Saturday, December 8, 2007
ICU Update 8 Dec
The end of week two finds Andrea stable. I feel she is improving but it is at a snails pace. Dr D&G came by this morning for his daily "No change" speech.
When I came in this morning Andrea was resting and when she is relaxed or sleeping her lung pressure is improved. Right now it is between 27-31. The lowest we have had up to today was 31. When I came in it was between 24-27 for about 30-45 minutes with a few readings in around 31. I take that as an improvement. When she is awake and "talking" her pressure goes up to 38-41. But all day the volume of air she is taking in has increased. Her volume of air has been steady all day at 250, it was 190 yesterday morning and hit 200 by the end of yesterday. The volume the machine is set at is 190 so she is already pulling more air then the vent is providing. Her breathing rate is about 34 resting and around 38-40 awake. That is still a little high. We want to see that rate around 20.
Okay for my 2 weeks of pulmonary training I would say those are all improvements. Slightly slower breathing rate, more volume and the same or lower pressure. This has to mean there is more room in her lungs or they are more flexible. I will tell you when she is awake or moves it maxs out her lungs.
The other good news is she is definitely stronger. She pulled herself up holding on to Nic's hand and she can move her arms and legs. I will also tell you there is a marked improvement. Before, she was unable squeeze the straw and pull it from her mouth and yesterday when she did it three times. Today her hands are a little stronger as well.
She has not had any meds that make her sleepy today so when she is awake she is very alert and smiling, big smiles in fact. That always melts away the pressure.
YEAHHHHH Andrea just hit 19 on the lung pressure machine. She had been hitting 20 and the boys and I were rooting her on as see slept to hit sub 20 for the first time in 2 weeks!!!! Now she is holding around 20-21 when I started writing she was at 27-31. Come on Lord....heal those lungs. If she can get to sub 20s in her sleep and hold mid 30s awake they can adjust the vent and increase the volume. That will be a sign of healing and help us decide about the trach option. If she keeps this pace up she should be steady in the sub 20s sleeping tomorrow. Okay she just woke up and now she is in the 32-35 range.
This is pretty much what we do all day in this room. Stare at the vent machine and wait for the numbers to improve.
Anyway, I still think she is getting better but the question is at this pace how long would she have to keep the vent in. If the pace is too slow and she would need a week or more then we will lean towards moving the vent to the trach. If the pace picks up and we think she will be off in a week or less then we stay how we are.
I think Dr D&G plans on the trach, because he has little hope and always thinks the worst.
These days are just up and down, but the slope is upward. Maybe only a 1 degree up slope up still towards the better.
Posted by Jim Ravella