Stop the Clock

I hope this doesn't ruin anyone's Thursday, but Andrew was intubated again just after midnight. He's fine now and resting comfortably on the ventilator. We know he likes it, so we have no worries about his stability tonight...everyone should rest easy.

They're still not sure exactly what happened, but the problem came down to CO2 (yet again). Earlier in the evening they tried pointing his head the other direction (toward his right shoulder), which he didn't seem to like very much. They turned it back to his left around 10:30pm. Around 11, they noticed he was breathing a bit harder than usual. They weren't worried, but they gave him his methadone dose early, hoping to calm him down. He was relaxing peacefully until his midnight gas, which came back with a skyrocketing CO2 (in the 140's) and a low pH (6.99). Those numbers, without any visible signs of distress, were bad enough that they needed to reintubate. They aren't concerned about any permanent damage, and he wasn't showing any signs of having problems in other areas. A chest X-ray showed his lungs to be the same as yesterday (looking good), there are no signs of infection, and his oxygenation is perfectly normal.

After half an hour back on the ventilator, his numbers were much closer to normal. After an hour and a half, they were better than they've been in quite a while. His pH is now 7.41 and his CO2 is 62. His nurse said that he's been awake and alert ever since they reintubated him, but not fussy at all and looking very relaxed. In the next couple of days, we'll try to figure out what happened and talk to the doctors about the next steps. I'm guessing they'll keep him on the vent a little bit longer this time, and focus on extended-duration sprints. When he's shown that he can tolerate long sprints (perhaps two sprints of three hours per 24 hour period), they'll try him again. Hopefully they'll be able to focus on his feedings while they wait, as his feedings have been going really well. He's still on minimal volumes (2cc per hour), but he hasn't spit up in over a week and his bowels have been working well...he's had plenty of dirty diapers to prove it.

I don't want anyone to worry unnecessarily, just because he's back on the vent. His bad numbers were temporary, he's quite content with the vent, and he is in no pain or danger of getting worse. It's a setback, but we'll learn from it and approach things from a different direction the next time. On the bright side, he was tube-free for 59 hours this time...nine hours more than last time. It doesn't seem like much, but every minute off the vent is a chance for his body to get used to breathing on its own, and one step closer to full-time extubation.