Weaning and Waiting

Here she is today. She is off her paralytics and beginning to move!

I changed her diaper for the first time last night. She is making lots of wet diapers, and this time she left me a little turdlet.

Here is the proud momma with her baby.

Last night Elise had an interesting time. She redeveloped some of the pneumothorax she had on the right side (Her lung partially collapsed). Fortunately this was not reflected in her oxygen saturation or PaO2. Regardless they pulled the chest tube they had and reinserted a new one through the same hole into a different location. The chest x-ray showed good placement of the tube and reexpansion of the lung. The left chest tube is not pulling anything off now, but we'll keep it in place as she makes transitions. The great news is that her blood pressure and PaO2 remain very good, and have been that way long enough to begin weaning support. First thing to go today was the vecuronium, her paralytic. It is renally excreted and her kidneys are working really well, so she has already started moving her tongue and limbs. We are being cautious as to not get her agitated, so her sedation (versed) will be dosed higher if needed. We began to simultaneously change some of her vent settings and reduce one of her blood pressure medications (epinephrine). We are alternating lowering her respiratory rate (number of breaths per minute) supplied by the ventilator and her pressure control. The physics of lowering these parameters will allow her heart to fill more before each pump so that she will be able to maintain a higher blood pressure. Today we slowly are weaning her epinephrine drip by .01 every hour as long as her mean arterial pressure (blood pressure) remains above 70. So far she has come down from .3 to .19. We have reduced her respiratory rate from 60 to 54, and her PC above PEEP to 22. All of these changes are small, but significant. She is maintaining her numbers with decreased support. We want to be very conservative and let her work through this. We are excited to get to talk about removing the epinephrine completely, then weaning the dobutamine, and maybe getting some breast milk in the next few days! The other benefit of decreasing her medications is that more fluid volume is freed up to give more TPN (nutrition). They have her restricted as to how much water they want her to have daily so she doesn't swell and the great number of medications she is currently on take up most of that amount. We have no results yet on all her viral cultures that were drawn yesterday. These won't likely change treatment plan, so we are patiently waiting. We may be trying new IV access tomorrow by PICC line, as the IV in her umbilical artery is starting to give us trouble. We are very happy with what we are seeing today, we feel more comfortable leaving her to get food and sleep. We really appreciate all the support we are receiving from all of you. It is difficult and time consuming for us to call all of you, but we appreciate and read all of your comments left below. If you have had trouble adding comments in the past, try again because I have changed some settings. Kristin is still doing great and looking good. We love you all.

-Jason