A Scary Night... Re-Intubated

Tonight was scary.  Please keep Owen in your prayers.

Owen has been very groggy today.  His blood gas levels were great and he was ready to extubate at around 4pm.  He was tired most of the day and had heavy eyes.  We tried to get him moving a little and coughing up the secretions in his chest, but he was too out of it.  He communicated with us all day with his raspy post ventilator voice, it was heartbreaking and very sweet.  He sucked on a sponge to hydrate his little mouth and we read a few books together.  Respiratory therapists had to suction him a few times and help him get rid of the secretions that he was unable to cough up. 

As we were getting ready to head back to the RMH to get some much needed sleep, Owen's sats dropped a little and his blood gas came back with lower PO2.  PO2 is the level they look at that measures the levels of oxygen in his blood.   The RT did a suction before we left and things were looking better and he was resting comfortably. 

We got back to the RMH and I was asleep before my head hit the pillow.  At 10:30, Owen's nurse called to tell me his blood gases looked perfect and it was just what I needed to hear to rest my head and get a decent night sleep.

The phone rang at 11:15pm and it was the charge nurse.. she said that Owen's oxygen was dropping into the low 80s and they were reintubating him stat.  I rushed back to the CVICU to find a bunch of doctors surrounding my boy and I broke down in tears.  Doctors came out one by one to update me, but I just imagined Mr Owen being so scared and I wasn't there.  I am always there!! 

They let me in right away and he was sedated and had a little paralytic.  His PO2 levels were lower than before and the chest xray had come back with the right lung looking hazy.  The surgeon came in and checked his chest tubes and did an ultrasound of the lung and said it's not fluid, but a collapsed right lung.  This is new for us, but not uncommon.

Owen's lungs are used to a totally different circulation.  With his HLHS heart, he had the right ventricle of his heart pumping blood to his body, while the lungs received less oxygenated blood.  This is why his 70% oxygen saturations were acceptable with his old heart.  Now his body is adjusting to a new heart and his lungs are getting an adequate amount of blood flow.

When the lungs fill up with blood it prevents the air from getting in and expanding the lung, causing it to collapse like a deflated balloon.  So Owen's lungs are getting more blood flow and his right lung just need to reinflate with air.  Does that make sense?  It's almost 2am and I'm running on 4 hours of sleep in the last 48 hours.. bear with me. 

The solution....  Owen is back on the ventilator.  We have him laying on his left side so that gravity will drain any blood/secretions out of the right lung.  The RT is suctioning him often to get the gunk out so that the air can get into his lung and get it inflated again.  We started Albuterol and Mucomyst to help expand the lungs and break up secretions as well.  The vent settings are forcing air into his lung and allowing his body the rest it needs. 

The good news is that his left lung looks wonderful, he has no fluid buildup around his heart or lungs and his chest tube output (drainage) isn't significant.  His heart is beautiful and working hard.  It's just one setback.  I just wish it didn't happen as soon as I left the hospital.  Now I am a hot mess. 

We decided to keep him off the Fentanyl drip for now and we will just give him Morphin or Versed as needed to keep him comfortable with the breathing tube and lung treatments.  Owen hasn't been in much pain since he left the OR and hasn't had any morphine since last night (the night he came out of the OR).  We have been managing his pain with only Tylenol.  All day long I asked him.. "are you sure you aren't in pain?  Do you feel okay?  Any ouchies?" and he said he was fine and was really comfortable.  Tylenol.  A day after having major open heart surgery and his pain med of choice is Tylenol.  INCREDIBLE!!!  He still doesn't have any morphine in his system and he looks peaceful and pain free. 

Owen is resting peacefully.  It's been almost 3 hours since intubation and he looks great.  All his blood gasses are coming back good, his sats are back up to 100%, and his vent settings are being slowly decreased. 

Please keep Owen in your prayers.  I am still deciding if I should go get a few hours of rest.  I need to take care of me so I can be here for him.  Until tomorrow....