07.22.08

Logan Plays . . . AGAIN!!

Posted in Logan at 12:35 am by kimi

FYI . . . this is going to be another LOONG entry . . . Sorry!

If you haven’t already heard yet, Logan LOVES to “play” on the weekends . . . unfortunately, his idea of “playing” always ends up shaving some years off of our lives!

This weekend, Logan decided to sneak in a little bit of playtime again. Each day, Logan’s nurses do several blood gas tests on him . . . the blood gas monitors his carbon dioxide & oxygen levels, along with a whole bunch of other things. On Friday night, Dr. Murai (the neonatologist on call) felt that Logan’s CO2 level was too high & his O2 level was too low. To address this problem, Dr. Murai began making some changes to the settings on Logan’s oscillator. When we left Logan at dinner time, the amplitude on his oscillator was 28 . . . within about an hour after returning from dinner, Dr. Murai had made 2 huge changes in his amplitude setting (it jumped from 28 to 41). Needless to say, we were shocked to see such a huge change in his vent settings. We know our son well . . . he does NOT like a lot of changes & takes a looong time to adjust to them. Knowing this, we were very concerned with the way that Dr. Murai was handling Logan’s situation. In Dr. Murai’s defense, however, his hands were kind of tied . . . Dr. Oliveros (the neonatologist in charge of Logan’s team this week) ended her day shift with specific instructions for Dr. Murai . . . if he needed to make changes to the settings on Logan’s oscillator, she only wanted him to adjust his amplitude. Dr. Murai was comfortable with the high vent settings because of the leak in Logan’s ET tube (which was minimizing the effectiveness of his vent). We could see that Logan’s body wasn’t shaking as much as it should have, given the high amplitude, so we knew that Dr. Murai’s theory was probably correct.

After the huge change in his amplitude, Logan took a good 2 hours to settle down enough to accept the new settings. Thankfully, subsequent blood gases showed decreasing CO2 levels & increasing O2 levels. Logan remained pretty stable for the rest of the night & throughout Saturday morning, but they weren’t able to wean down on any of his vent settings.

On Saturday afternoon, Dr. Kim (one of the residents) made the decision to reintubate Logan with a bigger ET tube. When they first noticed the air leak, Logan was still too small for the next size tube . . . they just had to compensate for the leak by increasing his vent settings. Dr. Kim felt that Logan was FINALLY big enough to handle the next size tube! YAY!

With a few doses of Pavulon & some extra pain medication, the reintubation process went fairly well. He was pretty stable throughout the evening, but by late Saturday night, his oxygen saturation levels were starting to drop. He does this quite frequently & usually comes back up on his own . . . this time, his saturation level dropped very low (into the single digits at one point) & he seemed unable to recover on his own. Carol (his nurse) & a respiratory therapist took him off the vent & began to hand-ventilate him. As they were doing this, they noticed that Logan’s oxygen level was much higher when they were using the hand-bag to give him long, slow breaths (instead of the short, fast breaths like the oscillator gives). Dr. Weiss (the neonatologist on call) decided to put him back on a conventional ventilator.

After several more doses of Pavulon & pain medication, the transition from the oscillator to the conventional vent went fairly well (although it did take them some time to figure out the right vent settings for Logan). He remained pretty stable on the conventional vent throughout the night & into Sunday. By Sunday night, however, they still hadn’t been able to wean down any of his settings. Because his pressures were so high on the conventional vent, they decided to switch him back over to the oscillator (the high pressures on the conventional vent were too dangerous for Logan to be on for an extended period of time).

At midnight on Sunday, Logan was put back onto the oscillator. Along with this change, they also started him back on the aerosol treatments they had given him during his last crisis. These treatments help to loosen up some of the gunk that’s clogging up his lungs. He’s now receiving the treatment every 8 hours, or more often if they feel it’s necessary. He’s also receiving a dose of Lasik twice a day . . . this helps him to pee out some of the fluid that he’s building up in his body. It also helps to release some of the wetness in his lungs.

After his weekend of playing, Logan finally seemed to be settling down again. By Monday, he was resting pretty comfortably on the oscillator (although they are giving him the occasional extra doses of pain medication). His vent settings are still high & he’s still requiring 100% oxygen support . . . this isn’t good, but it’s what he needs right now. The plan is to wean his settings & oxygen support level when he’s ready, which will hopefully be sooner rather than later! Given Logan’s resistance to change, we’re hoping that they’ll wean him slowly & allow him the time to adjust . . . unfortunately, they’d like him to get off of the high pressures as soon as possible, in order to minimize the damage to his already fragile lungs. It’s quite a balancing act that the doctors & nurses have to do with Logan. We’re crossing our fingers that he’s strong enough to handle the changes.

On a positive note . . . Logan is changing & growing every day! At 7 weeks old, he looks so much more mature & developed than he did several weeks ago!

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