So...Jude will be on ECMO for one more day.
Generally speaking, the trial off that ran from 4 am - 8 am this morning went reasonably well. His CO2 levels were a little high when his blood gases were tested, but Rose and I weren't that surprised by that because his CO2 had been a little high even before the trial. Otherwise, Jude weathered the trial without too much difficulty from what we were told. The ventilator settings were increased just a little bit during the trial, i.e. the rate that the ventilator was breathing for him was increased from 30 per minute to 40.
So what's next? Why is Jude still on ECMO?
In short, the medical staff want Jude to be in the best condition possible when they take him off bypass.
His pulmonary edema (i.e. fluid buildup in the lungs) and pleural effusion have worsened over the last few days because he has received so much extra fluid, largely in the form of blood products. Moreover, the medical staff previously adjusted the settings on the hemofiltration unit such that Jude would retain small amounts of fluid, thereby leaving him "wet" with sufficient fluid to test his kidneys and determine whether he could urinate. Prior to making said adjustment, the med staff had successfully used Lasix, a diuretic, and hemofiltration to remove fluid from Jude and "dry him out," which helped decrease Jude's edema and pleural effusion before. Over the next 24 hours, the same measures will be taken to remove fluid from Jude again, with the hope that net effect will be the same.
Provided things go well in the intervening time, the pediatric surgeons will decannulate him tomorrow -- that is, they'll take him off ECMO. Then, the tentative plan is for Jude to receive his surgical repair within 24-48 hours.
Tomorrow morning, prior to going off ECMO, another echocardiogram will be done, which will provide some information about the state of Jude's heart and his pulmonary hypertension.
If you would, please join us in praying that Jude's pulmonary edema and pleural effusion will get better, that his heart function and pulmonary hypertension will continue to improve, that his lungs will remain inflated, and that Jude will handle the transition off bypass well enough that he can remain on a conventional ventilator (as opposed to a high frequency ventilator).
Thank you all for your faithfulness in praying for Jude and for the many ways, tangible and intangible, that you are showing your love to our family.
Blessed be the LORD!
For he has heard the voice of my pleas for mercy.
The LORD is my strength and my shield;
in him my heart trusts, and I am helped;
my heart exults,
and with my song I give thanks to him.
The LORD is the strength of his people;
he is the saving refuge of his anointed.
Oh, save your people and bless your heritage!
Be their shepherd and carry them forever.