Extubation day part I

I am taking a little break from Woody's room to post an update, since I know that there are a few of you at least that are very anxious for news on the extubation front. Things are looking good now, but that was not necessarily the case right after the fact; he certainly took his time to get used to what was happening.

Maggie and I got there at around 7:30, and we were absolutely bouncing off the walls excited and nervous. Of course, nothing in a hospital ever seems to go off on time, so it wasn't until around 9 that he was actually extubated. The process itself is pretty simple; first you put the CPAP (an acronym, of course, and I'm too lazy to look it up; my best guess is "Continuous Positive Air Pressure") mask on him, then just pull the tube out of his throat. Simple, right? Well, I ask you, if you have only known breathing as a process where a machine forces air into your lungs at regular intervals, how easy would it be to figure out not only do you have to breathe on your own, but you also have to do it while breathing through your nose, a trick that you have never tried before?

At first he was keeping his mouth open, too, which made it difficult, because the pressure provided by the CPAP was going as much out his mouth as into his lungs. And he was very agitated by the prongs of the mask that go up the nose. His heart rate was shooting into the 180s and he was thrashing around pretty good; his saturation was staying in the 70s even with the oxygen turned all the way up. That first hour was incredibly nerve wracking, as we just tried to get him calmed down to TRY to figure out how to breathe. I was most nervous about them giving up and re-intubating, which they still could, but I didn't want the trigger to be pulled too soon because in my mind it's going to be an annoying, difficult time to get him to try to breathe on his own whenever it happens, and I would rather it happen sooner than later because mechanical respiration is inherently damaging to the lungs.

As it happened, the turning point came when Nurse M₂ gave him a half feeding and a dose of Atavan, and he started calming down. After an hour of stat watching, they started turning down his O₂ about an hour ago, and he's been stable in the high 50s to low 70s since, which is fine. The trick is going to be keeping him calm and stable and not fighting against the mask.

He does have some extremely good signs going for him. First, the BPM line on his stats, the one that I have previously said is not very important, is now important. And his is great so far. You will note there that the wave form is very regular and the rate is good. Second, the nurses report that his breathing is deeper than what he was doing on the ventilator, which suggests to me that he is getting better quality breathing and is figuring out what to do well. Third, after the first hour, his heart rate has gone down to the 150s on average, which is a fine rate for a 32 week gestational preemie.

The next big (huge) test is going to be his blood gas test ordered at 2. If his stats are not good, he is going to be immediately re-intubated. The numbers we are looking for are better than 7.2 pH and below 70 on the CO₂. His most recent results on the ventilator, by comparison, were ~7.32 pH and ~48 CO₂.

I will update after then-- think positive thoughts!