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,
Shawn
