Lungs are coming back online

Another stellar day for little Lucas.  This was almost more of a surprise than the heart yesterday. (Wow, was that just yesterday?)

So here are a series of pictures throughout the day from the respirator.  NOTE: That's the device on the other end of the tube sticking into his lungs.  Its working his lungs regularly.

This was from about 9 am this morning.

This was from around 3 pm.

And finally from around 10pm

A couple things to point out.

Look at the fifth number on the left.  That's what the doctors call the "tidal flow".  Essentially its how much air is being drawn into the lungs.  In the first picture it was about .3 and in the last 1.4.  They didn't expect it to be higher than .8 today.  Another thing to notice is that waveform next to it.  Notice its flat, then jaggedy (tech term) and then an actual wave.  That means he is breathing regularly.  Pretty awesome.  It means his lungs are back.

Here are his xrays from yesterday.

And then from today

You can see the dark bronchial structures opening up from his trachea.  With the tidal flow I showed on the first graphs, tomorrow morning's xrays should be pretty amazingly different.  Expect to see the whole lung back.

So this is awesome.  And in talking to the ECMO tech the clotting hasn't progressed (it still looks like a thing white thread) which means his blood supply is holding steady.  I think they even added platelets which could cause more clotting but, its always a delicate balance with ECMO.  They also added Thrombolysin to slow down the clots forming in the ECMO.  Dr. Christine is trying to get Lucas through this without having to change out the ECMO circuit which would involved setting up another machine and then performing a cardiac operation to switch between them.  So she has been pushing everything a little and looked thrilled earlier because it seems to be working.  Hopefully they will be able to only use this one circuit.

On top of that Mom's milk is coming in and Lucas is getting is GI track fired up.  This is good too because at some point that system will have to be brought back online.

So what's next?  The lungs need to be back up and to the point that they are only using the ECMO for .080 instead of .150.  I'm not going to explain these numbers but, basically his lungs need to be running well enough to pull the machine back.  They get this number by dividing the flow by his body weight (3.2 kg).  So the flow needs to be about .25 and currently it was .49.  At that point they will do a "trial" where they slow it down for 3 minutes intervals while adding heparin to both sides (baby and machine).  The attending ECMO doctor will be there, the ECMO tech and lots of other people.  If Lucas passes they will remove it and he will be on just the respirator.  That is one huge step for getting him home.

One thing they will be doing tomorrow is giving him a PICC line which will give them better access for delivering drugs to his system.  Currently he has 2 lines run in through the umbilical cord.  You can see these on the xrays.   One goes into a vein for delivering drugs, the other goes to an artery for reading the SvO2 (oxygen level) and blood pressure in real time.

They sort of have to run the PICC because the other lines are going to wear out.  The PICC won't be big enough to push platelets through so they also have to run a PIV but, that's pretty standard.

Anyway, things are moving forward.  Be happy.

Here is what our little Michelin man looks like today.    Hi head is less puffy.

And here is a video of his sister falling down a pile of laundry to celebrate.

Keep the prayers coming!