Ruby Hope McKee Starling

We had rounds this morning and the prevailing thought is that she could have an infection that's not being picked up by the blood cultures, possibly because she's receiving so many transfusions of blood products (usually 1 platelets and 1 FFP or Cryo every day -- I'm not sure of the quantities, but they usually look like about 60ml).  So the positive culture was definitely a red herring, but there could still be a bug lurking in there.  Another possibility is that her body is just getting irritated by the ECMO circuit and is having another inflamatory response. 

Either way, we're going to stick with the antibiotics and there is serious discussion of switching out her ECMO circuit.  This means her body will have to adjust to all the new tubing and lung membrane and will likely increase her edema in the short term.  But if there is an infection in her blood, it will literally remove half of it.  And if she's irritated by the circuit, it'll give her a fresh one.  Additionally, with her circuit being 14 days old, the tubing and connections and membrane and bladder are nearing the end of their expected lifespan.   Even with our modern technology, we can't build better blood vessels than the ones we're born with.  Nothing is definite yet, though.

She seems a little more alert and active today, but she's more swollen.  However, she gained less weight in the past 24 hours than the previous 24 -- around 160-something grams.  She's rather fussy right now and she just got a dose of fentanyl.  They also went up on her morphine/versed infusion.  Being so swollen is not comfortable, I'm sure.