Intubated

James was extubated at 2pm yesterday, he was re-intubated at 6am this morning.

There was some argument about whether he was ready to be extubated; the RT's (Respiratory Therapists) looking at the numbers and saying he was not ready and finally the doctor stepping in and saying he does not follow numbers, and so we were going to try it. When discussing with the RT's, I had a hard time getting clear enough answers to understand if they were aiming for the impossible with James. All the numbers on the ventilator were where they said they should be for extubation but still they said he was not ready. In their opinion he was breathing too fast, he was dropping his SATs too quickly when suctioned, and he was needing too much suctioning. If we wait for those things to change they would never extubate. He was breathing slower then his regular breathing rate and he always drops his SATs immediately when taken off oxygen. While intubated, James will always need suctioning because his lungs continue to produce surfactant that he cannot couph out, plus being intubated by itself creates extra secretion.

The doctor ended up stepping in to say they were going to extubate; he agreed with us that James was about as ready as he could be. He also put it clear that although the RT's have their input, it was not their decision to make, but his. The worst that could happen is we would have to re-intubate. Unfortunately that worst happened.

James was put on a regular mask after extubation. This means he just had air flowing to him, similar to nose prongs, but they can provide greater volumes with a mask. Surprisingly he tolerated this fine after his initial few minutes of fighting. He was having deSATs, not uncommon to James but more frequent then usual. We had hoped that once he went to sleep and relax he would get to better breathing going as well as time to recuperate from the extubation and be better off tomorrow. Considering James was on C-PAP when on the ventilator we did not think he would need to be re-intubated.

Unfortunately we were not with James last night, so I cannot say what really happened to bring the decision to re-intubate and we'll have to discuss it further with the doctors. They did try to put him on BiPAP twice, but he got so worked up that it just made things worse and so they re-intubated. We wonder if they could not have further sedated him in order to calm him. If he woke up with the BiPAP on afterwards he would likely have accepted it much better then having a crowd of people surrounding him and doing things to him which just make him panic. We are reminded of why we like to be with James at all times.

But whatever the case he has been re-intubated and we now have to emotionally accept this and deal with it. The biggest question is: if they can't extubate now, just after having MethylPrednisolone, will they ever be able to??

Pictures of the mask he was on.

Some day I'll have a chance to upload more pictures, but right now we're having internet issues that make it a bit time consuming to add pictures.