NICU Night #47 - Triple Extubation

Sunday, June 6, 2010

How many times can a baby extubate himself in 36 hours?  We really aren't trying to set any records here, but our answer is three.

I got a very nice surprise last night that Melissa was back.  I didn't think she would be there until tonight (Monday) but there she was!  I made it over to the NICU around 9:30 and got to see Dakota for the first time since the move.  Jason and Brittany were coming over for a visit when I walked into the hall so I took them in to see Timmy first and then stopped by to see Dakota before my initial pumping session.  He is doing really well!  Looks like they'll be starting their spell counts this week and likely be out of the NICU within the next 2-3 weeks.  So happy for them!

Got my pumping session out of the way and had Timmy in my arms bay 10:30.  He never seemed quite as settled as normal, lots of surfing (O2 sats going up and down) but nothing much lower than 85.  I tried adjusting positions a couple of times and not sure if that's what did the trick but once again when midnight rolled around, I heard a sudden wind tunnel, looked down and saw that the tape holding Timmy's ET (endotracheal) tube in place was stretched away from his mouth.  Melissa noticed his heart rate drop at the same time and asked if we were okay.  Nope.  She had him out of my arms in no time and the crowd was back.  So strange to have it be almost the exact same time as the day before.  Andrea, the NNP for the night, just amazes me.  She was so calm the entire time, just getting the job done.  Timmy's resident for the night is also named Melissa and she performed the actual reintubation.  I think it was a little trickier for her because his vocal cords were a bit swollen from having just been through the procedure twice so it took three tries to get the tube in but she did.  There was a little blood in the suction tube but, overall, Timmy tolerated the whole thing like a champ - no bradys, kept his sats up.  Practice makes perfect?  Hopefully he's already perfect and tonight will be the last time he has to be reintubated.

Francesca and I had just fed Timmy about five minutes prior so that added another element of fun.  Fortunately they were able to suction all 19mls out.  We didn't refeed, just waited until he was due again at 2am.  He is tolerating the feeds really well, generally no more than 3ml residuals.  (Which means Melissa and I are due for our s'mores celebration!  She usually gives me graham crackers to snack on and I told her we'd celebrate when Timmy hit 15mls.  I forgot, but there's still plenty to celebrate and plenty of time before we're up to full feeds.)

Last night Timmy weighed about 2.2kg.  Really not making sense that he would have gained over 100g in one day.  They have stopped the Lasix, though, so I'm guessing that he's retaining fluid again.  His eyes looked a little puffy.

He also got a bath last night.  LOVE the smell of clean baby!  Melissa told me she would wait next Sunday so I could help.  Just can't get there by 8.  So excited to get to give him a bath for the first time!

I repeated last night - pump and snuggle after the episode to help Timmy calm down (although this time I left at 3 instead of 4am.  So tired last night.).  It was weird to feel so anxious about holding him.  I couldn't help but hold his head.  Not sure I (or he, for that matter) can handle another extubation right now, unless it were permanent.  They did try Timmy on the mask ventilation to see if maybe he would be able to handle CPAP again.  He did well with his sats and heart rate, but it became rapidly apparent that he was working hard, taking lots of quick breaths to get the air he needed instead of slow deep breaths.  He would have tuckered out pretty quick on CPAP so they reintubated but kept his settings the same - O2 at 40% (lowest it's been in a while), PEEP at 6, flow rate at 16 and PC (pressure control) above PEEP at 19.  The nurse practitioner told Melissa on the way out that if his O2 requirement starts to climb we would need to increase his pressure.  So hope not!  We've been working so hard and weaning so slowly just to get him where he is!

The Goerckes extended their sympathies on having two hard nights back to back.  They like coming in at night as well and have been there for both of the midnight extubations.  We chatted a bit and they told me that Andrea has done a little better over the past couple of days.  Just hoping and praying that little fighter can hold on!