P. E . S.

Ash was extubated. Don't rejoice yet.

She is struggling. Something called Post Extubation Stridors. Basically her air way is swelling from the trauma caused by having the tube down it. The easiest explanation is this: She is oxygenating well. She is not ventilating well.

She can maintain her oxygen sats easily with a small flow of oxygen through her nasal cannula. She can't blow off enough CO 2.

All signs that can be monitored to warrant removing a patient from the vent were "rockin". Absolutely text book perfect. This morning the intesivists shared with me that there is NO way to know if a person will be successful or not. You read the signs, the monitor, and blood gases. If its perfect, its perfect and you remove the tube. So we did.

Unfortunately, it doesn't look as though it is going to work. If she can't blow off CO 2 her heart will stop beating, her ability to breathe will cease. Metabolic acidosis will set in. Currently the swollen air way is keeping her from getting her breaths down into her lower lung in order to exhale fully and dispose of the CO 2. Currently her blood gases came back with her CO 2 in at 89. Normal is 40. This is not good.

We are using a high flow nasal cannula, heliox(a mixture of helium and oxygen), and epi treatments. If things don't settle down soon, we will re-intubate her. ( By tonight or definitely in the morning.) Try again in a few days after they have loaded her up on steroids to try and reduce the trauma and swelling.

Its a dangerous place we live in with our sweet Ashley. Nothing we do is cost free. It all runs at very high risks. I desperately wish to change things for her. I just don't get too. Prayers, prayers, and more prayers. I don't know what else to say or do.

Oh, by the way, the meeting had to be cancelled.