Hi, folks! Rose and I decided to cobble together a quick update after a little more encouraging news we received this morning.
Jude's lungs have opened up considerably in the last 24 hours, and now the discussion has begun about weaning him off ECMO. The "sweep" on the ECMO unit will need to be brought down quite a bit before he is ready to come off, but the tentative plan is to continue his lung conditioning, re-postioning him, suctioning secretions and mucus out of his lungs, decrease his sedation to encourage a little more activity on his part, and gradually begin turning the sweep down on the machine (provided his CO2 levels don't get too high). Presently, the sweep is helping regulate Jude's carbon dioxide levels in his blood, which, in turn, affects his pH levels. Maintaining Jude's carbon dioxide levels within a particular range will be important as he nears a trial run off ECMO, which we're hoping may be on the docket for early Sunday morning, provided all goes well in the intervening time. The "flow" of the ECMO unit (i.e. the rate at which the unit's artificial heart is circulating blood through his body) has been turned down to 50%, and hopefully the medical staff will be able to bring that down to 40% in the next day or two. The CVVH component on the ECMO unit, which functions like an artificial kidney, has now been set to net zero, meaning that it's not going to be used to pull off additional fluid from Jude's body. He was puffy and swollen before, which is common with babies on ECMO because so much fluid and blood products have to be used while they are on bypass; however, after several days of using the CVVH unit and diuretics to get some of that fluid out of Jude's body, our little man is pretty dessicated and skinny, but he's healthy!
Also, Jude's pleural effusion on his right lung looks much better! This morning's chest x-ray showed notable amounts of air in both his right and left lungs, and it appeared to show notable improvement with his pleural effusion. (A recent echocardiogram appears to have further confirmed improvement with the pleural effusion, too.) His bowel appears to be rather decompressed, although some further decompression of his stomach may be in order (i.e. the pediatric surgeon would like to see it decompressed further prior to surgery).
So what does all of this mean?
In short, Jude is improving, and if the positive trend continues over the next few days then he may be ready to come off the ECMO unit. After that, he would probably go into surgery relatively quickly. But before there's any further consideration of surgery, Jude needs to continue on his present journey to get off ECMO.
All in all, we are very encouraged by Jude's progress. However, this is just the first stage in what will probably be a very long journey to Jude's recovery. Even after coming off ECMO, the battle will be far from over, and so we ask that you please continue to pray fervently for Jude's progress.
Please pray that Jude's carbon dioxide levels will come down to the desired range and stay there as the medical staff gradually begin to turn down the settings on the ECMO unit.
Also -- and this will probably be a recurring prayer request throughout Jude's journey to recovery -- please pray that Jude's pulmonary hypertension will abate. It will probably be Jude's biggest obstacle in the weeks and/or months to come as he comes off ECMO and recovers after his surgery.