When I got to the hospital this morning, Caleb had gained back most of the ground we lost last night. He was back off the paralytic drugs and had reduced some of his blood pressure medication. His oxygen saturation on the ventilator was still elevated. His catheter was removed and he is now peeing in the diaper.
Caleb was relatively stable today. He still bounces up and down too much for comfort. When he pees, he pees too much and his blood pressure drops. When his blood pressure drops, his oxygen saturation drops. The doctors would like a lower blood pressure and to reduce his blood pressure medication, but whenever his blood pressure drops, his oxygen saturations do too.
He is now on a light to help with his jaundice. The hematologists are checking on him to figure out why his red blood cells are breaking down (the cause of the jaundice). It may be a result of the heart/lung bypass, it may be something else, they don't know for sure.
The plan for the night is to wait and see if his levels will stay stable, instead of over-reacting to every little change they make. We may wait a day or two more to see if his lungs get stronger and do a better job of oxygenating his blood. He should be getting higher dissolved oxygen levels than we are getting and they are not sure if there is a problem with his shunt (the new connection from his heart to his lungs that they put in during surgery).
The major concern now is the next step. If his oxygen levels won't stabilize, it may be necessary to have a second surgery to either replace the shunt with a larger one or add an additional shunt. Of course, they would prefer not to do more surgery if we can avoid it, but they don't want to wait forever without making more forward progress. Hopefully in the next couple of days, the correct path of action will become clear.
I spoke with one of the cardiologists today. She said that Caleb's heart was trickier for the surgeons than normal. Right now, his aorta, pulmonary artery and shunt all come out of his undersized right ventricle. Normally in tricuspid atresia, the ventricle is so small that no vessels or maybe one are located there. Caleb's ventricle was large enough for the vessels, but not large enough to work. The structure of his heart and the location of the vessels make it difficult to see exactly what is going on with a heart catheterization (the usual standard to see the heart in depth), so in essence, we are flying blind.
On a very bright note, the nurse let me help give Caleb a bath tonight. He got mad and started crying, but because of the ventilator, there is no sound when he cries. As soon as we finished, I put my hand on his head and the nurse and I each held one of his hands, and he quit crying pretty quickly. I got to do normal Mom stuff!
Thanks for the prayers and all of the wonderful comments!