Thursday, June 5th - The Gauntlet Begins: Part 1

We start our morning very early because today they are going to test Kinley and see if she can come off of ECMO. We leave the house at 5:45 am and arrive at Kinley's bedside at 6:20 am. Noel and Sara are here and update us on Kinley. She received more platelets around 11:00 pm. Over the entire night they had to give her 2 doses of versed to help her sleep. She had her oxygen challenge at 5:00 am and scored a 406. That's our girl, always an overachiever. Her chest x-ray has been done and it looks like her right lung is a little more open than yesterday.

At 6:30 am Kinley received another round of platelets. Also, Dr. S stops by and lets us know that they are still planning on turning off the ECMO's O2 around 7:00 am.

The time has come. At 6:55 am, the oxygen provided by the ECMO machine is cut off. Kinley is now responsible for oxygenating all of her own blood. She is still on the conventional ventilator which is providing 40% oxygen. As we head out for shift change we meet Kinley's day nurses, Sarah and Brecklyn.

We return as soon as possible and at 8:30 am Kinley receives a round of RBCs (red blood cells) to help her oxygenate her blood. At 8:40 am we get back the results of Kinley's most recent blood gas test. Her CO2 is 63 and her O2 is 117. Her O2 is looking good, but we need Kinley to lower her CO2 level. We want that number to be between 35 and 45.

At 9:05 am Dr. P and Dr. W come by to evaluate Kinley. Her breathing sounds good and her oxygenation is going well, but she is not getting rid of her CO2 as well as they would like. They may put Kinley back on the high frequency ventilator to help her get rid of her excess CO2.

Urine Update: During the shift change they calculated Kinley's urine output during the night shift and also for the last 24 hours. Her output over the last 24 hours is 9 cc/kilo/hr and for the night shift it was 6 cc/kilo/hr. (Her goal is to be over 1 cc/kilo/hr.)

10:00 am - Her next blood gas results are back and her CO2 is 71 (going in the wrong direction) and her O2 is 91. The doctors decide to change Kinley over to the high frequency ventilator to help with her gas exchange and also to keep her lungs from working too hard.

At 10:30 am the high frequency ventilator arrives and they begin to get Kinley switched over. By 10:45 am Kinley is off of the conventional ventilator and back on the high frequency ventilator. Dr. P lets us know that this is not considered a set back. It is more of a lateral move because the percent of oxygen from the high frequency ventilator is less than it was on the conventional ventilator (from 40% to 35%), but the high frequency will be less damaging to her lungs and allow for better gas exchange. Dr. P and Dr. W also place orders for another blood gas test and a chest x-ray at noon. The main thing we will be looking for in the chest x-ray is to see if her lungs are opening up anymore.

12:00 pm - Kinley's blood gas test results are back and they are 59 for CO2 and 68 for O2. Her CO2 level is now moving in the right direction and her O2 levels are still looking okay. To make sure that her O2 levels do not drop too far they have decided to increase the percent of oxygen from the ventilator to 40%. Kinley's chest x-ray has been taken, but no results yet.

More to come as the gauntlet continues. . .