A Rollercoaster Week: Day 2 – Re-Intubation

Monday, November 5, 2007

The next day, doctors and nurses monitored Caroline closely. To monitor a child who is intubated (when a breathing tube is placed through the mouth to keep the child breathing), the doctors keep a close eye on her blood/gas test results. They get these results by taking a little bit of her blood every so often to check the amount of oxygen, CO2, and other gases in her blood. (She’s always hooked up to monitors that give them a general idea, but the blood tests are more accurate.) As the numbers look better, they allow her to breathe more and more on her own, and when she seems ready to take over breathing completely, they pull the tube out.

So, her blood/gas test results stayed strong throughout the day, and she was breathing more easily. She also remained somewhat sedated (standard operating procedure for an intubated kid because the tube usually bothers them so much otherwise). During the day, her pulmonologist (lung doctor) evaluated her. We asked him about the trach issue from yesterday. He said he wasn’t positive Caro needed a trach. He said that it may be something we need to look at in the future but not during this hospitalization, unless, for some reason, we couldn’t get her off the vent.

That night, the attending doctor (a different one from the night before) told us that they thought they could extubate (take the tube out) her that night. We approved and watched as the nurses and doctors again took the tube out. She only went for about a minute before her skin color and her monitors made it clear she needed to be re-intubated.

We were baffled and hopeless. What could be causing her all of these problems? When we brought her in, she wasn’t even close to requiring ventilation. The attending doctor said (and this was later confirmed) that he believed the vent tubes irritated her throat to the point where it was extremely swollen. Because her airway is already weak, this causes severe blockage. He said he’d work out a plan of action with the ENT (ear, nose, and throat) doctor and the pulmonologist.

On a positive note, her cardiologist came in to check on her again, and her ASD remained nice and closed, so at least the procedure was a success (a fact that was difficult to remember…strike that…was completely ignored that night).

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