Recipe for Success

Andrew's still going on the CPAP, managing to keep all his numbers under control. The main reason he's done so well is because he's staying calm, which is mostly due to a slightly higher dose of Ativan. By keeping him calm, he doesn't spike his CO2 quite as high, which would get him into a vicious cycle from which he couldn't quite recover without reintubation. As it is, a little extra aggravation can really upset the balance...while his nurse was at lunch today, another nurse flipped him over onto his back, making him work quite a bit harder and throwing off his numbers for an hour. It's a precarious line, but so far he's walking it well. They're giving him enough medication to stay calm without knocking him out; he's still able to be awake and alert, enjoying his mobile and not crying.

I just called, and all his gases were well within normal levels. The next step, assuming he continues to do well on CPAP, is to wean the CPAP settings a bit. He's actually getting twelve breaths per minute through the prongs in his nose, and those breaths are at a specific pressure. If his gases are good, they can lower both the number of breaths per minute and the pressure of those breaths. Eventually, they would get down to minimal CPAP, which would be a constant flow at a pressure of 6, without any breaths given by the machine. That process may take a week or more, at which time they could try again on the nasal cannula without any pressure.

We're still within the two day window that he was able to remain extubated last time, but it seems as if they've figured out how to help him deal with the situation a little better. Keeping him off the vent will require continued calm and keeping him from getting tired out. To that end, we are trying to make sure he has consistent nursing over the next several days, with nurses that understand his special needs and won't do anything to upset him unnecessarily.