Thursday, November 13, 2008
ARDS kiddo PART 2
For the past few days , her oxygenation never improved. We tried to recruit her lung many times ; still it was not great.Pa)2 was 60 - 90 then back to 50 mmHg.Lai did a good smacking chest physio ; which showed promise but unfortunately premature. I guess the team has exhausted our ways to improve the kid. Her lungs is the only organ which has not recovered. It just did not tally , her x-ray showed a lot of improvement but her blood gases were otherwise. There was however a lower lobe collapse which persisted. Input from the CHest team was much appreciated.I have this theory before , seeing ARDS patients that if the high settings cause worse ABG , then it is time to revert to normal ventilation.
I had a small chat with the parents ; and of course they were very afraid for her outcome. I updated on her progress and I was glad that the parents were very cool and calm . They really love their daughter more than anything else.
We bronchoscopied her today at a PEEP of 20! That would have been very dangerous because if we were to loose her oxygenation ; then it can be a point of no return. We had to do it ; we had no choice for now. We proceeded and Alhamdulillah , nothing bad happened. She was able to maintai nher oxygenation eventhough her ETT was almost blocked by our bronchoscope. Her airways did not show it was in bad shape but there were lots of thick mucoid secretions which we could not suck out all. We did some and hoped so much that she will improve.
The Chest team Prof had a word with me. HE was quite happy with the chest xrays and suggested that we wean her off . He was optimistic that we could extubate her really soon.
Tonight , it's my turn to watch over her again ; and perhaps with Prof's input ; just pray for the best..