Wake Up, Part 1

Well, this morning did not include the dramatic wake up that I thought it would. The plan from the attending intensivist is much more slow and subtle than that - a good thing for Mason. I thought I would give an update anyway since I know many, many are keeping us in their thoughts and prayers today. Here's what I know so far:

Mason did have a busy morning and a little trouble with his saturations as a result. I did end up going home last night and had a great, restful night's sleep. I think it was the right thing to do. When I got here this morning, his saturations were down after a diaper change - again with the not liking a poopie diaper... Just after he was repositioned, the Echo tech came by and did a heart ultrasound for about 20-30 minutes - don't know the results yet. Just after the Echo tech left, the PICC nurse came in and changed the dressing on his remaining PICC. Not surprisingly, after all of that, Mason had a very difficult time with his saturations, so we called the respiratory therapist and she and Mason's nurse "bag suctioned" him. I'm not sure if I've explained this before, but basically, they disconnect him from the vent, hook him up to the "bag" (you've seen it on ER as they're wheeling the patient back, basically it is a big air bag that you squeeze to give the patient breaths), and every once in a while suction out his trach. The idea is that the bag loosens up the gunk so that it is easier to get out with the suction. This time, though, they added some postural drainage to the mix and brought Mason in to a flat position and rolled him to each side while bag suctioning him. It worked really well and allowed them to get a lot of the gunk out of his lungs. Since he was flat, we also took the opportunity to change all of his bedding. Well, as you can imagine all of this activity was pretty rough on Mason and it took a good hour or so for him to recover.

During all that activity this morning, we did not attempt to change anything. At noon, however, the gradual wake up process began. Unlike what we thought, they are not going to take off the paralytic first. Instead, they are going to wean down the Propofol sedative by a certain amount every 3 hours to monitor his sedation under the paralytic and make sure that the ativan and methadone doses are adequate to keep him sedated. That way, if adjustments need to be made, because of the paralytics, we can still avoid fighting the ventilator and being totally agitated causing desaturations while the doses of ativan and methadone are being changed.

So, as of now, we're just doing the wait and see thing. We will just see how he does over the course of the day and night. Mason started on 150 mcg/kg/min of the Propfol, is now down to 135 and will continue to wean down by 15 every 3 hours until it's off. I'm still not quite sure when they will take off the paralytic, but will keep you posted on how things go.