Extubation Fail and The Plan

B & I were so excited for yesterday, we thought Miss Zoe was going to easily be extubated.  Little did we know that this process isn't east AT.ALL.  In fact, this was a nightmare of a day that really put a lot of stress on Zoe and us.

We made it to the hospital in time for the doctors' rounds and were happy to hear they were going to continue with extubation later that afternoon.  She also was taken off several drugs and weaned down on a few more.  We thought how wonderful this is, another step to getting to the "floor" and graduation.

Zoe's first challenge was the one hour sprint with pressure support (PEEP of 5) of which she was doing fantastic and her blood gases were really good too.  Basically she was challenged to breathe on her own but the vent was still assisting in keeping her lungs open through pressure support (PEEP).  Sprinting is an exercise to help re-train or train the muscles for breathing.  Zoe did excellent during this test and we thought extubation was going to be a breeze.  Since she did so well, they decided to move to CPAP which is the same exercise but with out assistance from the ventilator.

Unfortunately when she was put to the CPAP exercise Zoe was not at an optimal state since she was being assessed, had three poopy diapers in a row, and was in the midst of big fit that lasted about 5 minutes.  Her fit was already causing her to really struggle with catching her breath.  During this time the respiratory therapist hastily came in, shut off her support, and walked out.  I was questioning this and the nurse didn't really stand up and say let's calm her down first.  She started to and then just stopped (this may not mean anything, but this was her first day back after a 6 month leave).  I just didn't feel right about doing the CPAP at that moment and I should have been more firm.  Well, as just as I thought the whole challenge went to pieces very quickly.  Zoe failed the CPAP within 20 minutes, 20 minutes too long in our opinion.  Sadly she had a very difficult time recovering and simultaneiously taking her off/reducing several of her medicines didn't help.

Later that afternoon with talking to the doctors and our night nurse we all agreed that was not the opportune moment and the CPAP should have been delayed until Zoe was calm.  She should be at her best when put on these challenges so that she has the all the resources to keep up her stamina.   I made it very clear that we were very displeased with our afternoon nurse's and respiratory therapist's actions and this will not happen again.

In order to help her ready for extubation, the new plan is to put Zoe on a sprint challenge every 6 hours or over the next few days.  The goal is to work her way up until she can manage a sprint for three hours with out any complications.  This challenge will allow Zoe to rebuild her strength and quickly get her on the path to extubation hopefully no later then Wednesday.  

Last evening at 9:45 pm Zoe started her sprint and handled it very well for almost an hour before struggling and her blood gases came back perfect.  This time she quickly recovered.  We were not here for her morning sprint, but we were told she lasted about 50 minutes and had a few desats into the 60's therefore they didn't check her blood gases.  We are anxious for this afternoon's sprint around 2pm.

Our nurse mentioned that her morning's x-ray showed the right lung had collapsed a bit.  This has happened before, but I suspect the CPAP is to blame.  They have turned up her PEEP to 6 which will open up the collapsed area.  We are still waiting to talk to the doctor's about the x-ray.

These next few days will be rough since this is our next big hurdle.  Zoe is in charge and will progress on her own time, we just have to be patient and help her through this.  We are now fully aware of the extubation roller coaster.

On a good note...

Zoe started her breast milk feeds by NG tub again on Saturday.  She is tolerating it very well and hopefully she will start gaining some weight.  Her echo cardiograms are coming back with huge improvements and the cardiologists are very pleased.

snuggle buddies

Today was supposed to be Zoe's scheduled birthday, how quickly three weeks have gone by.  We would have loved her to stick around and grow those three weeks in my belly, but at the same time we are so glad to have already gone through much of the first surgery.  Happy three weeks Zoe!  We love you so much!