7/21 8:15am CT: Abby had a decent night. Her fever broke shortly after my update last night and lots of other things settled out along with it. She was able to get some rest and is on track to be extubated sometime today. Despite her history, it is still considered best to remove the breathing tube sooner rather than later due to complications that can arise from being intubated for extended periods of time. It also means that she can be less sedated, which would be great at this point since it is requiring so much medication to keep her still. They will extubate to CPAP, so she will still be getting support, but noninvasively. We'll see how today goes and I will update again this evening.
7/21 8:30pm CT: It hasn't been a horrible day, but it hasn't really gone as hoped either. It seems as though all of the meds that Abby fought off so valiantly yesterday finally caught up with her and she was zonked the entire day. While she got some good rest, it meant that she could not be extubated. She needs to be awake and alert in order to cough up any remaining post-op secretions in her lungs (while intubated they can suction them manually) and give her airway a chance to reacclimate itself to being free of the tube. Luckily, because she was so out of it, she's been off of sedation meds all day. If she wakes up enough overnight, they may decide to extubate then, since the ICU attending on tonight is also a CV anesthesiologist and prepared to deal with any mischief she may pose, but it may also be put off until tomorrow. Her temp has fluctuated quite a bit throughout the day, so they're running a bunch of labs to make sure there isn't an infection brewing somewhere. So again, not perfect, but not horrible. Hoping that the night is either super productive or totally uneventful! No mischief!!!
7/22 7:20am CT: Last night went well overall! They decided to extubate her to CPAP around 11pm and she's done great with it! She has had some atelectasis of her left lung, so they might be doing some breathing treatments today to keep that from getting worse. Her temp looks good again, so hopefully it stays that way this time. She's been doing a good bit of retching and vomiting up bile, so they've given her some Zofran to help keep that under control. She hasn't had any food yet, but we're going to start her off on feeds slowly today and see how she does!
7/22 9:00pm CT: Another day that was good overall with a few bumps here and there. Abby is doing well extubated. She was on CPAP for about half the day, and then on a little bit of oxygen support via cannula for the other half. She started to show signs of discomfort late in the day, so we put her back on the CPAP to let her rest. She's still been pretty sleepy, but is at least waking up for short periods now and reacting when people mess with her. PT came in and got her muscles moving a little bit, and we were able to start her feeds up today. She's actually tolerating her feeds pretty well so far. She isn't on anything close to her home regimen, but we're really happy with her progress on that front. Things we're less happy with: there is still quite a bit of fluid coming out of one of her chest tubes. It might be fine, but they're keeping an eye on it to make sure she isn't developing a lymphatic issue like chylothorax. Also, she is producing almost no urine. Some of this might be a side effect of all of the meds she was on, some of it might be because she's dumping a lot of fluid from that chest tube, but no one's sure. There are a lot of labs in the works, so hopefully we'll have some answers to these questions in the morning. I think the goal for the night is just to continue her feeds and lay low. Praying all goes smoothly.
7/23 7:25am CT: Not much to report about last night, no real changes. Breathing over the CPAP was good. She did ok with her breathing treatments and feed. Urine and chest tube fluid are still a concern and will probably be the main focus today. She seems a little more alert and was even snuggling her lovies overnight, so hopefully she's starting to get back to being a bit more like herself!
7/23 8:40pm CT: Our days seem to have established a distinct pattern of up and downage.
Ups: Abby's oxygen saturations have continued to be great - she was on room air for a good six hours today with no issues. Yay! Feeds are also going well. We actually started her back on her blended diet today (pushed waaaaay slower than usual, but still awesome). The amount of fluid draining from her chest tubes decreased today, which is great. They were able to pull her arterial and central lines, leaving her with only two peripheral IVs.
Downs: Her temp is still creeping up to fever status occasionally and then slowly going back down. She's having terrible diarrhea today, so we can't even tell if she's peeing, but they don't want to keep cathing her. Because of this, they had to start IV fluids back up to keep her from becoming dehydrated. Her respiratory rate was also a little high today. So far, her labs have looked ok, but they are still keeping a close eye on things to make sure none of these little issues becomes a big issue.
She was a little more engaged today, but still clearly feels pretty puny and tired. Praying that her labs continue to come back looking ok, and that she starts feeling less crummy.