Chest Still Open

Dr. St. Louis decided that Lynnea is still not stable enough for him to want to close her chest up today. Her blood pressures have dropped dangerously low several times today, so it is a constant struggle to keep them in the range that they would like them in. She also continued to run a fever all day -- her temperature sat right around 102.1 most of the day. They were finally able to bring it down with an IV form of ibuprofen that they were willing to try after Tylenol and ice packs failed. So far, none of the cultures that they sent to the lab yesterday have come back positive, which is good, but it often takes a few days for these things to show up, so we haven't ruled out the chance of infection yet. It is also unclear exactly how long she has been running a fever -- it showed up as soon as they took her off from ECMO, so the thinking was that it could have been related to the adjustment of coming off ECMO, but it's possible that she was running a fever even before they took her off ECMO. If that were the case, they would not have known about the fever because, on ECMO, body temperature remains constant because the blood that is being pumped and oxygenated by the ECMO machine is also temperature controlled by the machine, so a fever would not have been detected. To be on the safe side, a second antibiotic has been added so that if it is an infection, it is hopefully being treated before it can spread any further, or make anything else worse.

At one point today, Dr. St. Louis felt that it might help her blood pressures stay up if they would cut back on some of her sedation and paralytic drugs. This turned out to be a bad idea, and her blood pressures dropped even lower the more she was able to wiggle, so she was put back on all of her sedatives and paralytic drugs.

The good news for the day is that, this evening they were able to turn down the amount of oxygen she is on. She's now down to 60% oxygen, which is much safer for her lungs. It was only turned down about an hour ago, but so far she's doing OK with it. At this point, her blood-oxygen saturations seem more dependant on her blood pressures staying up than on the amount of oxygen she's getting through the ventilator. When her blood-pressures drop, her saturations drop, which is yet another reason we would really like her to keep her blood pressures up at a reasonable level.