Setting the plan in motion

For the last two weeks, we've waited on the eye doctor to give us the word on whether Woody was going to need surgery on the eyes, which would determine when he'd get another shot at extubation. And for the last two weeks, the eye doctor has said 'wait until next week' and we've waited again. Which is why before today's test, what I most didn't want to hear was 'wait another week'-- which is why it was basically inevitable what we'd hear today.

On the other hand, when he left Woody's room, I knew that it sounded a little different; first, it sounded like he was thinking that Woody wasn't going to need the surgery, and needed another week just to follow up. Second, I had a feeling that the NP and the neonatologist that were working today weren't going to let that be his final answer on the subject, especially with the way that Woody's been racing the leak. So I stuck around for a while longer, and the assembled health care professionals came to a quick consensus: we are extubating Woody again, and it is happening tomorrow. Which means it's time for...

Extubation Attempt II: Electric Boogaloo

I assure you that this came as a pretty sudden surprise to me, too. I knew that we were going to, if possible, act quickly, because Woody's pushing a number of developmental milestones, and we needed to do some kind of action in order to deal with that. So, a tale of the tape, as it were.

• Weight: ~2780 g (6 lb., 2 oz)


• Age: 36 weeks 6 days (gestational)
  96 days (outside)


• Chub level: substantial


• Lung quality: marginal(?)


• Feistiness: outstanding


• Most recent test results: 7.34 pH, 54 CO₂, 107 electrolyte, 32 bicarb

We shall have many things to watch during this extubation attempt. Woody won't have a hard and fast rule as to when he would get re-intubated (and eventually trached) by test results, but we generally know now what to look out for as danger signs: CO₂ levels creeping up, electrolytes crashing, bicarb spiking, increased heart rates, decreased feistiness, and general lethargy. Should we see these same signs, we'll know that things aren't going that well.

On the other hand, I have some reasons to be extra optimistic this time. First, the baseline of CO₂ is much lower to start; we pulled his tube for Extubation Attempt I when he was about 70, so every bit he went up was into bad territory. Second, we're doing this before his leak is so bad that he's had to be on the less-sensitive mode of the ventilator for a week running up to it, which makes me feel a little better. Third, his O2 needs are way down from last time. Finally, he's just made so much subjective progress in the last ten days in seeming feisty and strong and with it, ever since his UTI cleared up, that I just feel like this gives him a good chance to make it. Which is good, because it is almost definitely his last before the trach.* Tune in next time, for what happens...

*Dramatic enough lead-in? I had a dream the other night that I got called to be on "Oprah". That was a strange one.