We might have a trend....

>> Wednesday, July 8, 2009

First, thanks for all of your emails, phone calls, and comments on the blog after my temper tantrum last night. They helped more than you know today and I was able to get my head screwed on straight again. Thank you!

Day 22 in the NICU ended up being another good day for Kamryn! She was weaned again this morning and afternoon and responded very well to less assistance each time. We are actually back to the point we were at about a week ago when everything went nuts. I know the vent settings and blood gases are confusing so I thought I would explain them at a high level so it made a little more sense in future posts. If your not interested in my awful explanation of the vent, please feel free to scroll down to how the rest of the day went. ** I made a cheat sheet for future reference on the right side of the blog **

Kamryn is on a conventional ventilator in SIMV mode. The ventilator guarantees that Kamryn will receive a set number of breaths each minute (rate) with at least the predetermined level of pressure (pressure). It forces positive pressure into her lungs during these breaths and then lets her exhale passively. She can breathe more than the predetermined amount, but it is completely on her own. There are 3 main settings that the medical team works with to keep Kamryn's PH level balanced. Oxygen, pressure, and rate.

Oxygen percentage delivered is adjusted throughout the day and can be adjusted quickly depending on how well her blood is saturated with oxygen. Room air is 21% oxygen and she has been doing great with low levels between 21 and 35 percent.

Pressure in simple terms is the pressure the ventilator is using to actively push air into her lungs. This is one of the culprits behind the damage incurred by the ventilator. To be extubated, she needs to be somewhere in the teens, probably around 16-18.

Rate is how many times the ventilator will guarantee to assist her during one full minute. She can go higher than this number on her own, but the vent will give her this many full respiration's each minute. To be extubated, we would need this number down to 20 or so.

Each time they wean her settings, they focus on one or the other (pressure or rate), not both. When I talk about baby steps, it is because they only move down one number each time about 2 hours before the next scheduled blood gas.

Finally, to make sure she handled the change, they will primarily look at her carbon dioxide level, two hours later with a blood draw, which we want to be under 70. If it is under 70, she likely tolerated it just fine.

So, to recap:

Desired pressure: 15-17
Desired rate: 20
Desired CO2: Under 70

We are getting closer on the pressure, but you can see there is still a large gap with the rate. Going down by 1 number each time will take many baby steps and time and that is without any setbacks which are likely. Today, we are actually at the point we were at a week ago before things went crazy.

The rest of the day
We have Traci back today from vacation, Monica has been on the past couple of nights, Gretchen is on tonight, and Tamara will be there tomorrow or Friday so our team of the most amazing nurses anywhere is back in force for our little girls. These ladies truly are nothing short of amazing!

Traci let Stephanie help give Kamryn her first bath today which was great. Kamryn doesn't get agitated nearly as often as she used to and did great! We are just so proud of how hard Kamryn is fighting to get out of there. It's been fun to watch the past few days!

Marion from our Bible Study group came by with dinner for us tonight and our group setup a care calender for us. We just keep saying to each other how fortunate we are to have such amazing people in our lives.

Another good day and I really can't wait to let you all know how well tomorrow goes!

Take care,


Elizabeth July 8, 2009 at 9:04 PM  

Sorry - I missed your vent - but that is to be EXPECTED! Seriously this is so frustrating at times and patience doesn't come easily.

(I was in the hospital last night myself! Ugh - last week my son Noah had surgery. Hospitals are no fun!)

Here is hoping that little Miss Continues her little steps forward and soon - she will be out of there an in your arms!

With thoughts, prayers, positive vibes and Lung Function Chants!

Tracy Meats July 8, 2009 at 9:08 PM  

Way to go Kamryn on the GOOD day!!! Many prayers for a good night and even a better day tomorrow...keep doing well with your support weans little girl, you are doing awesome!! That is wonderful the nurses are starting to let you do Kamryn's cares...what a feeling that is.

Hugs! Tracy

Jay & Allison Anderson July 8, 2009 at 9:12 PM  

Thanks for breaking it down so I can understand it just a little better. I'm so excited she's doing better! Praying things will not go crazy like last week, that she'll continue making progress tomorrow. Looking forward to tomorrow night's post.

kmm0305 July 8, 2009 at 9:29 PM  

To be honest, I never understood/followed the vent settings. ;) I let my husband worry about that. Coming into CDH with no warning, we had no predictors or ideas what it involved (she was a R-CDH anyway, and LHR isn't a predictor in those cases). Not knowing what a monster it could be, I never even had it in my mind that there were other options than coming through everything just fine. Everything will come in her time, it sounds like she is a strong girl with a very loving supportive family and followers! And a great team of nurses help, too. Here's hoping for another good day.

Jaime's World July 8, 2009 at 10:18 PM  

Hello Friends,
Watching the vent and monitors is enough to drive anyone CRAZY! We're at day of life 84 in the NICU. We tried to get out Monday, no suck luck! Feel free to be frustrated...I know exactly how you feel. I've learned that all of the prenatal tests really mean nothing, it's the babies themselves that truly dictate what's what. Anyway, make sure you take a break from focusing on the numbers and learn to focus on what Kamryn looks like...it will drive you less crazy that way! ;-)
Love and prayers,

Liz and Shane July 8, 2009 at 10:53 PM  

watching the machines drove me nuts. I took the advice of one nurse and just watched Nayeli. I would peek at the machines but tried not to worry.
Great news on a good day. I am praying Kamryn continues to have good days. I am so glad you are being taken care of by your friends. I would too if I lived closer.
Hugs from Cali

Chanda D Brady July 9, 2009 at 7:18 AM  

You guys rock for keeping us so educated and informed!!! I personally love this and it makes all the difference in understanding how to even pray for Kamryn! ....I'm thinking of your family often and can't wait to read the blog and find that everyone is at home and having mundane tasks to complete. Chanda

Christina Jones - dpsg July 9, 2009 at 8:04 AM  

I am still praying for strength, patience and comfort for everyone in your family. It is very frustrating spending this much time in the hospital wishing you could just scoop that baby up and take her home and everything be great. Remember though, sometimes God calms the storm and sometimes He lets the storm rage and calms the child. He is the Almighty Healer and He is holding Kamryn in His arms right now until the time comes to hand her back to you.

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