Shout out to my PEEPs

We, the parents, have been trying to be patient post surgery with our expectations for Calder's improvement. Apparently we are the product of the 30-second news cycle because we hate waiting. Calder rewarded our suffering by going down on his ventilator settings for the first time in three weeks. Prior to surgery his PEEP was at 17 and his respiratory rate was at 55. Thursday (surgery +3) they were able to bring his respiratory rate down to 50.  On Sunday morning Calder made his first progress by going down to 16.  We left from our morning visit and returned in the afternoon to be greeted by yet another reduction in settings. The little man was rocking a PEEP of 15.

While they are reducing his settings they are also weening him off of his fentanyl, which they started him on about a week after birth to calm him down because he didn't like the tube in his throat. Apparently, opiates are not an easy habit to kick so Calder tends to squirm a bit now.

The doctors have a goal of extubating Calder by the end of this week or next but they need his PEEP to get down to at least 12 for him to have a shot at it. Our impatience isn't unfounded. The ventilator damages his lungs because, as a preemie, parts of his lungs are mature and supple and other alveoli  are immature and stiff. The ventilator can't discriminate and simply inflates his entire lungs to the set pressure. Since each little alveoli is expanding at a different rate, some don't expand at all and some are over-expanded, leading to chronic lung disease (CLD). Since the severity of CLD increases the longer he is on the vent, the doctors will eventually reach a point where they determine that the ventilator is doing more harm than good. To prevent that scenario from persisting, they will then probably use Decadron, a steroid that works miracles on the lungs but which can lead to horrible side effects, brain damage among them.  Now that Calder's come down 2 PEEPs in a day its tough to revert back to being patient. Maybe we can get 1 a day.