Extubated….finally

April 21, 2016

ICU Day 4

Den got another round of breathing treatments at 1AM. Thankfully, they don’t have to wake him for them if he is sleeping. The respiratory therapist can just send the meds through the ventilator.

Den woke up at 2AM. He couldn’t sleep and needed something to do. I sat next to him, held his hand and did my best to keep him calm and distracted with movies and the TV. When the nurse came in around 4AM she removed the cooling blanket and machine from the bed and room….another item gone! Den’s stats were looking very good and he got some more chest x-rays.

Just before 6AM the nurse came in and asked Den if he would like to sit up a little. He excitedly nodded yes. I wondered how she was going to accomplish this feat with him connected to so many machines and monitors. I was amazed when she pressed a button on the bed and the whole thing lifted up and put Den in a sitting position with his feet down…kinda like a recliner! Den started doing his leg exercises almost immediately! He was very happy. The only sore spot for him was that the ET was starting to irritate his tongue and lips. The nurse showed me how to move the tube side to side without pulling on it, so I could give Den some relief from time to time.  After about an hour the bed was put back down and Den napped for a bit.

At 745AM, Dr. Hart came in to see Den. He ordered the NG feeding to be held so they could safely extubate Den…this ensured that Den would not aspirate anything into his lungs when the tube was removed.  Less than and hour later…the ET was removed! The doctors asked if I had Den’s Bi-Pap with me. I told them it was in the car and I would go get it. They wanted Den to go directly to a nose only mask on his machine, but he was breathing well on his own and the nasal mask was very uncomfortable. So the doctor said as long as his breathing continued to improve he could just go with out it for now. But if he had any kind of problems to use his machine and let the nurse know. They also removed Den’s wrist restraints.

The NG tube had to stay for the time being. Den was not cleared to eat or drink anything yet. He was still getting all his pills and nourishment thru the NG until they were certain his throat was undamaged and he could swallow without problems. The good news is that he can talk to me again! No more 20 questions! No more pounding on the bed to get my attention! This is a major step forward! Den was able to cough up mucus and suction his own mouth. He was also given a resperometer. This is a device that helps you improve your lung capacity before and after surgery. Den was at 250 on this device and the goal was to get to 1000 before moving to the step down unit.  They did need to put give Den supplemental oxygen for a while. But it was only with a nasal canula, the tubing that they put against your nose.

Dr. Sayer stopped in again….everything is going well and Den’s stats and blood work look good.

Physical Therapy came by to get Den up and moving. They told Den his rules for moving around every time they worked with him….No pushing, pulling or lifting with his arms for 6-10 weeks. They got him sitting up on the side of the bed and helped him stand for the first time since surgery. He even took a few steps to the chair. He was so happy to be in a chair and not the bed. He asked if he could stay there for a while, since he was exhausted from the short walk from the bed to the chair…maybe 3 steps.

Dr Uriel and Dr Sayer came back with the plan for the day. The diuretic therapy would be started again, the Foley could come out tomorrow, and moving forward they would start removing lines and tubes one at a time. Steady progress was the key, not speed at this point. The pneumonia was starting to clear, but they would continue the antibiotics and breathing treatments. Dr Sayer came back a short while later. The diuretic would be held until tomorrow and he wanted some readings from the monitors when Den was back in bed (which was about an hour later).

The nurses and I noticed a marked weakness on Den’s right side. He was having trouble holding anything in his right hand and could barely lift his right leg when sitting. The possibility of a stroke was hard to take, but we didn’t say anything to Den yet. The nurse did call the doctors, who would call for an assessment of the possibility of a stroke.

When Den was finally back in bed, he started having trouble breathing. He was very congested and couldn’t seem to cough anything up or take a deep breath. He again tried the nasal mask that the doctors wanted him to use, but he couldn’t tolerate it. The nurses tried to suction his airway, but the mucus was too thick. They let him switch over to his full face mask on his Bi-Pap. He felt some improvement after just a few minutes. And when we remembered to turn off the humidifier on his machine, he felt even better.

They stopped Den’s insulin IV when his blood sugar reached 90. He was instructed by the respiratory therapist to do his breathing exercises during commercials while we were watching TV…10 times at every commercial break. This would ensure his lungs continued to clear and the pneumonia would not get worse.

The only worrying thing today, other than the possibility of Den having had a stoke, was that his urine was VERY dark.

We settled in for the night and tried to sleep again.