What a busy afternoon! The big news is that the breathing tube is out! Hooray!! They removed it around 3:15, and along with it they took out 3 other “lines” – the forehead stickers which were monitoring the oxygen levels in his brain, the IV in his scalp, and his urinary catheter. So now he only has 3 IV lines, an arterial line (like an IV but in an artery instead of a vein), an oxygen sensor on his toe, stickers on his chest to monitor his heart rate and breathing, a tube down his throat to decompress any excess air from his stomach (and possibly feed him in the next few days) and a blood pressure cuff on his ankle. Not bad!
Earlier today, with lots of tubes.
Looking pretty tiny with all those machines.
In order to remove the breathing tube, Christopher’s level of sedation had to be decreased. If he was too sedated when it came out, he wouldn’t be able to cough if he needed to, and would be at risk of choking. So the focus before it came out was to wean down the sedating medications that he was receiving, particularly morphine which he has been getting for pain. They are now giving him Tylenol and an anti-inflammatory and those seem to be working quite well.
When the tube came out, he was very awake. His eyes were wide open and he was looking at us. He was also crying quite a bit, which is to be expected – it can’t feel pleasant to have a tube yanked out of your throat! His vocal cords are irritated from having the tube sitting between then for a day and a half, so he is quite hoarse and sounds like a little kitten when he cries. However, his voice is already getting stronger, only 5 hours after extubation.
No more tube and wide awake!
We got to hold him for some snuggles after the tube came out. What a wonderful, wonderful feeling it was to have him in my arms again. It’s only been a day and a half since I held him just before he went off to surgery, but it felt like forever. He snuggled in and went to sleep. Brad also got a nice cuddle with him.
This was the best part of the day.
Our nurse for today, Nicola, told us that it’s pretty unusual for cardiac babies not to need some kind of help with breathing in the first few days after surgery. That help is basically one of three things: (1) the breathing tube with a ventilator doing all or part of the work of breathing, (2) CPAP, where a machine basically helps push air into the lungs when the baby breathes but does not initiate the breaths – this is delivered by an apparatus in the nose, and (3) oxygen by nasal prongs, the little tube that goes in the nose which we’ve all seen on TV.
By about the 2 hour mark after Christopher’s breathing tube was removed, it was obvious that he was still having to use a lot of energy to breathe. His oxygen levels were starting to drop down a little bit as a result. So he was started on CPAP to help support his breathing. The great thing about CPAP is that it’s easy to remove and isn’t nearly as invasive as the breathing tube, so when he’s ready to be without it, it will be no problem to get rid of it. He started to look more relaxed almost as soon as it was applied, and his oxygen levels are back to being excellent.
Relaxed and snoozing once the CPAP was started.
He’s also starting to look a little hungry today! He has a feeding tube that goes in his mouth and down to his stomach. It’s there to decompress his stomach as the CPAP can blow a lot of air into the stomach and cause gassiness. Christopher has been sucking on the tube a lot tonight, as well as rooting at anything that touches his cheek. We are hoping that he will be able to try breastfeeding in the next day or two, or at least that they will be able to feed him through the feeding tube. At the moment, he’s just getting IV fluids, which will keep him going in the short term, but it’s important for him to start getting some more calories soon so he has lots of energy to heal and recover.
We did have a little setback this morning. He had a spell of low oxygen levels in the wee hours of the morning which I think I mentioned last entry. The chest x-rays that they did at the time showed a tiny bit of collapsed lung on the left side – which isn’t surprising because they have to go through lung tissue to reach the aorta during the surgery, so that lung is pretty irritated. The collapse is already improving on its own, so we are hoping it will completely resolve without any interventions to fix it.
He has also needed a bit of blood pressure medication again after the breathing tube was removed. We were told to expect this as he wakes up more and is more stimulated by the world around him and all the things that are being done to him. Thankfully, they have already decreased his dose a few times, so hopefully he will be off the medication again soon.
Overall, it’s been a great day. We are so pleased with how things are going, and are feeling incredibly blessed by the amazing care here at CHEO. Please keep sending good thoughts and prayers. Our next goals are to wean off the CPAP and hopefully to breastfeed in the next day or two. He’s a hungry little guy and he’s getting impatient!
Wow! What an amazingly strong little guy (not to mention the parents!)! I'm so happy that he is doing so well! Hugs!
Posted by: Patti Dsouza | 06/22/2011 at 09:03 PM
That is so great that they took out the breathing tube and other "accessories", especially the IV in the head- those things are gross. He looks so good in that photo after they took it out- he must have been very relieved and happy. And SO great that you got to hold him- awww! Keep up the great work everyone!
Posted by: Apps 55753818692 849610074 Dfdaa2a77305aed169c7513bc7c07cee | 06/22/2011 at 09:07 PM
Ah wow!! Such fantastic news; he sure looks terrific now that he's weaned off the vent! Glad to read that he's doing well post surgery, he sure is a fighter that one. I hope you guys are doing well yourselves and know that you probably have many, many, many people praying for you family.
Posted by: Julie Savage | 06/22/2011 at 09:39 PM