Tuesday, November 11, 2008

ARDS kiddo Part 1

( I apologize for my technicality in this entry.. )

I was not able to rest properly on early Monday morning.Usually the nurse will call me in my room at the end of ICU , telling me about red flags that I have set earlier. Phone consultations sometimes is adequate because I know which patient needs what and thats why I asked them to inform me as I have my limited rest.
I was literally in front of the little girl till 6 am whose oxygenation had gone from bad to worse. It started off at midnight when she desaturated to 90%. After some adjustments on the settings , it further worsened. This was the 13 year old girl i mentioned in the earlier blog ; having a severe bronchopneumonia which tipped her off to ARDS ( Acute respiratory distress syndrome ). Despite the lung protecting strategy we initiated earlier , she was not improving at all. The worse thing that could devastate her parents was she could just die because of hypoxia that night.The bad thing about that was I may not be able to do anything much ! I was looking at her , seeing the innocent body lying there helplessly.
It was at 2am that I decided , i should recruit her lungs. ( Recruitment is a method used in ICU setting to improve patient's oxygenation for ARDS ) It was scary , because of the high possibility that things can go wrong at the middle of the night . But her PaO2 was a mere 30 mmHg and that is with 100% oxygen ! I knew I had to do something.
So there it was , after paralysing ; pushing up her PEEP , 15 to 20 .. to 25... to 30... to 35.. Waahhh... I was really afraid in causing barotrauma for this young kid but what choice do I have. I need to improve her oxygenation somehow. It was dramatic when she desaturated on me then , but I remembered what Tuxen ( the ARDS expert ) mentioned in his July ICU conference. CARRY ON !!!
After twice recruiting her lungs , I was sitting in front of her ventilator ; watching closely all the settings ; PEEP , rate , Minute volume , Compliance, Fi02 ; titrating it to patient's best condition. ABG after ABG ; I dunno why i did not feel sleepy then , perhaps the thought of seeing the parents watch her die in front of their eyes affected me so much. I mean , imagine if it was your kid ! I knew she could become better and I guess thats why I persisted. Perhaps , my upmost attention in my ICU posting so far in the training..

At 530am .. Her PaO2 was 75 mmHg , FiO2 65%.....

No comments: