There was such a debate again that the director of the entire NICU weighed in on the decision. And he decided to move to conventional ventilation. I was thrilled to hear him say it.
His reasoning reflected my feelings exactly. He argued that he's an older baby now, and because of that a conventional would feel better. Since it gives him normal breathing rhythms and even allows him to take his own breaths, it would help him thrive on a psychological level as well.
In order to test if he was truly ready for this, they bagged him as a way to copy the feel of a conventional and see how he did. And he did awesome. In fact, his CO2 levels began to drop as they did it. After seeing how well he did, the medical director made the final decision that he would indeed be moved onto a conventional ventilator. (YAY!)
Before making the big switch, they wanted to extubate and then reintubate him with a larger tube. Because the tube going down his throat doesn't completely cover the circumference of his esophagus, you get what's called an air leak. Air leaks happen when the air the ventilator is forcing into your lungs ends up escaping from the extra room around the tube. Ultimately an air leak isn't wanted when anyone is intubated. But because his lungs are smaller and he's been on higher pressures, they want a little bit of an air leak in order to control the pressure better. On the flip side, to much of an air leak means that he isn't being properly ventilated. It's a very fine line that I quite frankly don't understand. I do understand that his air leak had become too great, and therefore they decided he grew out of that tube size and needed a bigger one before we moved him to conventional.
Because of Aiden's C-spine precautions, they didn't want to reintubate him at his bedside. You have to stretch the baby's neck all the way back in order to get a straight shot down the throat. Extending his neck too far could paralyze him. So they ultimately decided it would be better to take him downstairs to ENT. This way they would be able to put him asleep under general anesthesia, and then use a tool called a Glidescope to switch him out. Ultimately they wouldn't need to move his neck at all while they switched out the breathing tubes.
He has already been extubated and reintubated three times before genetics came by and mentioned his C-spine might be a problem, so a part of me felt that going down to ENT was pretty silly. But I agree it's better to err on the side of caution and was relieved that he would be asleep for the entire process. I've been lucky enough to not see any of my babies being intubated. David on the other hand has seen both Lydia and Aiden be intubated multiple times, and he tells me he still has nightmares from seeing it. It's not a pretty sight. And if David is that terrorized, I can only imagine how frightening it is for a baby to experience. So I was perfectly fine with them putting Aiden under before anything happened.
When the time finally came to take him downstairs, I giggled to myself as I observed there was more machine then baby leaving. They had to bag him the entire way down and he did great. When we first started to leave he woke up and began to panic himself, but when I took his little hand he calmed right down from there. As they wheeled him away to the surgery room in ENT, and as David and I went to wait in the surgery waiting room, I felt a panic attack coming on. I knew he was going to get upset before he was put under (and believe me he surely did - they told us he put up a good fight and had a big desat before he went to sleep) and I wasn't there with him. He was only back there for 30 minutes, and that 30 minutes felt like an eternity.
The reintubation went perfectly. They also put on a micro-cuff around the bottom of his tube that will allow them to inflate or deflate the opening and control his air leak. And he now has a bigger tube and won't feel quite like he's breathing through a straw when he gets upset.
When they brought him back upstairs, his entire medical team and multiple neonatologists came to watch as we immediately hooked him up to the conventional ventilator. This was a big moment and time to see if he could handle breathing on his own with this ventilator. When he got all hooked up, his audience all exclaimed with excitement as he immediately started to breath! He was even breathing on much lower pressures then they were expecting him to! I let out a huge sigh of relief myself. I was holding my own breath as they hooked him up.
When he started to wake up from the anesthesia, he was a little grumpy. When I put my hand on his head and told him everything was ok, he peeked an eye open at me and reached out his hand. Everyone ooed and awed as I took it and he calmed right down.
He's been on the conventional ventilator for four days now, and he is doing really well. His PIP and Peep pressures have been significantly low for him, and he's been doing much of the breathing on his own. I learned that a conventional ventilator allows him to breath on his own accord, senses if he needs more support for his own breath, and then gives him breaths in between as needed. I've been staring at the ventilator screen religiously, mentally charting every breath he takes on his own, and it's amazing. The machine barely needs to step in and give him extra breaths.
Aiden seems to be a new baby as well. He's much more comfortable in general, and the moments he does get upset you can actually console him. He hasn't had a moment where he's spiraled out of control and has brady spells to the point of nurses standing by to perform CPR. And when he wakes up, he's much more happy and content.
I have a good feeling about this ventilator. I think he's really going to start taking off and begin to prove even more doctors wrong.
I, on the other hand, have been thinking about his future surgeries non-stop after his visit to ENT. He has at least three surgeries that will happen for sure, quite possibly many more. And those surgeries are going to be much longer than a measly 30 minute tube switch. I'm going to have a hard time not falling into a complete panic attack while he's in OR for hours.
|Walking down to ENT|