Changes, Lots of Changes

For agreeing not too make many changes at once, today was a day of a lot of changes. Oh, and we agreed to all of them. Some of them were medically related, some of them convenience. All in all, though, a better day than yesterday.

Steroids:
During rounds this morning we talked about the major setback we experienced yesterday and asked if maybe we needed to slow down our steroid wean. We realize that it's important to get off the steroids, but if we can't make progress on weaning anything else, then it's kinda pointless. So, we agreed to slow down the wean to a 10% cut every week instead of a 25% cut. Hopefully we won't see as much of an effect. Don't worry, I'll keep you posted!

As far as the effects of the last wean, today was a better day. Mason saturated mostly in the 70's with a few dips into the 60's and 50's. He was also able to wean down on his oxygen concentration some, though not as low as he was on Saturday.

PICC:
One of the agreements that we made in the care conference was to work toward removing the PICC line. It is completely foreign to be in the ICU and not have an IV, but in Mason's case, it is a straight open line into the body that is ripe for infection. So, it is best to remove it. However, we needed to make sure that we didn't need the IV before removing it. We have been using it for blood draws and lasix doses. On Saturday, we switched to lasix by g-tube, but needed to do an IV dose yesterday. After a lot of discussion about it today, we decided that if we needed lasix, we would do it by shot or by g-tube, so no need for the PICC for that. As far as blood draws, we proved that Mason can tolerate those well without too much effect on his saturations. So, no need for the PICC for that. Tonight, all parties agreed and the PICC was removed. Mason is now IV free! For all you nurses out there, don't worry, if things go bad again, we can still use the PICC veins and get another line in ASAP if needed. :-)

ECHO:
Well, upon preliminary report, it looks like Mason's heart and pulmonary veins are changing, too. Mason had a repeat Echo today and the report said that there isn't as much pressure on the right side of his heart. If this is true, it is fantastic news!! This means that the Viagra and his other heart medication are working!! His heart is not having to work so hard to get blood into his lungs to get oxygen. We will verify tomorrow to make sure the news is what we see today.

Respiratory Rate:
Unfortunately, Mason's carbon dioxide retention is increasing. In other words, he isn't exhaling all of the carbon dioxide that he needs to, so the amount in his body and his blood is too high. Months ago when we were first considering the idea of a trach and vent, the rationale was that they would help Mason blow off the carbon dioxide that he was retaining. On the higher settings, the vent was doing just that. However, now that Mason is much more active and using his body more and the vent is on lower settings, he is creating more carbon dioxide and not blowing off enough. One of the ways that the ventilator can do this is by increasing the rate that it breathes for him while he lets it work on it's own. So, after consulting with the pulmonologist today, the respiratory therapist increased his rate. We are hoping that this simple change will be effective and he can get rid of more carbon dioxide with every breath.

New Address:
Yes, Mason, Bill, and I have a new address in the PICU. While on another wagon ride today, Mason noticed that one of the empty rooms on the unit appeared much bigger than the room we have been living in for the last 9 weeks. Mason used his powers of persuasion to woo the nurses into letting us move. We have settled in nicely and amazingly don't have to trip over each other to move around the room. We love it! Well, ok, we don't love it, but it's much better than the other room we were in.

Well, after all these changes today, we're hoping for a very boring day tomorrow with the only changes being decreasing the oxygen concentration. I think that will be my prayer tonight.

Rate: 35
Inspiratory Pressure: 18
Inspiratory Time: 0.65
PEEP: 10
FiO2: 64%