They will turn his flow down by 1 step every hour until he's at 5. If he needs additional vent support, they'll turn it up, but he's been responding great so far without any need. When he gets to 5, they'll clamp the tubes in his neck for an hour and take blood gases every fifteen minutes. If everything is still good, they'll unclamp and turn the ECMO back up to 20, just to keep everything heparinized and flowing well through the machine. They'll do that twice through the night, which will reassure them of his stability without ECMO.
Assuming everything goes well, they'll do the surgery tomorrow morning at 7:30am. It will be a LONG process. First, they have to move him (and the ECMO) down the hall into the OR. Then they'll perform the actual surgery, during which they need to be very careful to clot (cauterize) every little capillary to prevent bleeding. The surgeon also does a lot of pediatric plastic surgery, so he is very precise and does a meticulous "close." When the hernia surgery is finished, they'll almost immediately remove the ECMO....they're pleased enough with his progress that they don't think he'll need it for long. Then they have to move him back to the NICU, and it'll be another half-hour before we get to go in and see him. Someone quoted 5 hours, but I would expect the total time to be more like seven or eight, so don't get worried if there are no quick updates.
There will be a lot of hurdles to overcome after the surgery, and it will be a long, hard process, but making it through the surgery tomorrow will be a huge milestone. There are many dangers inherent to the surgery itself, the additional clotting issues introduced by the ECMO, and the trauma of this pair of procedures on such a tiny body (not that 9 pounds is anything to sniff at). Though we are both nervous about the surgery, we are hopeful that it will put him in a very good place.
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