Sabrina Lee fought through multiple surgeries and procedures in the PICU,
She endured unimaginable pain throughout, She is in many ways the definition of Innocence,Bravery,Courage,Strength,Determination,Honorable,
Honesty,Patience,Purity,Purposefulness,Joyfulness,Perseverance,Awe and Love,
She truly exhibited all of these Virtues and more.
She endured unimaginable pain throughout, She is in many ways the definition of Innocence,Bravery,Courage,Strength,Determination,Honorable,
Honesty,Patience,Purity,Purposefulness,Joyfulness,Perseverance,Awe and Love,
She truly exhibited all of these Virtues and more.
*December 20th 2014* Sabrina was in the P.I.C.U. after having surgery on her intestines she was still on high doses of inotropic support to maintain adequate blood pressure and very critical, Sabrina would awaken spontaneously and answer questions by either nodding or shaking her head,
Here is the critical care problem list at 3:57am
Here is the critical care problem list at 3:57am
- Uncompensated shock requiring high levels of inotropic support and ongoing fluid resuscitation
- Rule-out-sepsis
- Chronic bouts of emesis,diarrhea
- Failure to thrive, malnutrition related to an undiagnosed GI disease
- Resection of 10cm of distal ileum
The P.I.C.U. team were running all kinds of test, x-rays,ultra sounds, an echocardiogram, Cultures, blood work and other lab's on Sabrina trying to get her bodies pH balance and oxygenation under control as well as fighting infection's, viruses and pain, They were adjusting her ventilator settings, giving her vitamin K, Vancomycin, Zosyn,Protonix,Fluconazole,Fentanyl,Tylonol,Versed,Dopamine,Epi and Norepi infusions, Administering albumin and CaCl, They also gave her platelet's and some more blood,
Sabrina Lee was literally fighting for her life minute to minute, She was absolutely terrified of what was happening, Her head would go up and down with every breathe in distress, She was in extreme pain regardless of what they gave her, When she would open her eyes it was painfully obvious that she had so many questions as to why and how all of this could be happening to her, Her parent's were asking the same painful questions.
"Up to here has been a detailed 24hrs of events that took place on 12/19-12/20 every day and night in the P.I.C.U. with Sabrina was terrifying, Trying, Worrisome and busy, With a long list of event's,Procedures and care's, Much to long to put all of them into detail on this website so we will detail the major surgeries and event's as best we can here. Sabrina Lee had 13 surgeries in 36 days in the P.I.C.U. and 2 more after leaving P.I.C.U. for a total of 15 surgeries in 75 days".
* December 21st 2014* Sabrina had a brief period of slight clinical improvement; However, She decompensated today and given her clinical decompensation both from an hemodynamic and oxygenation standpoint and also her need for pressor support the P.I.C.U. team decided it was time to proceed with ECMO life support,
They elected to make this an Veno-arterial support mechanism, Prior to going on the ecmo circuit and dealing with anticoagulation the surgeons wanted to take a look inside Sabrina's abdominal cavity to see if there was any development of of a septic source, They removed the negative pressure dressing (wound vac dressing) from her abdominal wall went in and evaluated her entire small and large bowel, The only area of worrisome intestine seen was the most distal of the ileum, The surgeon resected this 24.8cm in length, 3.7cm to 6.2cm in diameter segment, Decompressed the small bowel then oversewed the staple line along the mesentery in an effort to minimize the risk of postoperative bleeding, Returend the intestine to the abdominal cavity and washed out her abdomen, They replaced the negative pressure dressing that measured 20cm x 5cm,
They now moved to placement of the groin cannulas for the ecmo circut,
They made a 4 inch vertical incision on Sabrina's upper right thigh directly over her femoral vessels and obtained control of both her femoral artery and femoral vein, They placed and secured a 19-french venous cannula to her vein using 2 silk ties over a vessel loop stent, They then placed the 15-french arterial cannula to her artery using 2 silk ties over a vessel loop stent, They then went online with Sabrina's ECMO circuit and obtained normal flow immediately, "All of the cannula placement was done after an infusion of heparin", They then placed a 6-french distal perfusion cannula into her femoral artery, This was then tapped into the arterial line of the ecmo circiut, After adequate hemostasis in the room was ensured her skin was closed over the cannula's with sutures and wound dressing's were applied,
Sabrina Lee was literally fighting for her life minute to minute, She was absolutely terrified of what was happening, Her head would go up and down with every breathe in distress, She was in extreme pain regardless of what they gave her, When she would open her eyes it was painfully obvious that she had so many questions as to why and how all of this could be happening to her, Her parent's were asking the same painful questions.
"Up to here has been a detailed 24hrs of events that took place on 12/19-12/20 every day and night in the P.I.C.U. with Sabrina was terrifying, Trying, Worrisome and busy, With a long list of event's,Procedures and care's, Much to long to put all of them into detail on this website so we will detail the major surgeries and event's as best we can here. Sabrina Lee had 13 surgeries in 36 days in the P.I.C.U. and 2 more after leaving P.I.C.U. for a total of 15 surgeries in 75 days".
* December 21st 2014* Sabrina had a brief period of slight clinical improvement; However, She decompensated today and given her clinical decompensation both from an hemodynamic and oxygenation standpoint and also her need for pressor support the P.I.C.U. team decided it was time to proceed with ECMO life support,
They elected to make this an Veno-arterial support mechanism, Prior to going on the ecmo circuit and dealing with anticoagulation the surgeons wanted to take a look inside Sabrina's abdominal cavity to see if there was any development of of a septic source, They removed the negative pressure dressing (wound vac dressing) from her abdominal wall went in and evaluated her entire small and large bowel, The only area of worrisome intestine seen was the most distal of the ileum, The surgeon resected this 24.8cm in length, 3.7cm to 6.2cm in diameter segment, Decompressed the small bowel then oversewed the staple line along the mesentery in an effort to minimize the risk of postoperative bleeding, Returend the intestine to the abdominal cavity and washed out her abdomen, They replaced the negative pressure dressing that measured 20cm x 5cm,
They now moved to placement of the groin cannulas for the ecmo circut,
They made a 4 inch vertical incision on Sabrina's upper right thigh directly over her femoral vessels and obtained control of both her femoral artery and femoral vein, They placed and secured a 19-french venous cannula to her vein using 2 silk ties over a vessel loop stent, They then placed the 15-french arterial cannula to her artery using 2 silk ties over a vessel loop stent, They then went online with Sabrina's ECMO circuit and obtained normal flow immediately, "All of the cannula placement was done after an infusion of heparin", They then placed a 6-french distal perfusion cannula into her femoral artery, This was then tapped into the arterial line of the ecmo circiut, After adequate hemostasis in the room was ensured her skin was closed over the cannula's with sutures and wound dressing's were applied,
* December 22nd 2014 * Sabrina was now on veno-arterial ECMO via her femoral vessels, throughout the day today she has developed a significant split between her upper extremity vessels and her lower extremity vessels (Her lower body was getting adequate oxygenation but her upper body was not) also she has a large right pleural effusion, (A buildup of fluid between the tissues that line the lungs and the chest) Sabrina needed to have another frightening and risky surgery,
Here is the critical care problems list at 6.02am
Sabrina is in critical condition with multiorgan failure requiring full ECMO support by systems, Respiratory is worsening with ARDS with bilateral airspace disease as well as increasing pleural effusions, She has a tracheal tube in her mouth, She has an nasogastric tube in her nose to her stomach, She has an central venous line catheter in her upper right chest, She has an arterial line in her right wrist, She has an IV line in her left wrist, She has electrodes placed on her scalp, connected to a video EEG monitoring her brain activity, She has an open abdomen with a tube going to a wound vac suctioning, She has VA cannulas in her upper right thigh, She has a foley catheter in place, She is on 100% Fi02 (Oxygen ) from both the ventilator and the ECMO circuit, She is now going into surgery to have Veno-Venous (VV-ECMO) cannulas placed in her internal jugular vein ( Her right side neck) and also placement of a thoracostomy tube, (12" french pigtail tube) placed via the 5th intercostal space ( right side of her chest) to drain fluid from between the lungs and chest wall, Her right internal Jugular vein was cannulated with a 23"french avalon cannula, This advance under echocardiographic guidance to make sure the jet was in the right atrium directed toward the tricuspid valve, At this location the cannula was 24cm at the incision, The veno-veno arterial ECMO support was uneventfully initiated, They then placed the 12"french pigtail in her right side chest using electrocautery, they then hooked it to a chest drainage system, Serious fluid was then drained, Sabrina's Surgery went well, Another frightening day was over.
Here is the critical care problems list at 6.02am
- Status/Post PEA cardiac arrest
- Uncompensated shock requiring high levels of inotropic support and ongoing fluid resuscitation
- ARDS,Hypoxia requiring increasing mechanical ventilator support
- Dehydration
- Rule-out sepsis
- Chronic bouts of emesis, Diarrhea
- Failure to thrive, Malnutrition related to an undiagnosed GI disease
- Resection of 10cm of distal ileum, Including ileocecal valve
- Resection of 4-5 inches of bowel
Renal failure
Sabrina is in critical condition with multiorgan failure requiring full ECMO support by systems, Respiratory is worsening with ARDS with bilateral airspace disease as well as increasing pleural effusions, She has a tracheal tube in her mouth, She has an nasogastric tube in her nose to her stomach, She has an central venous line catheter in her upper right chest, She has an arterial line in her right wrist, She has an IV line in her left wrist, She has electrodes placed on her scalp, connected to a video EEG monitoring her brain activity, She has an open abdomen with a tube going to a wound vac suctioning, She has VA cannulas in her upper right thigh, She has a foley catheter in place, She is on 100% Fi02 (Oxygen ) from both the ventilator and the ECMO circuit, She is now going into surgery to have Veno-Venous (VV-ECMO) cannulas placed in her internal jugular vein ( Her right side neck) and also placement of a thoracostomy tube, (12" french pigtail tube) placed via the 5th intercostal space ( right side of her chest) to drain fluid from between the lungs and chest wall, Her right internal Jugular vein was cannulated with a 23"french avalon cannula, This advance under echocardiographic guidance to make sure the jet was in the right atrium directed toward the tricuspid valve, At this location the cannula was 24cm at the incision, The veno-veno arterial ECMO support was uneventfully initiated, They then placed the 12"french pigtail in her right side chest using electrocautery, they then hooked it to a chest drainage system, Serious fluid was then drained, Sabrina's Surgery went well, Another frightening day was over.
* December 23rd 2014* Sabrina has decreased movement, She has attempted to open her eyes but once, The P.I.C.U. team is very concerned about her neurological function's, They have decided to take Sabrina out of the P.I.C.U. down the elevator through a long set of hallways to have a brain CT scan, This is a very difficult, dangerous and terifying thing to have take place, Sabrina is hooked up to so many different life support systems with multiable tubes from her ECMO machine to her ventilator to IV trees to her wound-vac on and on, They called security guards to block off all hallways and the elevator, They gathered 16 of there best qualified personnel, nurses,Respiratory therapist and tech's, A couple doctors and a surgeon went with them as well, It was a very complex move with everyone involved having a specific duty, They were able to get a CT scan of Sabrina's brain and the result's were good. No fluid or bleeding in her brain,
* December 24th 2014 (Christmas eve) * Sabrina has been able to wean off her need for the arterial support , She is therefore going in for another surgery to decannulate the femoral vessels, But now she has a left pleural effusion (A buildup of fluid between the tissues that line the lungs and the chest) and will need another chest tube put in place, "Decannulation" The surgeon removed the sutures holding the cannulas in place and also the sutures used to close her skin allowing the vessels to be re-exposed, The right femoral vein was enclosed with silk suture's, They then cut off the ECMO flow and withdrew the cannula, After verifying brisk forward bleed and back bleed the edge of the open artery wall was cleaned with micro scissors, The artery wall was then closed with sutures, Prior to putting the last suture's in place they forward bled the artery to verify there were no clots, Attention then was then directed to the distal perfusion cannula, The artery was closed with a vascular clamp and enclosed with silk suture's in a vessel loop fashion, The distal perfusion cannula was then withdrawn. They then closed the distal artery wall, Upon completing this the arteries demonstrated to have pulsatile flow, Attention was now moved to decannulating the femoral vein, It also was enclosed using silk sutures, The ties holding this cannula in place were then removed and the cannula withdrawn, Vascular control was obtained with clamps the vein was flushed and verified to have no clots, The vein was then closed and the clamps removed, there was good flow in the vein, Her wound was closed in layers, The fascia and subcutaneous tissue where closed with vicryl sutures in two layers and her skin edges were rejoined with surgical staples. A 12" french chest tube was then placed into the 5th intercostal space on her left side, The catheter was secured at the exit with nylon sutures, Serious fluid was then drained, Surgery went well and that was Christmas eve for this amazing little Angel Sabrina.
*December 25th Christmas day* Sabrina tolerated transition off of VA ecmo with removal of the right groin cannulas, An ultrafiltration device was added to the ecmo circuit to remove volume(excess liquid) She was in severe pain, She was in and out, She would try and open her eyes and would wince when the nurses would turn her from side to side, She now has pneumonia on top of ARDS, They now however are able to give her better antibiotics now that she has come off the VA ecmo and has drained some of the chest walls of fluid.
*December 26th 2014* Sabrina had some procedures and cares, She is Resting.
*December 27th 2014* Sabrina's lungs appeared to be widened out on her chest x-ray today, Although she is on 7 days of ECMO support, She also started to have blood coming out from around her vac pac (wound vac dressing), The surgeons are going to do an abdominal exploration with wash out and replacement of a temporary abdominal vac-pac closer as well as a flexible bronchoscopy with bronchioalveolar lavage. The old vac-pac was removed and then they explored her abdomen with some irrigation, Her abdomen was actually very clean there was no bleeding or real adhesion's within her abdomen at all, They irrigated all 4 quadrants with warm normal saline and suctioned dried, They placed her bowel back into her abdominal cavity, The omentum was placed over the bowel and a perforated bowel bag was placed as a visceral cover followed by a black sponge which was cut to form, This was stapled to her skin to help hold it in place, The plastic covering was then applied, A hole was cut within this form and the suction device was applied then hooked up to the wound-vac device with good suction and no evidence of a leak, Attention was then moved to the bronchoscopy, A bronchoscope was introduced through the endotracheal tube, They noted a kink in the tube which did cause some trouble throughout, They looked down the right bronchus it was fairly clean with few secretions, However down the left there was a significant portion of mucous plugging, They performed bronchoalveolar lavage with sterile water and suctioned it out until it also was clean of any plugging, They withdrew the bronchoscope with no bleeding noted at bronchus or the trachea areas.
*December 28th 2014* Sabrina has multiple skin tears on her abdomen and face every time they take tape off of her it tears her skin, Also her old ECMO site where the cannulas were is oozing blood and pus and is covered with large dressings, She is being transitioned to a different ventilator machine today(Volumetric Diffusive Respiration) in an effort to clear secretions and re-recruit her lungs, She didn't show much improvement following the bronchoscope despite removal of several mucous plugs. (continue to next page)
