Unhappy Baby

It's been a really long, hard day for everyone, but mostly for Andrew. Starting last night after my post, he started having a harder time breathing. He was working hard, getting upset, and desaturating himself, all for no apparent reason. He had several breathing treatments, plus some extra sedation to keep him calm. His x-rays were clear and his white blood cell counts were normal, so they didn't suspect infection, but they weren't sure what the problem was.

The issue continued into the morning, when his chest was tight and constricted. During the day shift, they gave him six breathing treatments, far more than normal. He wasn't getting the lung volumes that he normally gets, again for no clear reason....the breathing treatments helped, but weren't solving the problem. He was also getting upset for no reason, waking up crying and dropping his oxygen saturation. Combined with the trouble breathing, his episodes were much worse than normal and it took longer for him to recover each time. There were times when he was on extremely high oxygen, on a high ventilator rate, and still not recovering at a normal pace. I hadn't been that worried about his long-term recovery potential for almost two months.

It got to the point where he would put himself in a precarious situation every time he woke up and got fussy. To prevent him from making his condition worse, they gave him additional sedatives, as well as a paralytic. He's always been pretty tolerant of medication; today was no exception. They switched the choice of sedative and the choice of paralytic, put him on a constant drip, and then raised the dosage. He also got extra methadone and Ativan. Even with all of those on board, he was still waking up every now and then...but he was much more calm and wasn't causing himself problems. To help with the tightness in his chest, they switched from a normal nitrogen/oxygen combination to a helium/oxygen combination. Because helium is a lighter gas, it's easier for him to inhale and exhale...exhalation seemed to be the issue.

We thought all the changes would resolve the issue and keep him stable for a few days, allowing him to relax and recover. However, when we called just a few hours later around 9pm, he was having even more issues. After a particularly bad blood gas, they took a chest x-ray and saw that his lungs were significantly whited out. This means they are being congested, constricted, or otherwise impeded. Again there were no signs of infection, but he was heavily congested and finding it hard to breathe. They gave him a treatment of something called Mucomyst, which loosens secretions and allows the nurse to suction them out of his lungs. This seemed to help, as his follow-up blood gas was much better. He's currently asleep and calm, and responding well to both the ventilation and the sedatives. They'll get another x-ray in the morning to check on his progress.

I spoke with a doctor and she doesn't think there's any immediate concern of an unrecoverable problem. That being said, there are two very different long-term paths that Andrew could potentially travel down. If he recovers well, they'll attempt to get him back to good baseline behavior on the ventilator, wean his sedation and paralysis, wean the ventilator settings, and then start on sprinting and looking toward the next extubation. I don't really want to discuss the other option.