Cautious Thumbs Up

I don't want to post anything too upbeat, considering the sharp turnaround he made yesterday, but today was a little better.

They've restarted the feedings using a different method, where they slowly drip milk into his stomach from an open syringe. This allows the milk to be processed as the stomach is ready for it...if he has any reflux or clamps down, it will simply move back up the tube into the syringe instead of coming up as vomit. So far he has successfully taken everything they've given, though he's still on miniscule (1cc/hour) doses.

He had another respiratory sprint this afternoon, during which he again got upset and spiked his CO2. He calmed down relatively quickly, but they still aren't very happy with his response. They're looking at other sprint methods to try, as well as causes for his misbehavior on this method. He shows no signs of infection, lung collapse, or any of the other possible physical setbacks; on the contrary, his lung X-rays have looked fantastic, with his left lung already noticeably larger. In the end, it may just come down to the fact that it's difficult to breathe through a straw (his ET tube). We tested the scenario at lunch by trying to breathe through our straws. Breathing in was difficult but doable...the really hard part seems to be breathing out. Exhalation is supposed to be a passive process, where gravity and lack of flexing muscle allows the lungs to deflate and push air out...if that process is being impaired by the tiny airway, it could be hard for him to exhale the CO2...his precise problem.

Just to give him another opportunity, they did another sprint at midnight tonight. He did fine for 50 minutes, then got upset when he needed his mouth to be suctioned...saliva and other mucus tends to build up quickly. The stress of suctioning caused his CO2 to spike just a bit, though not as bad as this afternoon. He quickly got it under control and ended up going 70 minutes on the sprint. A good result, and hopefully good exercise for his respiratory muscles.

At the moment, the plan is to let him wean back down on the ventilator tomorrow, then perhaps extubate again on Friday. I'm not sure whether they'll continue the sprints in the interim. We're also not sure what the feeding plan is, though I suspect they may increase his dosage a tiny bit at morning rounds. Slow and steady wins the race, so any progress is good progress.