Thursday, January 20, 2011

When I got to the hospital this morning, I found out that Caleb's blood pressure had increased overnight and he was on a new medicine for high blood pressure. The medicine worked, but it required some tweaking throughout the night. By this afternoon, they were able to wean him off the medicine.

Caleb's chest x-ray looked much better and he was finishing up his second sprint when I got there. The bloody secretions have also stopped. At rounds, it was decided to sprint him one more time and if everything looked good, they would extubate this afternoon. Caleb passed with flying colors and was extubated around 1:00 pm. They put him right on high flow because of his past history. I had no problem with that because the bottom lobe of his left lung had not fully inflated and the high flow should help reduce the potential for further collapse.

Because he is off the ventilator, they were able to start feeding him tonight. He had his first breastmilk at 7:00 pm. They will give him 25 mL feedings every three hours to start. If this goes well, they will increase his feedings by 16 mL every two feedings. If there are no hiccups, he should be to full feedings by Saturday morning. Based on our past history and his family history, full feedings should make him much happier.

Caleb threw a major fit when the nurse put in his NG tube and he required some supplemental oxygen. He turned a bright blue/purple color and went back to his breath holding trick. He did not lose his cry from the ventilator. He is only at about 50% volume, but he is at 100% anger. Once he settled back down, his oxygen saturations went back to acceptable levels.

The diuretics are working well and we have not had to work nearly as hard as last time to get him to pee. They removed his catheter today, so now we are one line down. Like last time, he has required a lot of potassium to replace what he is losing. At least when his potassium is low, it is not causing weird heart rhythms.

Our problem now is access for medications. Because they were unable to get a central line started during his surgery, we cannot remove the lines through his chest that go directly into his heart. While these lines are in, we cannot hold him or leave the PCTU and move to the floor. I also think the chest tubes have to stay in. The great debate is whether to find another way to get access (possibly going through his liver) or to wait it out and hope we can wean off enough stuff in the next couple of days so we don't need as much access.

Tonight when I went back after supper, Caleb was still doing well on the high flow, but he was agitated and his blood pressure was back up. They may have to start the blood pressure medicine again. The oxygen saturation in the high flow was weaned from 50% to 25% and he has tolerated that well. They are not planning on weaning the volume until tomorrow to make sure he can handle it.

We will see what tomorrow brings. I am very nervous because huge backslides in the respiratory department are so common - especially for Caleb. Maybe he will surprise me and still be on high flow when I go in. It is a good thing that nothing regarding Caleb's care is dependent on my blood pressure when I go back each morning!

Thank you for your prayers. They are working and we are making some real progress.