running to stand still

We woke up knowing that it was going to be a big day but not quite knowing how it would unfold. We called the NICU around 9 a.m. to flesh out the approach and find out when they would extubate. The plan was to extubate to SNIPPV (synchronized nasal intermittent positive pressure ventilation -- basically a ventilator through the nose and without a tube) and hope that Calder would transition successfully. While we had a lot of hope, we didn't think that his chances were very good. As a backup plan, if Calder weren't doing well on the new vent arrangement we would administer Decadron with the hope of keeping him extubated.

Taryn and I arrived at the hospital around 1 p.m. thinking that the procedure would be done (we try to avoid peering over the doctors' shoulders when they're "at work.") Although the nurses and doctors were gearing up for the procedure the attempt had not yet been made so we went to lunch; when we returned Calder had been moved to SNIPPV... he was also on 100% oxygen. This means that when he struggled to breathe, he was already at the highest setting and thus had nowhere to go. The nurses reassured us that he would need a while to adjust, but he would, so Taryn and I settled in to giving words of encouragement and inspecting the getup that was SNIPPV.  Essentially it's the same ventilator machine but with a nose cone, which is velcroed to Calder's head. So that the velcro has a place to stick, they put  him in a stocking cap, turning him into a mix between a fighter pilot and a swimmer. The tension on the mask is so tight (to get a good seal) that Calder's eyes are squinched shut. All in all it was quite the getup. After about two hours sitting at maximum oxygen and continuing to desat, the doctors were sure that he would need the Decadron to get off the vent. After all of the anguish deciding about whether or not we should do it, it became pretty obvious that we didn't have much of a choice. The nurse administered the drug and Taryn and I went home to wait.

By 6 p.m. we were feeling fairly good that the doctor hadn't called to tell us he was reintubated; 30 minutes later the doctor called and told us he was reintubated.

From here we wait for the Decadron to do its thing (reduce the inflammation in his lungs and throat), let Calder build his strength back up, try to wean his pressures over the coming week, and then extubate successfully on the next go. Calder gets most of the heavy lifting but his cheerleaders (and fashion fan club) plan to have a nice supporting role. It's been an emotional week, but in some ways having made the decision about the drug has taken at least a little bit off our plate.