Huge Volumes

Today was a pretty good day. We weren't fortunate enough for a full night's sleep, but Mason did only wake once last night. I can report, though, that he woke in a good mood and was much less frantic for most of the day. As a result, saturations were overall better. He stayed mostly in the 70's and 80's while playing. He did take a nap today, but didn't end up sleeping for too long. Does that bode well for tonight's sleep??? We shall see.

We ended up weaning the ventilator twice today because Mason was showing big volumes of air with his exhalation. We were told that 15 mL/kg was high and could put him at risk for over inflating his lungs and creating a pneumothorax (a collapse of the lung because of a rupture of Mason's pockets of carbon dioxide in his lungs). Normally, Mason does well when he has volumes around 9 or 10, but sometimes goes up to 13 or so. This morning, after suctioning, he was staying at 17 and 18, so instead of weaning the oxygen concentration or the PEEP, we weaned the inspiratory pressure (the amount of pressure with which the oxygen is pushed into Mason's lungs). Several hours after weaning it, his volumes continued to be huge so the respiratory therapist used a different machine to make sure that Mason's ventilator was reading the volumes right and sure enough, it was. So, we weaned the pressure again. Amazingly, after 2 weans, he still has high volumes, but 2 weans in 1 days is a lot for him, so we're going to hold on doing any more. We (doctors included) have no idea why all of a sudden Mason's lungs are moving better and allowing more volumes of air to enter and exit. We did have another xray done today and overall there's not much change since the last one 3 weeks ago. We'll just have to see how he does over the next day or so to make sure that he tolerates the big changes today.

As far as the g-tube, it looks better and better. We are hopeful that we'll be able to be done treating it tomorrow or the next day. After doing some research last night, I found that if we used a numbing agent before using the silver nitrate (lidocaine), it might help with the pain (a treatment confirmed today by a wonderful friend!!). So, this morning, during rounds, we asked for the lidocaine and used it this afternoon. I think it worked to some extent, but we still have to wrap Mason's abdomen to keep him from grabbing at his g-tube site. I can't wait for this to be done!!

We have our care conference scheduled for tomorrow afternoon. It sounds like there will be quite a few people there making sure all of us will be on the same page. I am hopeful we can come to a good understanding and be able to move forward comfortably after that.

Yeah for another good day!

Rate: 28
Inspiratory Pressure: 18
Inspiratory Time: 0.65
PEEP: 11
FiO2: 67%