Woke up early to be there for his 4th intubated CPAP trial.

Got to the PICU,   cpap trial starred about 10 minutes ago.

He’s doing good!

Sounds like he had a good night!

IV line installed.  Getting fluids, he has not been getting fed since about 0300. Due to the risk of regurgitation and aspiration when the ET tube is pulled. The Dr. has seen it cause babies to pass away…. obviously better to let him be hungrier for several hours!

30% oxygen for stability. Ventilator likes to auto cycle due to his massive leak around his ET tube. When it auto cycles it doesn’t really give a good breath.

After about 2 hours we put him back to nava mode.

The respiratory therapist that was here yesterday that we know from the NICU is coming up to help with the extubation!

I’m glad we are having an extra set of hands!

They prep everything for extubation set up the high flow nasal cannula.

They are going to start him on a flow of 8 liters per minute and 30% oxygen.

If they have to they can go up on oxygen or flow uo to 12 liters per minute for RT’s size.

They also prepare for re-intubation, if need be, same size ET tube,  but cuffed to stop his leak.

Eventally everything is ready,  the Respiratory therapist from yesterday takes the lead,  today’s respiratory therapist assists with everything.

They rotate RT 90 degrees so his head is near the edge of the bed so that if he needs to be reintubated it is set up to the correct position. They undress his chest sof they can see how hard he is working to breathe.  If he is working hard its easily observed by chest retraction.

The doctor helps to hold RT steady, takes a listen to his breathing with a stethoscope, the respiratory therapist makes one last suction pass, then they remove the tape,

1215 The respiratory therapist pulls the ET tube out,  suctions his mouth and they put his nasal cannula mustache on.

Flow of 8 LPM(liters per minute)  30% oxygen.

RTs heart rate dips into the 70’s briefly but he comes back up.

His spo2 goes to about 50, then comes back up.

Good boy,  he already looks more relaxed with the tape and tube not down his throat!

They keep him sideways in the bed for about 45 minutes.

Mom gives him a finger to hold on to,  he immediately pulls it directly into his mouth and starts sucking on it!  Good boy! Makes mom get teary eyed with happiness.

His respiration is nice and low,  heart rate in a good range and he is satting well (spo2 at a good number.)

After about an hour and a half they decide his flow can come down to 6LPM oxygen down to 25%!

Xray ordered,  it arrives around 3pm, xray actually looks pretty good!

RT is rocking it.

A primary nurse from nicu comes to visit and sees RT on high flow,  so much excitement!

A respiraroty therapist from NICU, comes and checks on us.

Lunch.

Cares, just pee.  Just mom and I do the care,  diaper and temp.  Goes good!

I would say, he is acting more stable on this than intubated.  Much happier too!

Hang out,  time for a blood gas before the next set of cares, blood gas is awesome!  Co2 is lower than when he was intubated! Potassium was a little high, likely because he is on a potassium sparing diuretic, IV fluid had potassium, and it’s in his multivitamin.

Feeds restarted,  IV fluids stopped.

Mom’s turn to hold him!  She holds him swaddled, with this high flow nasal cannula transfers are a little easier! They allow us to hold more frequently now that he is on nasal cannula.

He is doing so good that they decide to wean his ltiers per minute to 5. Oxygen. Up to 30%.

NICU discharge coordinator comes to visit!

They are weaning pretty quick! Slightly anxious about it.  But he is one tough guy!

Dinner time after the hold.

Shift change, nurse we have not met yet.

Hang out.

Time for cares.

He didn’t sleep much at all today,  he is one awake little baby!

Throughout the day rather frequently when he moves he knocks the prongs out of his nose, mom and I are quick to respond.

Hopefully it is not an issue when we are not here!

The nurses seem attentive to all of the alarms.

Unfortunately there is no alarm for it coming out of his nose…

Just an alarm if he desats after having it out for a bit.

It is difficult to leave. But he will be ok!  If anything he seems more stable now that he is extubated! Hopefully the prongs stay in!

Only 2 patients in the PICU right now,  they should be able to take good care of him!

Glad we have so many NICU friends that come to visit!

Love you so much buddy!

We will put up photos tomorrow!