W came by with the heart echo test results. Kinley will not be making the move off of the ECMO machine today. The heart echo test shows that Kinley's pulmonary pressure has not changed since yesterday. It is still too high and therefore too close to her arterial blood pressure. (If Kinley were to come off of ECMO with high pulmonary pressure, that would be a big concern because it means that her pulmonary hypertension could come back and that would be an even bigger concern because Kinley would not be able to go back on ECMO.) This means that the oxygen input will be reconnected to Kinley's ECMO machine and the ECMO machine will return to being her full support. She will be moved back to the conventional ventilator, which will be at minimal settings, to help rest her lungs. The NO (nitrous oxide) machine will remain to help lower Kinley's pulmonary pressure. Dr. W. has also ordered a tracheal aspirate. This is a culture of the mucus in Kinley's lung. This will help to tell us if Kinley has an infection that is affecting her pulmonary pressure. Overall, they will let Kinley rest for the weekend and check back with her on Monday to see if she is ready to come off of ECMO then.

At 12:30 pm, oxygen is reconnected to the ECMO machine.

At 1:00 pm, the conventional ventilator is in place and running.

At 2:10 pm we get the results from Kinley's most recent blood gas test. Her CO2 is 65 and her O2 is 50. This is a bit concerning because the ECMO machine is back in charge of Kinley's gas exchange and this means that her CO2 should be lower and her O2 should be much higher. If you can remember back to yesterday and/or earlier today, Kinley was putting up better numbers than this. Dr. W has come back to help make adjustments to the ECMO machine.

Some good news for Kinley today, she received a new friend that she seems to really like. Here are a couple of pictures of Kinley with her new "sugarbear".