NICU Day #58 - Another Extubation Attempt

Timmy's repeat extubation (I really cannot remember whether this is #3 or #4 now) was planned for around 1:30pm.  I had a little trouble finding parking and couldn't get in until 1:45.  Dana was downstairs with Axel for the MRI he's been waiting days for and didn't get back until after 2:00 anyway.

Melissa came in, ready to go, and started getting things ready.  Dana begged to eat lunch first, promising to be back in 15 minutes.  Who performs well when they're starving?  So away she went and the rest of the team assembled.  Andrea came in and Linda, the respiratory therapist, hung around until we were ready to go.

Timmy had been pretty irritable, silently screaming off and on since I had arrived.  We could get him calmed down with lots of firm back patting but then he would start screaming for no apparent reason and his heart rate would surpass the 200 mark, setting off the monitor and we would pat some more and he would calm down again.

Finally the time came around 3.   I had only seen the self-extubations to that point.  Dana removed the tape and the ET tube was removed and a mask was placed near Timmy's nose, I'm guessing the "steam" was oxygen flow.  My heart honestly swelled to see his cute little face unobstructed for the first time in almost 6 weeks.  He has such darling little features!

That swelling was dimmed shortly after when Andrea placed her stethoscope on Timmy's chest and said she couldn't hear anything.  Was that good? - as in she wasn't hearing anything abnormal.  Or was that bad? - like she wasn't hearing anything period.  Unfortunately, it turned out to be the latter.  Dana tipped Timmy's head back, opening up his little chest and then breath sounds were heard, but that wasn't the only thing.  Timmy was making a loud squeaking sound while he was breathing.  No doubt whatsoever that he was definitely stridorous on this attempt. 

There would definitely be no nasal cannula this time and CPAP was out of the question.  Intubation was not only imminent but of the essence.  Timmy bradyed down to about 70 beats per minute, O2 sats dropped into the 50s.  At that point I had to turn away.  I knew that he was in good hands, but getting my hopes beat to a pulp and having my baby have to have a tube shoved down his throat yet again was a bit rough.  The first attempt to get the ET tube placed resulted in formula coming back out so the end of the tube was obviously not in the right place.  Upon removal, blood was suctioned out.  Heart rate and O2 sats were up and down in a scary way but, thankfully, Melissa nailed it the second time.  It is nice that she has experience with Timmy before.  Even still, having Andrea tell her that she only had five seconds to get the tube in...  Not nice.

I may be a bit off, but this is what the procedure looks and sounds like to me:  The interior of the throat - larynx, vocal cords, trachea - are visualized using a laryngoscope and the ET tube is inserted while it is in place separating the vocal chords.  Then the tube is bagged to give ventilatory support and breath and abdominal sounds are checked to make sure the tube is in the trachea and not the esophagus.  Then the tube is taped to baby's cheeks and length is adjusted and the tube is connected to the ventilator and we're back to square one.

All settings were returned to where they were.  Timmy's lungs are perfect; the #1 concern of PPROM.  I wanted to cry.  I'm not entirely sure why.  Timmy is fine.  Once the tube was in, check x-ray taken and he had been swaddled, he was perfectly content, sweet peepers just scoping the room.  Heart rate was back into the 140s, O2 sats in the 90s...  He was fine.  I think I'm just frustrated.  He's been on the ventilator for almost 6 weeks and the only reason he is on it is because he had to have surgery.  Why couldn't he have just been able to eat and skip the surgery?  But there's really no sense dwelling on it because he couldn't and didn't and we just have to go from where we are now.

And where we are I don't know.  Dr. Bedrick came in to talk to me and asked what I had seen.  I started to try to tell him, but I was so sad and honestly am not entirely sure all that the doctors and nurses are watching so couldn't say yes or no to what I may have missed.  He gave that sad little nod of "this is what I didn't want to tell you more about this morning, but now here we are."  We won't know how to proceed until Timmy sees Dr. Perry, one of the ENTs (Ear, Nose and Throat doctors).  Very anxious for him to come in and check Timmy out.  However, since it was closing in on 4pm, it didn't seem likely he would be in to see Timmy today and I don't think he has.

At that point, I envied every first time mom there too.  I wanted so badly to hold him, cuddle him, love on him...but with three other kids at home, it just cannot always be.  But I will be back tonight.

Thanks to Bridgette and Sondae for watching the kids so I could be there.  So very much appreciated.