Extubation

After much debate back and forth in regards to whether or not they were going to extubate Caden today, the end result was they decided to do it. I asked the nurse to call me and let me know when they were ready to do it so I could be there for it. I had just finished eating in the cafeteria when she called and told me they were ready. So I went back to Caden's room and stayed while they took the tube out and put him on CPAP. They thought this was the best route to go since he had been on CPAP prior to surgery and felt he would be able to tolerate it reasonably well.

However, once he was off the ventilator, and on the CPAP, he was having quite a hard time breathing and was working really hard. The nurse took a blood-gas to see how he was processing CO2 and it was really high which is bad. So, the doctor decided to let him work for a few minutes to see if he would become more comfortable. And, the respiratory therapist adjusted the pressures administered by the CPAP trying to find a balance of what would work best for him. After 15 minutes they took another blood-gas and the number was still high, but it was coming down slightly. At this time, an attending came in and got involved in the process. He suggested some other ways to evaluate how Caden was doing and they assessed him for a few more minutes. By this time though, they had taken him off the CPAP machine and were using a face mask on him and they still weren't liking how he looked. But they took another blood-gas. It was even higher than the first one they took which was a bad sign. So, based on that information, they decided to put him back on the ventilator.

It was pretty emotional for me because once he had the breathing tube out of his throat and was on CPAP, Caden was trying to cry. But his larynx was so swollen and traumatized, no sound came out. It broke my heart to see him like that. And, it was really hard for me to see him put back on the ventilator. Not because of the machine itself, but for fear of doing more damage to his airway and cause him more trouble or possibly permanent damage to his vocal chords. The doctor said they would use a smaller tube so as to help prevent more damage.

When they intubated him again, they asked me to leave the room. They had to sedate him and I didn't want to watch the procedure anyway so I went to pump. When I returned, they were done and the doctor talked to me for awhile. I asked if they would leave the tube in for a couple more days to let him heal more and she said she didn't know, it would really depend on him. She said she felt it was the right decision to extubate today and push him a little bit. The blood-gases they took after putting the new tube in were the best ones he's had all day. So she thought working a little harder might have helped move some plugs out of his lungs which was good. And, she said it wasn't that uncommon to re-intubate.

By the time I left the hospital tonight, they had already lowered the ventilator rate down a couple times and she said they would continue to adjust it through the night based on how he responded. She said it was too hard to predict how long they would leave him on it this time but I told her I didn't want a repeat of what they did tonight because I was worried about more trauma for him. I also asked her about the possibility of starting feedings tomorrow and she said she really didn't want to guess because it would depend on how he did tonight.

Anyway, this evening ended up being a little stressful and emotional for me. The doctors feel this wasn't taking a step backward, but from my perspective it's hard to see it that way. But, Caden is still stable and hopefully will progress to the point where they can take him off the ventilator and leave him off. The biggest difference with Caden compared to the rest of the babies they deal with in CVICU is that he is not just a cardiac patient, he has respiratory issues as well and it seems like they didn't take that into consideration when they pushed to extubate him. The doctor said if he had just been a cardiac patient only, they would have taken him off the ventilator the day after surgery. So, things are definitely different with Caden. Please continue to keep us in your prayers.