We've weaned down about .5 lpm at a time and are currently at 5 lpm! Slow but steady! 50% FIO2 still.
Even though he was technically on too high of flow to take food by mouth, since he has always been a good eater, we started oral feeds!
In rounds yesterday morning I requested we start bottle feeds and in today's rounds I requested we start purees. Cardiology backed me up as the PICU team was a bit skeptical, but he's done well! And the look on his face when he got his first taste of carrots?
He yanked out his NG tube last night to ensure no more tube feeds.
We haven't needed access while up here on the seventh floor, but it's standard proceedure to have two points of access while in the ICU. Job, like a lot of kids, blows or pulls out his IVs and is a tough stick to begin with, so I'm always protective of his IVs and have worked double time teaching him "no" and "no touch". We don't want any more pokes!
(Side note: in both the neurological and speech assessments we did last month, I got a lot of questions about whether Job understands "no" and I realized we never told him no. Since he's immobile we can control his enviromoment and just never let him touch or do anything he wasn't supposed to. But of course that won't last forever and I'd been trying to manufacture situations to teach him various different words, including no. I mention this because it was such a poignant realization that we skipped such a basic developmental milestone... And will skip plenty of others.)
They took out his IJ (neck IV) yesterday because that vein drains directly to his lungs and we didn't want to mess with that (though it was the only vein we could get access to in the ER when we really needed access). His foot IV is getting really swollen, so IV therapy said I could talk to the attending interventionist about taking it out and just poking him again for a new IV if we need emergent access. That will be a tough decision when he wakes up from his nap.
The attending told me this morning that a lot of the typically developing kids that come in with human metapneumovirus have to go on the ventilator, which helped put into perspective how nasty this cold is.
I'm thrilled (and shocked) at how quickly things are progressing right now. The hope is to discharge Wednesday?
But Dr. Penelver (the attending cardioloist this week) said that most likely Job will be going home on about 2 lpm of oxygen and it will take a good 6-8 weeks to get back to where we were before this cold. Certainly that's only a guess, but realizing we essentially have to start the weaning process all over again is very hard news to swallow. I have been dreaming of a luxurious summer OFF of oxygen.
Buuuttt, this is when I remind myself that only three days ago we were fighting pretty hard to get Job stabilized.
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