Killing the Bug; Surgery Is Delayed; ECMO Continues

So it looks like Jude will continue to be on ECMO for a while.

How long? Possibly another week.

The problem is Jude's sepsis, i.e. the infection in his blood. The lab is still culturing his blood from Wednesday morning, and that sample tested positive for a gram positive cocci (which includes a range of bacteria), but, as yet, the exact organism still hasn't been identified. Jude has been on broad range antibiotics since Wednesday afternoon or evening, I think, but their effectiveness hasn't been determined just yet; however, Rose and I are encouraged that Jude's blood that was drawn for culture yesterday morning at 4 am is still, at the time of this post, testing negative for growth of the infection. The bug grew pretty quickly in the first culture that tested positive, so the fact that more than 24 hours have passed and yesterday morning's culture is still negative is good. Once (and if) it's negative for 48 hours, then I think the medical staff may be clear to take some additional measures that are needed (e.g. putting in a central catheter), even though Jude will probably continue to be on antibiotics for some time.

So although Jude's infection may tentatively resolve within the next few days, why does that mean it may be a week from now before he could possibly receive his surgical repair? Well, the main reason, as we understand it, is that Jude's pediatric surgeon can't touch him while he has sepsis, and sufficient time needs to be given for the infection to clear up before surgery can be done.

Beyond the problem of sepsis, Jude is still in relatively rough shape right now (even though he's slowly looking better): His body is still recovering from the trauma associated with his ECMO circuit change and having half a liter of nutritional fluid in the peritoneal space of his abdomen that had to be drained through surgery and insertion of a tube. Such cumulative trauma or insult has prompted an inflammatory response in his body, which has had various consequences that are still being resolved as he recovers. His lungs collapsed; his abdomen has become irritated, inflamed, and has been leaking serous fluid; his blood vessels have temporarily been "sick" and have been leaking more fluid into surrounding tissues than they probably would otherwise; and fluid has accumulated on his chest wall, which is exerting a certain amount of pressure on his lungs. Suffice it to say that our little man has already been through a lot, and he still has a long journey ahead of him.

The plan for Jude's care over the next week won't be too dissimilar from what has already been done. The difference will be that the medical staff will probably be more aggressive in conditioning him and getting him primed to come off ECMO. They'll be using the a component of the ECMO machine to do hemofiltration and dialysis, which will pull extra fluid out of his body. They'll also continue with lung conditioning, which essentially consists of chest physiotherapy -- a little vibrating tool is applied to Jude's chest and torso, which breaks up accretions of mucus and other secretions in his lungs and allows them to expand -- and adjusting ventilator settings to inflate Jude's lungs and push them to work a little harder. And, of course, Jude will be on antibiotics, broad range or more specialized (if needed), to resolve his sepsis. The idea is to optimize Jude's condition before coming off ECMO so he'll have the best possible chance of surviving both before and after surgery.

Over the next few days, as you are able, please pray that Jude will continue to recover from the trauma he sustained earlier in the week, that his lung conditioning and dialysis will be effective, and that his infection will resolve quickly.

    God is our refuge and strength,
        a very present help in trouble.
    Therefore we will not fear though the earth gives way,
        though the mountains be moved into the heart of the sea,
    though its waters roar and foam,
        though the mountains tremble at its swelling. Selah
    There is a river whose streams make glad the city of God,
        the holy habitation of the Most High.
    God is in the midst of her; she shall not be moved;
        God will help her when morning dawns.
    The nations rage, the kingdoms totter;
        he utters his voice, the earth melts.
    The LORD of hosts is with us;
        the God of Jacob is our fortress. Selah
    Come, behold the works of the LORD,
        how he has brought desolations on the earth.
    He makes wars cease to the end of the earth;
        he breaks the bow and shatters the spear;
        he burns the chariots with fire.
    “Be still, and know that I am God.
        I will be exalted among the nations,
        I will be exalted in the earth!”
    The LORD of hosts is with us;
        the God of Jacob is our fortress. Selah
   
(Psalm 46)