Postponed Again

So much can happen in a day at the NICU. For instance, today:

1. They lost the arterial line in his arm.
2. We were both able to hold him again, this time without him vomiting on me.
3. They had to change the dressing on his PICC line twice, once because of a kink in the line.
4. They eventually got a new arterial line placed in his foot.
5. They upped his feeding from 1cc to 2cc per hour.
6. They switched his Ativan from IV drip to an oral form.
   
7. He successfully passed a sprint this evening.
8. They postponed his extubation yet again, to either Sunday or Monday.
9. He had a period of extreme alertness and activity, where he waved his arms and legs without any desaturation.
10. He had two moments of desaturation without any recognizable reason, other than getting upset.
    

To explain why they've postponed the extubation, let me give you a little (boring) medical background. The number they've been most concerned about is the CO2 content in his blood. CO2 is meant to be moved back into the blood (from the muscles), carted to the lungs, and exhaled; when this doesn't happen and the blood concentration gets too high, his blood pH drops and it becomes a bit acidic. Acidic blood can cause problems with the body...when the body is a bit stressed, it creates what they call "base excess," extra alkaline substances that counterbalance any acidity in the blood. Yesterday: They were trying to place an arterial line --> That required painkillers and a paralytic --> That required extra support from the ventilator --> That told his body that he didn't have to worry about acidity --> That lowered his base excess value, which means he has less reserves with which to combat CO2 problems. In order to let it build back up, they want him to spend another day at lower settings (and sprinting) so his body will prepare itself. Then, they can extubate.

Andrew was all over the place today, from relaxing comfortably in our arms to getting upset and desaturating over nothing at all. He's doing really well when he's calm, but having problems when anxious, so it's difficult to predict how he'll do when they extubate him. However, it is good that they were able to get a new arterial line placed, so they can get blood gases whenever necessary and keep a close eye on him during the extubation period. That will save them from re-intubating just because he looks a bit distressed. I can't predict how he'll do off the vent, but I can't say that I have the highest hopes...we might have to settle for some quality time and gear ourselves up for the next attempt. I certainly hope I'm wrong, but too much has happened this week for me to be completely optimistic.