Lung Fluid
- This morning's chest Xray showed another increase in the fluid both at the base and the top of Bob's right lung. They pulled another sterile sputum specimen to culture for bacteria. He has had no spike in fever (still having a steady reactive fever at 38.3C/101F) so they really do not think it is pneumonia. They're pretty sure it is third-spacing fluid that is still lingering in the lung, and since he is already on high amounts of antibiotics, they're not going to change anything unless the sputum culture grows bacteria.
Third-Spacing Fluids
- They gave him another round of diuretics (Lasix) today to try to remove more of the excess retained fluids. Along with the increased fluid in his lung, it is also still present in his abdomen and lower body, especially his calves and feet. If there isn't enough reduction in the chest fluid tomorrow after today's diuretic, they will run another course of the Albumin protein to try to pull some fluid back into the capillaries.
Extubation Attempts
- Tried two different spontaneous breathing trials today with the goal of weaning off the ventilator. First attempt in the morning led to almost immediate de-sats (drops in adequate oxygenation) and after a few minutes they reinstated the vent back to 35% forced air.
- During the second attempt in the afternoon, they moved him from forced air to pressure support only, and he did pretty well until this evening, when he began to have insufficient tidal volumes as pain began to increase. So they are putting him back on forced air tonight (35%) and will start over the trials again in the morning.
- This morning's chest Xray showed another increase in the fluid both at the base and the top of Bob's right lung. They pulled another sterile sputum specimen to culture for bacteria. He has had no spike in fever (still having a steady reactive fever at 38.3C/101F) so they really do not think it is pneumonia. They're pretty sure it is third-spacing fluid that is still lingering in the lung, and since he is already on high amounts of antibiotics, they're not going to change anything unless the sputum culture grows bacteria.
Third-Spacing Fluids
- They gave him another round of diuretics (Lasix) today to try to remove more of the excess retained fluids. Along with the increased fluid in his lung, it is also still present in his abdomen and lower body, especially his calves and feet. If there isn't enough reduction in the chest fluid tomorrow after today's diuretic, they will run another course of the Albumin protein to try to pull some fluid back into the capillaries.
Extubation Attempts
- Tried two different spontaneous breathing trials today with the goal of weaning off the ventilator. First attempt in the morning led to almost immediate de-sats (drops in adequate oxygenation) and after a few minutes they reinstated the vent back to 35% forced air.
- During the second attempt in the afternoon, they moved him from forced air to pressure support only, and he did pretty well until this evening, when he began to have insufficient tidal volumes as pain began to increase. So they are putting him back on forced air tonight (35%) and will start over the trials again in the morning.
Wound-Vac Dressing Change
- Today was Bob's first wound-vac sponge change that hasn't happened while he was unconscious in the OR. Watching him experience that pain was indescribable. They finally added back his sedative IV drip (Versed) because his abdominal spasms wouldn't stop after the sponge dressing was removed and replaced. This vac-dressing will be changed every Mon, Wed & Fri, and it will take several weeks for his body to re-grow tissue and close the wound. (The wound itself measures 8" long x 3" wide x 1.5" deep. They refer to it as a defect. It's going to take a good while for his abdominal muscles to be covered and no longer exposed.)
Future Health Care
There were a few discussions with me today about the path Bob's care will take once he leaves the ICU. He will likely go to a long-term hospital first (like Kindred) and then move to a skilled nursing facility/inpatient rehabilitation hospital (like Sea Pines) after. They've advised me his brain will have to relearn to coordinate his body's muscles, since he has been immobile and under duress (high fevers, blood infection, multiple operations) for this extended period. Some of the initial goals will be:
* Transitioning from IV nutrition (TPN) to slow-trickle tube feedings through the NG tube, then to full meal feedings via the NG, and then finally to oral ingestion. This transition process could take up to 2 weeks, and might even include him having to relearn how to swallow.
* Strengthening atrophied muscles with physical and occupational therapy. This doesn't just include gross motor skills like sitting up, standing or walking, it starts with him becoming strong enough to simply hold a pencil, or move a utensil from a plate to his mouth, etc. Right now he struggles to lift up and hold his head from the pillow for more than a minute at a time. Small steps, but at least he's heading in the right direction.
* Improving pain management: Once Bob's at an inpatient rehab facility, he'll have to be able to take oral pain medications that will last longer periods of time (4 to 6 hours). This morning, his IV pain meds were decreased ever so slightly (Fentanyl drip went down from 250 to 200). But the more awake and less sedated Bob becomes, the more pain he feels. So today they had to return to supplementing the Fentanyl with Dilaudid once an hour, which is a short-term control and can't be a long-term solution.
- Today was Bob's first wound-vac sponge change that hasn't happened while he was unconscious in the OR. Watching him experience that pain was indescribable. They finally added back his sedative IV drip (Versed) because his abdominal spasms wouldn't stop after the sponge dressing was removed and replaced. This vac-dressing will be changed every Mon, Wed & Fri, and it will take several weeks for his body to re-grow tissue and close the wound. (The wound itself measures 8" long x 3" wide x 1.5" deep. They refer to it as a defect. It's going to take a good while for his abdominal muscles to be covered and no longer exposed.)
Future Health Care
There were a few discussions with me today about the path Bob's care will take once he leaves the ICU. He will likely go to a long-term hospital first (like Kindred) and then move to a skilled nursing facility/inpatient rehabilitation hospital (like Sea Pines) after. They've advised me his brain will have to relearn to coordinate his body's muscles, since he has been immobile and under duress (high fevers, blood infection, multiple operations) for this extended period. Some of the initial goals will be:
* Transitioning from IV nutrition (TPN) to slow-trickle tube feedings through the NG tube, then to full meal feedings via the NG, and then finally to oral ingestion. This transition process could take up to 2 weeks, and might even include him having to relearn how to swallow.
* Strengthening atrophied muscles with physical and occupational therapy. This doesn't just include gross motor skills like sitting up, standing or walking, it starts with him becoming strong enough to simply hold a pencil, or move a utensil from a plate to his mouth, etc. Right now he struggles to lift up and hold his head from the pillow for more than a minute at a time. Small steps, but at least he's heading in the right direction.
* Improving pain management: Once Bob's at an inpatient rehab facility, he'll have to be able to take oral pain medications that will last longer periods of time (4 to 6 hours). This morning, his IV pain meds were decreased ever so slightly (Fentanyl drip went down from 250 to 200). But the more awake and less sedated Bob becomes, the more pain he feels. So today they had to return to supplementing the Fentanyl with Dilaudid once an hour, which is a short-term control and can't be a long-term solution.
It's so relieving that Bob is able to open his eyes
and look at us again when we talk to him.
and look at us again when we talk to him.
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