Scary Evening

Wren was extubated this afternoon. That means the tube that had been going down his nose into his airway was removed and the ventilator is no longer providing any breathing support. The process was traumatic for him - probably painful. They stopped the morphine to wake him up enough to take over breathing properly and he cried so much he turned purple. His heartrate went very high and he started having episodes of rapid breathing.

Over the next few hours he seemed quite distressed - whimpering as he breathed and working quite hard doing it. His heartbeat remained high. Anyway, to cut a long story short they called the RT (respiratory therapist) to suction his lungs. This was very very upsetting to Wren and his HB went to 194, BPs rose skyhigh and his breathing was very fast too.

I was very sad because he seemed to be in pain and struggling to breathe. The nurse paged the Fellow and she examined him and they made some changes:

1) Overall she was pleased with how he sounds and thinks that he is doing well for being newly extubated. She thinks he is stressed (they used words like "gets mad" and "fed up" which seem a bit weird for me) and needs to relax.

2) She stopped the Dopamine entirely.

3) He had one shot of morphine to settle him down but from now on will have another drug like benadryl.

4) The goal for today is to make him fluid negative. That means that the amount of fluid he has to pee out is greater than the amount of fluid they have given him. Right now he is VERY fluid positive and so he's still very swollen and his lungs are also a bit wet.

After a few hours he settled down and when we left he was sleeping without the sad noise and his BPs were down (MAPs still 50s or high 40s). His Breathing was in the low 40s (down from 70) and he sounded much less distressed.

I am going to call regularly throughout the night because he had me really worried.

The doctors feel he is doing fine and that the extubation was an important step and a success. The apparent distress is not a sign he's doing badly. BUT its so hard to see him looking so upset.