Off ECMO and Stable

They took him off ECMO late last night, and the surgery went very well. There were no problems during the close and it is SO nice to have the tubes out of his neck. They had to tweak his ventilator settings just a bit, by moving the strength of the high-frequency vent from 34 to 36, but he's been stable at those settings since midnight.

There are a few numbers they're generally looking at when deciding what to tweak. The first is his overall oxygen saturation, which represents how well his lungs are taking oxygen out of the air (or from the vent) and putting it into his bloodstream. If this number went down, they would have to turn up the percentage of oxygen in his vent (currently 50%).

The next is the difference in saturation between his upper body and lower body. If there's a big difference, it means the blood pressure around the heart/lung is too high and the blood isn't being oxygenated before traveling to the rest of the body. The solution to this problem is the inhaled nitric oxide, which helps dilate the nearby blood vessels and even out the pressure. Yesterday during the test off ECMO, they added the NO tank and his numbers immediately equalized.

The last is his carbon dioxide saturation. His lungs are supposed to take oxygen out of the air and stick it into his bloodstream, then take returning blood and pull out the carbon dioxide for exhalation. The better this process works, the lower the CO2 content in his blood, which reduces his blood acidity (a good thing). They will try to get to a stable number for Andrew, even if that number is a bit higher than a normal baby. Last night, his number was in the 70's, which led them to turn up the hi-fi vent strength. The high frequency vent has the effect of getting air into the lungs air sacs more efficiently, allowing for better gas exchange. By going up on the strength, they got his CO2 stable in the 50's.

Too much medical jargon, I know, but this is what we'll be living with for a while....it's just a matter of letting Andrew's body heal, his lungs develop, and his problems subside. When all his numbers look perfect on 30-40% oxygen, on a standard ventilator, with no nitric oxide, that's when they'll start thinking about letting him try to breathe on his own (I think). If you take anything away from this post, let it be this....his hernia has been fixed, the ECMO has been removed, and he is stable and healing. We've crossed a major hurdle.