Breathe

Andrew had a mixed day today. On his ventilator, he did great. He's gotten down to ridiculously low levels in the last week...just amazing progress. He's at twelve breaths per minute, yet is keeping his respiratory rate in the 50's and continuing to have good saturations and good CO2 results. His current respirator will only go down to ten breaths per minute, so he'll soon hit a wall where they'll have to wean him on other settings, switch to a more advanced conventional ventilator, or extubate him. He's still on 10 parts per million of nitric oxide, so there's plenty of room to come down there. On his inhaled oxygen, they had him down to 27 today, only six percent above normal room air. Being able to breathe normal air is of course the eventual goal, so that's a great step forward.

There were two tiny setbacks today, because having all good news would make our brains explode. First, it seems like his fussiness is getting a bit more violent, and how he manages it seems to depend on what he's feeling like at the time. Much of the time we were there, he was alert and happy, with his eyes open and looking around, but with no noticeable concern. However, he had a few freak-outs that lowered his saturations and raised his blood pressure pretty significantly. While it's still great that he manages to recover quickly, they sometimes give him additional oxygen (by turning up the percentage) to help him stay stable. This is the sort of activity that will be much more difficult once he's extubated. So while the numbers above are fabulous, I feel like he needs to show some consistent stability (for a few days), even with anxious episodes, where he doesn't need any additional help from the nurses.

The other setback was digestive. They suspended feedings after last night's failed attempts, and today were simply sticking to the IV fluids/fats. During one of his "episodes," he managed to vomit, even with a tube down his throat. It was obvious from the color that it was from his stomach. The doctors and nurses want to control all fluids going in and out of his stomach using the nasogastric tube, to prevent accidental aspiration (breathing) of acidic stomach juices. Since he can't cough or swallow on his own, he's at higher risk for this issue, which could cause damage to vital lung tissues. If he were at home already, this would be the sort of thing we'd go to the emergency room for. Fortunately, he's already getting better care than any ER I know of, and they quickly suctioned his mouth and solved the problem. Though he was in no immediate danger, a subsequent X-ray didn't show anything wrong, and steps will be taken to insure this doesn't happen again any time soon, it was still termed an "acute episode" and presents just a little more for the doctors to worry about. It may change their feeding strategy moving forward, or make them more likely to think about surgical methods for solving this reflux problem.

When we got to the hospital this afternoon, Andrew's eyes were wide open. When I saw his vent settings, so were mine. It's probably a good thing that the day had some negatives, because otherwise I think I'd be setting myself up for some disappointment. We are preparing ourselves for a possible setback when his current course of steroids is complete, though I hope in general I can continue to report good news.