The word of the day is ... extubate

After a somewhat unstable Tuesday and Wednesday, today, Jonathan appeared much better.

On Tuesday and Wednesday, his oxygen sats and blood pressure were all over the place.  When they tried to improve one, it fiddled with the other, so the doctors spent a lot of time trying to find the right balance.  They found he was very sensitive to adrenaline - which they used to bring his blood pressure and saturations up - but even the slightest whiff of it caused him to go from one end of the scale to the other.  

To complicate things further, when he started to wake up, he was wriggling around trying to pull all the tubes out, and then tried to cry - something he's unable to do while he's got the ventilator tube down his throat, which seemed to make him even more upset!  And then all of that commotion set off his saturation and blood pressure alarms too - so in the end, they said they needed to sedate him more and upped his morphine and clonidine, and when that wasn't enough, gave him some vecuronium which seemed to do the trick.  They also swapped the adrenaline to dopamine and dobutamine instead, and that seemed to help stablise him a bit further.

The physios were also called in to work on him to loosen the gunk in his right lung (they call it secretions), but during his treatment, he managed to dislodge his ventilation tube and cause his oxygen sats to plummet.  When that happened, the nurse looking after him ran to the other side of the room and pressed a big red button which sounded the crash alarm (complete with flashing lights - it reminded me of a fire drill) and within 3 seconds, about 10 doctors rushed in (where were they hiding?) and we got ushered out.  After a few minutes, they managed to reposition the tube and Jonathan seemed OK ... but his parents are still recovering from the scare.

When we went in this morning to see him (Thursday), they said he'd had a really stable night which was a great relief - his blood pressure and saturations were stable, and they were able to take him completely off the heart meds.  The only thing left to do now was to take him off the ventilator - but instead of just saying that, they talked a lot about "extubating" him.  Not knowing what "extubating" meant at the time, we were a bit worried about Jonathan having to go through some other invasive procedure ... but when it clicked that extubating just means to take a tube out (why didn't they say that in the first place), it all made sense (and we also found out that the opposite of extubate is intubate).

The ventilator he's using is a very nifty piece of equipment (and for some reason it's named Stephanie) - it ensures that he gets enough air, supports his own breathing, and lets him breathe more if he wants, and it also has a bunch of sensors so that the doctors and nurses can see exactly what his little lungs are doing.  The machine was giving all the right readings to indicate that Jonathan can breathe on his own, so they decided to extubate him around lunchtime today.  They sent us out of the room for this because it can be a bit uncomfortable to watch ...

But as with most things with Jonathan, it didn't go exactly according to plan.  They were able to get the tube out fine, but he wasn't too interested in breathing on his own.  They told us he did a bit of gasping, so they tried him on CPAP (which is a step down from a ventilator) but he didn't like that either.  They also but him on a nebuliser and gave him some other medication to try and open up his airways, but it didn't really help.  Eventually, he had to be intubated again - so for next few days, they're going to let him stay on the ventilator.  We were told at the end of the day that they think it's probably an inflammation of the throat that caused today's breathing problems (as opposed to a problem with the lungs), which can often happen when a baby needs to have tubes inserted quickly in emergencies.

They're still trying to figure out what caused the whole catastophe on Sunday night - the best explanation so far is a chest infection, so they're pumping him full of antibiotics to be on the safe side.  Some samples that were sent away to the lab came back indicating there was an infection - but they said infections usually don't cause babies to react in the way Jonathan did.  So, they're still scratching their heads over that one.

They're sending him down for an MRI tomorrow mainly to see if there was any damage caused when his heart stopped, and also to re-scan his brain as they're not totally in agreement with GOSH's assessment of his hydrocephalus ... so hopefully we'll have news on that soon.

Anyway, to sum it all up - Jonathan's much more stable today, but still in NICU.  His irregular heart is doing its thing and pumping enough blood around his body, and he should be off the ventilator in a few days time.  He also got his hair washed twice in two days so it's nice and fluffy and no longer smells of salt and vinegar and dirty socks...

And thanks everyone for your prayers and support over the last few days - it's made a huge difference!