Saturday, October 3, 2009

In Typical Elias Fashion

Yesterday was an up and down day. We took some steps backward, but by the end of the da regained some of that ground. With Elias retaining carbon dioxide at a high level they are unable to feed him, but that is not the real issue. They minds that be had a meeting today and with the rate of pressure Elias is needing on the ventilator it is not exactly safe to just let it ride out the next 72 hours. So they decided to switch Elias to a cuffed trach tube. The difference between this and the one Elias currently has is there is a small balloon around the trach tube that is inflated to block air that potentially could be escaping upward and leaking out. With this set-up Elias’ carbon dioxide levels would lower, they did not. Yet another example of Elias not following clinical logic. So with the cuffed trach still on they just played with the vent settings for awhile and watched him. They ultimately found that a higher rate and a lower pressure was having a more positive effect that the higher pressure which is typical for keeping floppy airways open. Thirty minutes after the settings were settled his blood gas showed a 20 point drop in CO2. The doctors were baffled, but were happy with some positive results. They are going to be able to begin his feeds today, if they do not they will have to do TPN for some nutrition. They are also checking with the FA doctors concerning a potential blood transfusion. His Crit & Hemoglobin are pretty low. We will see what they say about that. Last night he was VERY agitated, even after a double dosing of morphine and Versed. They gave him a different sedative. I can not recall the name but the description the nurse read to me was, “ a non-barbiturate hypnotic. It worked through the night and we have not had to give Elias anything since then. As I have been typing this update they just came in to tell us they are transfusing him, 105 mL over 2 hours of blood. Overall, I would say there is great improvement over the last 12 hours. We are still on the vent though and that is a bit upsetting. Hopefully monday that can begin trials for Si Pap. If we have to go home on some sort of mechanical intervention I would much rather it be Si Pap over the ventilator.

We will try to update as we can. Here in the CICU the internet access is a little limited, so it is not as easy to shoot off the updates. Thank you all for the continuing thoughts & prayers.

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