Sunday, July 09, 2006

Getting ready for the big move

As mentioned yesterday, the doctors are trying to be as cautious as possible when it comes to Woody's extubation attempt, because it's always traumatic to have to re-intubate the kids, and because we just want him to succeed after 60 days on the ventilator. On the other hand, there is a countervailing force that is beginning to push us to do it as quickly as possible: his growth rate. Recall that the little necks and tracheas on preemies are so small, and you have so little wiggle room, that a tube only is big enough (or small enough) to fit inside their throat for a month or so at a time. Woody was moved up in tube size about a month ago and now he's showing signs of a major air leak again, as the tube is too small for his growing airway. The net effect here is that the leak means that he can't be kept on the most sophisticated pressure settings for the ventilator, and if he wasn't going to be extubated they'd have to re-intubate him with the next largest size up in ET tube soon. So the more I walk into his room and see 85% leak on his measurement settings, the more I know that the race to extubate has pressures to go slow and to go fast, and I think we're going to have to try to play it right down the middle.

Woody continues to do fine. He lost a little bit of weight last night, which is totally normal; he often has a day of a slight loss followed by three or four with a good gain. The difference between a gain and a loss can often be something as mundane as whether they weigh him before or after changing his diaper. He is still right around 1500 grams. His O2 needs also are quite good still from his perspective, in the low 40s. And he continues to handle CO2 in the blood a lot better, although his test today wasn't quite as spectacular as it has been.

Two minor concerns I have today: he is showing some very preliminary signs of elevated calcium in the kidneys due to prolonged use of the lasix (diuretic) to keep the fluid out of his lungs. This is not independently much of an issue, especially at this stage, but gives us something to be concerned about for calcium uptake and bone density down the line. The other issue is his lung x-rays, which apparently are not showing major improvement yet, although the doctor hastens to tell us that x-rays can change day to day greatly based on how much fluid is in there. Since they only take the pictures every week or less, it's really pretty tough to draw too many conclusions there.


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