Professor Mason - School Is In Session

Hmmm...I'm trying to think of a catchy title for today's events, but it's hard to categorize. Maybe it will come to be as I write.

I awoke to Mason doing fairly well lying on his left side, 65% oxygen concentration, 85% saturation. Pretty good. His fever had broken in the night and his temperature was staying in the 98 degree range. Rounds were fairly uneventful other than his right lung was less inflated and generally didn't look happy on xray. Crap! We planned on doing the paralytic holiday after 10 and planned on today being a relatively ok day. Well, that's what we get for planning!

Mason had other ideas. His lungs decided to act up a bit again after being on his left side for a couple of hours (they change his position every 2 hours to avoid getting bed sores). His saturations went down and despite ventilator changes, a position change, and some suctioning, they stayed down in the high 70's/low 80's for a couple of hours. After about an hour and a half, Mason decided to move a bit (despite being on the paralytics) and evidently loosened up whatever mucus plug was limiting his oxygen flow. The suctioning after his little dance did produce some gunk that we were able to remove. Unfortunately, the more he stays down, the more mucus plugs will happen. I just hope we are able to get them each time so that he can continue to get better overall and we don't see his lungs deflate again. Tomorrow, they are going to repeat the brochoscopy, this time while he is off of the paralytic, to see how his lungs do when he's breathing on his own.

Oh, I forgot, there was a big change discussed during rounds. Once again, Mason's blood count was down so he got another transfusion. It was clear that the low blood count was affecting him because between that and the removal of the mucus plug, he returned to his current "normal" and was ready for a paralytic holiday again around 4 pm. Once again, he did well with the holiday and was able to breathe on his own with the CPAP support from the ventilator. He did not saturate quite as well as previous times, but did not work as hard either. He did end up pooping himself out after a couple of hours and fell asleep without the paralytics on board. While relaxed and asleep, he did even better and maintained his saturations in the mid 80's. Unfortunately, Mama had a bright idea that would surely help his saturations improve -- get him in a better position so that there wouldn't be such a big leak in his trach (in certain positions, air leaks around the tube itself, so it is less efficient). Real bright idea!! It ended up that I startled him, woke him up, and sent him into a small panic over what was happening. When that happens, he starts fighting the vent and doesn't breathe as well. Luckily, we were able to re-sedate him and re-paralyze him so that his breathing evened out and he could fall back asleep. Real bright idea, Mama!! Ok, Mason, lesson learned. I promise I won't disturb the sleeping baby again!!

All in all, he did well with the holiday, but must have moved around some of those mucus plugs again. We're ending the day similar to how it started, but I'm encouraged by the fact that he was able to pull himself out of it this morning with a little shimmy. I've got it...lessons learned: silly Mama, don't make plans without including Mason, don't poke the sleeping baby, and above all, keep moving!