A Turn For the Worse

Wow! We've had a rough 24 hours. When I finally posted the blog yesterday, things were looking up. We were hopeful that the Propofol dosage would level out and that Mason would stay sedated and ride out the rapid detox. Unfortunately, Mason continues to get doses of medication that would put down a horse and still awakened and pushed back against the ventilator as it tried to give him breaths and with the Propofol, there's a limit to how much he can get. They tried different ventilator settings that were supposed to be more comfortable for Mason, but he ended up working too hard and didn't get enough air. So, in the words of the attending intensivist who started this treatment: "It's clear the treatment isn't working like we planned." They think that the mega doses of the sedatives and narcotics have make him hyper anxious and hyper reactive so that any stimulus puts his mind into a tailspin of agitation and as is his nature, he fights back. They still think it is worth continuing, he needs to detox from those medications so that his body and brain can restart and hopefully go back to normal for him. We just need to come up with a way to help Mason stay relaxed so that the ventilator can do it's job for his lungs while he detox's from the medications. The only answer that we can come up with is to re-paralyze him. So, at about 6:30 last night, they started the paralytic medication and Mason no longer was allowed to wake up and fight the ventilator.

About an hour after starting the paralytic last night, Mason's saturations tanked to the about 69-70% despite everything we tried to do - increase the oxygen, re-position him, suction him, bag him, etc. On xray it looked like the middle lobe of his right lung had more stuff in it, so they called the pulmonologist again and did another emergency bronchoscopy. While the pulmonologist was setting up the bronchoscope, another respiratory therapist (the one I fought with during the last hospitalization, in fact), came in and tried one more thing -- increasing the pressure in Mason's lungs as he bagged in more air. That did the trick!! So, the doctors determined that putting Mason on the paralytic took away whatever ability he had to keep the air sacs (alveoli) in his lungs open and ready to take in air. Increasing the pressure re-opened them and allowed his saturations to come up. Unfortunately, we can't bag him with increased pressure all day and all night. So, they continued with the bronchoscope to see if there was something else going on that could help to explain it. Good news: Mason's airways looked good and there was a little fluid on his lungs. Bad news: Mason's airways looked good and there was a little fluid on his lungs. Good and bad news because there was no mucus plug to remove that would be the quick and easy fix, but there was fluid that could be treated with a dose of lasix to help him pee it off.

So, 3 or so hours after it all started, Mason received more diuretic and his ventilator settings changed dramatically to better support him, and he finally started saturating better. So, now, he's on much more ventilator support, more oxygen with lower saturations (still in the 88-91% range for his saturation), and is somewhat sedated and maximally paralyzed. He continues to have a fever, continues to have a high heart rate, and more than likely is still agitated under his paralysis. It is still worth continuing this treatment because the hope is that once his neuroreceptors are reset, he will be able to be awake and not as agitated causing another desaturation.

Bill and I are having a difficult time dealing with all of this right now. Mason is very, very sick. Please re-double your prayers and positive thoughts. We really need it. Please pray that his lungs will tolerate the higher settings without more damage, that he makes it through this detox, and that he comes out better on the other side.