June 5

 Brian continues to be stable with various challenges that keep his medical team on their toes. His ECMO machine has been working very hard to provide the oxygenated blood his body needs. This morning, his machine needed to have its circuits replaced. According to his doctor, replacement of the circuits usually is needed once a month with the average ECMO patient (ideally every 6-8 weeks as they get better). Brian has been on his machine for two weeks, which indicates how hard it is working to give Brian what he needs. Changing over the circuits can be a bit of a risk because it requires Brian to be unattached from the machine for a short period of time. It also requires Brian's blood to be thinned down for better flow. I mentioned a day or so ago that Brian has been bleeding and so the doctors haven't been giving him blood thinners to try and help control the bleeding. This morning, there wasn't much of a choice, he needed the blood thinners to make the transition with the ECMO machine successful. They were able to safely change out the circuits and get Brian hooked back up properly. However, it did cause some hypoxia that will just need to be given time to filter out. The blood thinners caused increased bleeding from his nose that just needs to be managed until they ware off. He was also given more coma-inducing medication so it will likely be a few more days before Brian will be able to respond to commands and show his neurological abilities.

His Tidal Volume is very low. Throughout the few hours I was there today. His numbers were between 16-18 ML. This is why the ECMO machine is working so hard. As the ventilator is eventually able to increase Brian's Tidal Volume, the ECMO machine will be able to back off and allow the ventilator and then eventually Brian to do all the work. If the ventilator was programmed to push more oxygen into Brian's lungs, it would cause further damage to them and possibly cause his lungs to collapse. 

There are other concerns that are also being monitored regarding his nutrition digestion and gall bladder looking like it is struggling. For every issue that arises, his care team enacts solutions. One big success is that his pacemaker has not needed to be used. After the pacemaker was placed, they switched his medication to slow his heart rate. Since they switched his medication, Brian's heart rate has been more stable.