Friday, November 21, 2008

ARDS kiddo part 3.

It's 2 weeks today ; her admission to ICU. Her infection settled but the ARDS was a nightmare for the ICU team to manage. We've tried everything to open up her lungs and improved her oxygenation.We recruited and last week ; the bronchoscopy.. still her oxygenation was bad. In a way , we were baffled. Why can;t we improve her PF ratio ?
It was paradoxical through ; the numbers did not correlate at all with the clinical picture. Her hypoxaemia was evident , but .. she was comfortable. After the sepsis settled , her ventilation was never a problem. Her SPO2 was 98 - 100% but her ABG did not show good PaO2 at all ! There was no difference increasing or decreasing the Inspired O2 ; 1.0 or 0.4 !! Slowly we reduced the PEEP ; and her oxygenation remained as it is. She was totally comfortable. The question was , to extubate or not to extubate ?

We theorized that since she has chromosomal abnormality ; her bodily physiological function must have compensated itself and regulate on different limits. The readings that we get maybe totally normal to her because she was never admitted and investigated. She was ruled out of any congenital heart problems ; but somehow her physiology is unique and different. her Oxygen Dissociation Curve does not comply to the norm and maybe a mixture of fetal haemoglobin type ODC. Her SPO2 was amazingly 100% eventhough her PaO2 is barely 60mmHg!!
And today afternoon ; after a successful spell of 24 hours spontaneous ventilation ; we extubated her and immediately on BiPAP. She was OK amazingly !! She was comfortable ; and the look on the parents' face was rewarding to me :) I reckon she will not deteriorate and hopefully in the near future to be transfered out to normal ward for rehabilitation...

1 comment:

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