Keep it down, son

I feel like a lot has changed in the last week or so, and I don't know that I can do it justice this late at night. We had lots of visitors and excitement last week (and more next week), so we may try to relax a bit on Monday. If so, I'll try to write more, since just giving his daily stats won't really cut it.

As for those daily stats, he's doing great. His oxygen is in the 30's...we're trying to get it down to normal air content (21%) eventually, but this is very good progress. It fluctuates as he needs it for breathing treatments, "freak-out" recovery, etc...but it has steadily been going down. He is still on the conventional settings on his new ventilator, and has been for over 30 hours. Remember I said that nurses are a bit superstitious? Well, they still haven't told him that they've moved away the hi-fi vent, just so he doesn't hear that and need it again. His current vent can do some of the hi-frequency oscillation if he needs it, but hopefully they won't ever have to bring back the other machine.

On this new vent, he's down to 18 breaths per minute (bpm). That means even if he doesn't try to breathe at all, the machine will give him 18 breaths. Generally, babies need quite a bit more than that, which means that he has to "breathe above" the vent. When it senses that he's taking a breath on his own, it will give him a shot of air, just like the other machine-induced breaths. He's been able to keep his own respiratory rate in the 50's and 60's, which means he's breathing on his own twice for every one breath the machine gives him. Eventually they'll want to get the machine below 10 (five would be a very nice number) with his numbers all stable...meaning that he'll have to take most of his breaths himself and still keep his oxygen saturation up and his CO2 content down. He got to 18 bpm tonight (from 20) because the CO2 content was great on his last blood gas.

One area in which he has (so far) fallen a bit short is feeding. He did really well for the last day or two, but brought a bunch back up this evening. Here's how his feedings work...skip this paragraph if you have a queasy stomach. They put some volume of milk in a syringe, and hook it up to the nasogastric (NG) tube going down his nose to his stomach. If the chosen volume is 8 cc's, they'll deliver it over two hours, at 4 cc's per hour. Then they wait another hour for him to digest it and pass it through to his lower digestive system. After the third hour, they put an empty syringe on the NG tube and pull it open, creating a vacuum that sucks any remaining milk out of his stomach. We would like to see either no milk, or very little. If they get a little back, they'll often return it to the stomach, so he can continue to digest it (gross, I know). From his afternoon dose of 8 cc's, he had residuals of 6.5. The doctor decided to try something new and told them to return the 6.5, then add another 6 over the next two hours, for a total of 12.5. Unfortunately, when they pulled it out an hour later, they retrieved 18 cc's. If you do the math, it doesn't add up...which means the extra either came from his lower digestive system, or contained extra digestive juices, saliva, etc. This has happened before, and they're not really concerned, but they have stopped the feedings for now to give everything a chance to rest...they'll re-evaluate in the morning.