Wednesday, May 18, 2016
May 18, 2016
It's been several days since our last update. Zeke has been extremely up and down, and it's been hard to know really what to say.
Apparently, over the weekend, he had been having increasing issues with his lungs and oxygenation. His right lung had collapsed again, and due to this, his left lung was working harder than normal to make up for the right, and was overinflated.
When I came in on Monday around noon, they had just switched out the dialysis pump. During pump change, his O2 saturation dropped to 40% and wouldn't come back up, so they had to bag him. I was so thankful that I had missed that. Due to the sudden drop in oxygen, they did a chest xray, which showed that his left lung had collapsed. This was the first time for the left - before Monday, it had always been his right lung that had the issues. At this point, his ventilator settings were fairly high - he was getting 100% oxygen, with a rate of 80 resp/min, and the pressure was fairly high as well. Even with these vent settings, he wasn't oxygenating well, and his O2 sat was in the low-mid 80's.
I had a less than pleasant conversation with the neonatologist during rounds that morning. Zeke's lungs are severely scarred from the ventilators (a condition called PIE - Pulmonary Interstitial Emphysema). Due to the scarring, they're not sure if he'll ever be able to breathe on his own. They also said that because of everything he's got going on in his abdomen (the intestinal issues/colostomy, infections, fluid build up, etc...) he'd likely have scarring that would prevent them from being able to do peritoneal dialysis. He said that the prognosis was not good, and there was maybe a 1% chance he'd recover and ever be able to come home.
Monday night, they had several issues with the dialysis pump and the pressure in the catheters. It took quite a while to get everything sorted out and working again, and he had a rough night. He gained 300g (10.6oz) overnight, due to the dialysis not pulling extra fluid off. He did tolerate fluid change that night extremely well, though, which is rare for him. Usually his blood pressure will crash for a while, and that didn't happen.
Due to the issues with the dialysis pump Monday night, his heart rate was extremely high (190-210bpm), and his blood pressure was fairly low (high 20's/low 30's), so they decided to put his dialysis at +5 for the day. He spent most of the day getting 100% oxygen, with the same high vent settings. He was getting fairly agitated, acting like he was in pain, which was causing his heart rate to go up, and causing him not to oxygenate well, so they gave him a couple of extra doses of fentanyl. This helped lower his heart rate, and bring his O2 sats and BP back up. His temp was higher than normal, so they turned off his heating pad, and he seemed to do fine.
I left for a few hours in the evening, and when I came back, things had changed a bit, for the better. He had done well with fluid change - his blood pressure dropped to the 40's, but came back up to mid-60's fairly quickly, without a change in pb meds. His heart rate had dropped to 150-160's, and he was satting in the 90's.
2990g (6lb 9.5oz)
3280g (7lb 3.7oz)