To stay off the tube, Garrin must
□ gain weight,
□ maintain appropriate oxygen saturation while weaning oxygen, and
□ diffuse and exhale an appropriate amount of carbon dioxide.
Since being put on CPAP, he has been able to check each of these three boxes, avoiding intubation.
Unfortunately, he was not able to check any of them overnight. The doctor called me before I could even get to the hospital this morning, stating that Garrin had experienced an episode of labored breathing that included retractions, grunting, and poor color. His CO2 was far too high, his oxygen needs were also up, and he was an ounce lighter at weigh-in. To say I was shocked by this phone call would be an understatement — roller coaster! With additional CPAP support and more oxygen and nitric oxide, Garrin was able to finally recover, but his CO2 remained alarmingly high.
Before rounds the doctor thought he would be intubating Garrin today, but when he examined him, Garrin looked so good clinically that he decided to wait and repeat the blood gas. This gas came back better but still not where it needs to be. Instead of intubating him, the doctor and NNP, a familiar face from the hospital Garrin was in, decided to start a couple of different medications. Luckily, his CO2 was down to 62 tonight and barring any surprise events over night, they will wait and retest in the morning.
I have been extremely nervous about Garrin needing to be intubated again, and much of that stems back from his days as a micropreemie, I am sure. The doctor helped me to see intubating Garrin and a tracheostomy, if necessary, as an investment in his future. This analogy really helped me to feel better about the prospects of the procedures, even though the potential timeline is difficult to swallow. But we are not there yet, so it’s a worry for another day.
“The day you stop worrying will be the first day of your new life; anxiety takes you in circles, trust in [God] and become free.” ~Unknown