Tuesday, June 3rd

We arrive at Kinley's bed station around 10:00 am. Dot and Megan are here and get us up to date on all of the Kinley news from last night and earlier this morning. Last night Kinley had a couple extra doses of morphine and versed. She also received some more platelets and her urine output is still going strong. This morning Kinley had another oxygen challenge, but her numbers were not as good as yesterday. Today she scored a 154 and yesterday was 246, but they want her score to be over 300. It looks like Kinley will need a little more time on ECMO to rest her heart and lungs. She had her chest x-ray and head ultrasound before we arrived. For the most part, her chest x-ray looked good, but it looks like a little bit of her right lung is starting to loss some air volume. It is not collapsing, but it does appear that some of the air sacs are closing. This is not overly concerning because they have her vent settings very low. The reason her vent settings are so low is because they are trying to rest her lungs as much as possible. (Technically, she doesn't even need her lungs while she is on ECMO.) When the time comes for Kinley to come off of ECMO they will make sure that her lungs/air sacs are open. No news has been heard about her head ultrasound, so that is good news. Only if something is wrong will the nurses hear back about the head ultrasound.

Currently, Kinley is doing well. She opened her eyes when we got here. She is also moving around and trying to grab all of her cords and tubes. If she keeps this up we might need to put mittens on her.

At 12:30 pm, Dr. W came by and decided to adjust Kinley's vent settings. The pressure of the vent and the oxygen percentage going in will remain the same, but the frequency of her breaths per minute will be increase from 20 to 35. This should help open the air sacs in her lungs. It will also help get Kinley prepped for her heart echo test tomorrow. A heart echo is where they turn down the blood flow from the ECMO machine and see how Kinley does when she has to do most of the work of oxygenating her blood. During this process they will also be using an ultrasound machine to look at her heart and determine the pressure in her right ventricle. The reason they want to know the pressure in her right ventricle is because it is the best indicator of the blood pressure in her lungs. Knowing this helps to determine if Kinley is overcoming her pulmonary hypertension.

Kinley was given a dose of lasix around 12:45 pm. Lasix is a diuretic and will help with the swelling that she has from getting so many fluids and being on ECMO.

Around 1:30 pm Kinley decided to test her heart rate and blood pressure monitors by getting fussy and moving around a lot. Dot and Megan gave her an extra dose of morphine and versed to help her calm down and rest. Kinley's urine output is up to 7cc/kilo/hr. This is up from normal due to the lasix and all of her extra movement.

The rest of the afternoon is pretty quiet and we decide to go to dinner during the shift change.

Upon our return we find that Kinley is in the care of Julie and Kelly. Julie is the nurse who admitted Kinley to Children's Mercy and took care of her on her first night. During the shift change, they calculated Kinley's urine output for the entire day shift and it came out to be 11.7 cc/kilo/hr. That lasix really works. We can already see that Kinley's swelling is beginning to go down.

Unfortunate for the blog, but great news for Kinley, the evening was especially quiet since the only thing Kinley did was sleep. There were no temper tantrums or any other issues of concern. We left around 9:45 pm with Kinley still fast asleep in her bed.