Friday, June 23, 2006

Life, the universe, and everything

[Note-- This post represents a high point on including inlined pictures and media into the Woodyblog. If your connection makes this take a long time to load, please let me know, and I will go back to simply linking stuff offsite, or creating a second text-only page for ~weenies~ like you.]

As of today, Woody's six weeks old. Upon his birth, he was 565 grams. As of today, he's 1050. He was 11 and a half inches long, as of last week he was 14. Perhaps the most graphic difference between now and then can be seen in the difference between the still picture of him wearing our rings on his elbow:



and this brief video clip*, taken yesterday, where I put my ring up to him again so you can see the difference. This movie, by the way, is my directorial masterpiece up to now. I kind of woke him up peeling back the blanket to allow in enough light to take pictures, but at the end of the video I give him a little caress and he fell back to sleep.



No, that ring isn't going back on his arm again. Woody's had quite a bit of play in his vent settings this week, ever since he extubating himself last Saturday. Wednesday he was re-intubated, as noted (over and over), and as of yesterday he seemed recovered enough to make a fairly significant tweak in his settings, namely lowering the breaths per minute setting to 40; it was at 65 as late as Tuesday. Woody's relevant vent settings now show him of getting a VT (tidal volume; the vent is a Dräger vent, made by Germans, and I'm guessing that the VT setting is reflecting the abbreviation auf Deutsche) of 5.0; his max pressure is up to 30, and his PEEP is down to 7 (check the illustrated vent settings over to the right, if you are interested in how the display shows).

There are some interesting and heartening signs of progress that have now begun to develop. First, Woody's oxygen needs have been coming down on an average basis all week, peaking in the mid-70% level on Wednesday, and now are back in the mid-40%s as of today. This may reflect a little bit of a spike below what his 'normal' because he was on some anti-inflammatory steroids to coincide with the re-intubation, but if you consider that he wasn't even put on the really strong ones, I don't think it can account for all of his improvement. Besides, when they attempt to extubate him for good, they're likely to give him a couple of days of strong steroids to help him out, and I doubt we'll discount his progress when that happens.

Second, the max pressure setting (30, recall) has a corresponding measurement that the machine takes with every breath, called the PIP (peak inspiratory pressure), which roughly measures (untechnical definition, so don't get too pedantic with me Nurse S!) how much effort the machine is having to exert vis-a-vis Woody's own breathing, to fill his lungs with the required VT, which is a relatively constant figure around 5. To illustrate, if Woody is doing no effort at all in breathing and just allowing the vent to take every breath for him, his PIP will show at 30. If he's taking some effort, the number will be in the 20s. If he's putting out a good amount of effort, it will be in the teens. If he's doing most of the work, that number will be below 10. Prior to last week, I very rarely saw Woody's PIP go under 20, but in the last few days it's been there an awful lot, and dipping under 10 frequently. This looks like a very good sign to me.

Finally, Woody continues to gain weight, and despite the discouragement of the nipple nazis Maggie has been able to keep up with the production. We'll see how that works. However, they have now upped his feedings AGAIN to 14q2, which means that to break even Maggie needs to be providing 168 mLs a day, which is about the upper limit for her up until now. I'm hoping for a good weekend.

*For the nurses and lawyers (hi colleagues!) who are checking me out from The Hospital That Shall Not Be Named, you already know that your web filter blocks Youtube videos. As a redundancy measure I am also hosting them here, so you can see them too. Have fun.

4 Comments:

At 2:00 PM, Blogger Augmented Brain said...

This comment has been removed by a blog administrator.

 
At 4:34 PM, Anonymous jared said...

Have a great and productive weekend Maggie, Nathan, and son.

 
At 6:58 PM, Anonymous Grammie said...

Love the video! If you give up your day job, I think you have other possibilities (mesmerism, filmmaking, etc.), Nathan.

 
At 12:57 AM, Anonymous Anonymous said...

Yes, despite the other troubles and inevitable speed bumps the trend seems to definitely upward. It's good sometimes to assess the progress made.

Love to the whole family.

Kevin

P.S. Looking forward to Maggie's first post.

 

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