Andrew was reintubated around 8pm tonight. New nurse, new doctor, and Andrew apparently looked like he was having to work even harder to breathe. The word they used was "gasping." After getting the tube back, his subsequent gas was okay, so I don't think he was necessarily in a bad place, ventilation-wise, but he was definitely tired out from the stressful day. Being upset every waking moment has to take its toll, and it will be vital that next time we make him as comfortable as possible.
I think most of that can be accomplished by having a better ventilation strategy, making sure all the parts fit him so that he's neither leaking air nor uncomfortable, and preparing him a little better for what he's going to face. If he's going to wear a headband, we should start putting him in hats....if they think being on his tummy will help, we need to flip him over and get him used to that now....if they want to crank up the bed so he's sitting up (like they did today), then extubation day shouldn't be the first time he ever experiences that.
They sedated him to put the tube back in, and so he's back to full settings on the ventilator. He's in absolutely no danger at all...quite the opposite, as his pH is above adult normal and his CO2 is very low for him (48). They'll let him rest tonight, then start turning the settings back down with his next gas in the morning. He should be back at minimal settings pretty quickly, depending on which doctor is writing the orders. After that, we'll come up with a new sprinting strategy, which will probably involve longer (and more frequent) periods without the vent giving him any breaths. I'm going to focus on getting him used to whatever he's going to experience next time and maximizing his comfort level. I really believe that today would have gone much differently had he been less upset...and the way to relieve his anxiety is to change as little as possible. When it comes time for his next extubation, the only thing that should change is where the tube is located (from down his throat to across his nose)...everything else should be practiced ahead of time. They might also have to order a different part, research different tubing, or use a different ventilator....all so that they can have a more effective seal, without an air leak or ill-fitting nasal prongs.
Of course this is a short-term disappointment, as we had hoped he'd stay off for good this time. However, we learn more every time they try, and I think he proved that he can ventilate well on his own, and even recover from being upset...it was just the constant anxiety that ended up being overwhelming for him. Now that he's back on the vent, this weekend will be a lot less stressful, so hopefully D can enjoy her sister's wedding without worrying about Andrew breathing on his own. Next time we'll try to schedule the whole process a little better, so that his primary nurses are around and we're available the entire time. I'm not sure how his next try off the vent will fit in with his next surgery (the Nissen fundoplication....one-way stomach valve), but we'll make sure that's all planned ahead of time.
Thanks for your support today. Have a nice weekend with no worries, and we'll get back to the grind next week.
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