Postponement Over

I hesitate to post anything because Andrew's situation is changing on an hour-by-hour basis, but I wanted to get something posted before I go to bed.

Andrew was extubated around 1:30pm today. For an hour or two, things went really well. They took a blood gas test after an hour off the ventilator and his CO2 was great. Just like last time, he got upset whenever he woke up, but he was able to recover quickly once he fell asleep. Over time, he had some issues with the secretions in his mouth and throat. Everywhere the tube had been in his upper respiratory system, he was now congested, requiring frequent suctioning. When he wasn't suctioned, he would start to wheeze and choke. Of course, every time his mouth was cleaned out, he got upset. His nurse finally found the sweet spot...it involved sitting at his bedside and suctioning his mouth every five minutes...literally. Apparently he likes being decongested even more than he hates the suction tube. He's always needed attention, but never quite this much.

After the nurses' shift change, he behaved for a few hours. He was generally calm (asleep) and didn't need to be suctioned quite as often. I think there's a good chance most of his congestion had been coughed up or sucked out. However, his CO2 continued to spike every time he got upset, which was every time he woke up. Though his CO2 would come back down, eventually it caught up with him. We got a call at 11:30pm that he had been breathing particularly heavy, requiring a new blood gas measurement. His pH was far lower (more acidic) than it should be, and they were getting to the point where something had to be done. They said they were going to try a different ventilation method called CPAP, which provides constant pressure through the nose and doesn't require a new tube. They tried it the last time he was extubated, and it didn't help enough to prevent re-intubation. The doctor we spoke with (and his nurse) weren't optimistic about his chances of remaining off the ventilator...they were going to give him an hour, then take another blood sample, then make a decision.

I called after two hours, expecting Andrew to be back on the vent. Instead, he was on CPAP, awake, and resting. His recovery had been so good that they hadn't even done the test as scheduled. It didn't look like he was breathing quite as hard, and he seemed more comfortable on the whole. They postponed his next gas to 5am, hoping that would give his body more time to compensate for the low pH. If he got too upset, they planned to put a little mask over his face to give him extra oxygen, then test his blood again.

His 5am gas went well, and for now (I can only speak for hours at a time, if not less) he's stable and happy. His pH came up from 7.01 (very low) to 7.33, which is right where they want it. His CO2 was also good. On the non-medical side, the nurse said he was awake and calm for half an hour earlier, which means he may be starting to calm down. I think the key to keeping him off the ventilator long-term will be having some periods of calm alertness. If he can stop getting upset every time he opens his eyes, he can stop the cycle of having to recover from bad numbers. Once the cycle is broken, hopefully he'll improve.

Everything is still very volatile at this point...when we call in the morning, the situation could be entirely different in one of several different ways. Not many of them will surprise me, so I'm going to bed with an open mind and a realistic attitude. Though we of course always hope for the best possible outcome, this is still going to be a long, arduous journey...if we hit a speed bump tomorrow, we'll keep on truckin'. On the positive side, I almost entitled this post "NOT Fun While It Lasted." At least he's made it past twelve hours, which we feared earlier tonight.