Liking the Tummy

Andrew's doing well so far in his new position. According to the x-rays, his left lung has inflated more, but isn't yet over-inflated. The right lung also seems to still be an appropriate size, and his numbers (volume, CO2, and oxygen saturation) have all been good. Now that his left lung is nearing normal size, it's time for the second part of the plan. They're going to try and let him wake up tomorrow (Saturday) morning. They'll definitely do it slowly and keep a close eye on him, as he's likely to be groggy and maybe even grumpy after being sedated for so long. They'll reduce the paralytic first, so he'll be able to move in his sleep, then start turning back the sedation until he wakes up.

Tomorrow is a relatively important day for him, as the next steps will depend on how he reacts to waking up. There are really three options that I can think of:

1. He wakes up and eventually calms down and does well (both emotionally and physically), and his lung stays a normal size. He's definitely allowed to be a bit grumpy, but can't stay that way long-term. In this case, they would start to wean the ventilator back to minimal settings over the next few days.
   
2. He wakes up and the additional force of breathing on his own causes the left lung to hyper-inflate. In this case, they would almost definitely sedate him again, then probably move him back onto his left side until the lung collapsed again. Then they'd try to schedule a lobectomy to remove the upper portion of his left lung.
3. He wakes up and simply isn't able to be awake and relaxed at all. If his lungs cause problems in a way that isn't expected, if the right lung collapses as soon as he wakes up, or if that constricted bronchus generates significant difficulty for him, he will likely be behaviorally difficult and medically unstable. This would include any bad diagnosis other than a hyper-inflated left lung, for which they have a solution....if it's a problem without a solution, then we'll be very close to running out of options entirely. He needs to be able to be awake and stable...keeping him sedated and paralyzed long-term isn't really an option.

There are no indications that a problem will necessarily arise when he wakes, though I don't think anyone would be surprised if his left lung over-inflates again. In options 1 or 2 above, there is a clear method of treatment and expectation of improvement (even with the surgery). He'll show us tomorrow how he's grown or changed during the last several weeks of sedation....let's hope it's for the better.