Sick and Back on the Ventilator

Truman has had a tough weekend. He is clearly sick. His blood count yesterday shows that he's fighting something, so more blood cultures were ordered. On Friday, his blood count was only slightly "shifted," and those blood cultures haven't grown anything.

After doing fairly well on Sunday, he had a big Brady/Apnea episode during the early afternoon and was clearly struggling to breathe during our afternoon visit. We arrived right after the episode, and spent the whole visit rubbing his back or annoying him in other ways to make him breathe.

During the dinner break, we got one of the dreaded calls from the NICU. He had had his worst Brady yet and had to receive chest compressions to get his heart rate back up this time. His lungs were also bagged during this episode, which lasted a few minutes, to keep him breathing. Knowing that adults don't receive CPR unless their hearts have stopped altogether, I assumed this is what happened, but we later learned that preemies get chest compressions when their heart rates drop below 60. Truman got into the 30s during this episode. Thinking his heart had stopped was a very scary time. He also got a shot of epinephren during this episode, so his heart rate was very high when we arrived at the hospital soon after.

He was re-intubated during this episode. He's back on the conventional ventilator and was completely "riding the vent" (letting it do all the work) last night, which is actually a good thing because he is so exhausted from trying to fight this infection and breathe at the same time that he really needs to rest. Preemies just don't have the energy reserves that the rest of us do. During the episode his O2 saturation dropped to the 30-percent range as well, and he had been fighting low oxygen saturation and episodes of stopped breathing all day.

The docs and nurses think he just got too tired trying to fight an infection and breathe. He was awfully small to be on the C-PAP anyway, and we had been told most preemies fail the first time they are extubated. He just took a long time to do so. We still wonder whether he could have continued doing well on it if he had not gotten sick.

During the night, he's had trouble with low blood pressure, so he's back on Dopamine this morning. He also had a blood transfusion this morning. They ordered more blood cultures because they think the infection is bacterial, but neither of the first two cultures have grown anything. He's been put on three broad-spectrum antibiotics in the hopes that one will do something. They were doing some blood tests this morning to see the "peaks and troughs" on the antibiotics to tell whether they are at the right amount and whether they are doing anything for him.

Before yesterday's episode he was down to one IV, but overnight last night he had another IV put back in as well as an arterial line, so he has only one free limb now.

Breast milk feeds were also stopped yesterday while he recovers from this illness. They don't want him to start rejecting milk just because he's sick, and Dopamine makes it hard to digest things.

I guess there's a reason they call it the NICU roller coaster.

--Kara