PICU Day 10 ~ {July 4, 2012}

~Nearing the end of the extubation process~

We missed the fireworks tonight, but Noelle provided her own little 4th of July celebration that was enough for us.  It was not without some drama, but she was extubated today and is doing quite well, considering the overall circumstances.  At this time last night, we thought the extubation might happen some time today; but this morning the medical team informed us that they would prefer to do a long, slow wean and have her come off the ventilator sometime Thursday or Friday.  This did not bother us since this is the fourth time we have been through this process, and we always want to be sure that she is fully awake and ready to have that support removed.  However, she began to wake up this afternoon and really start fighting the ventilator, and they decided it was the time for extubation to take place.  At first, things seemed to be going normally; but we quickly saw that Noelle was not responding as she should once the breathing tube was removed.  This is not a completely abnormal response, so they gave her some extra oxygen and watched for her to recover and start breathing on her own, but this still did not happen.  Several things were happening all at once, but they bagged her to provide manual breaths along with oxygen and kept working with her.  She would take a breath when stimulated but then had difficulty moving the air in her system, so she would then stop and clamp down.  It was nerve racking to watch her little body struggling to adjust while hearing the monitor sounding because of a drop in her heart rate and oxygen levels.  The team continued to manually help her and work with her and also decided to administer a drug to reverse the effects of the pain/sedation medication {Fentanyl} and allow her to awake; and thankfully, the tiny amount they gave her worked almost immediately.  The doctor had told her this was her last chance before they reinserted the breathing tub; but she opened her eyes, began to cry, and started breathing and moving air on her own, allowing us all to breathe a sigh of relief.  The entire process took more than 30 minutes and was the most difficult extubation we have ever experienced with her. 

~Exhausted but ventilator free Baby Girl~

Perhaps it was her way of celebrating the 4th and making up for the fact that she cannot watch fireworks tonight or wear her sweet little 4th of July outfit that Mommy has been saving for her for weeks!  Either way, we are grateful that she is now doing well without the ventilator and having very few desaturation episodes thus far.  She does still have the blood clot issue in her leg, but it appears to be better than last night and slowly responding to the medication, so we are hopeful that it will be resolved within the next day and her circulation back to normal.  We hope you had a wonderful 4th of July holiday and appreciate your continued concern and prayers for us.