Lucas Camilo

Yesterday Lucas began his second voyage into the world beyond the endotracheal (or ET) tube.  First, at around 11 am on Monday the doctors shifted the settings on his ventilator to “CPAP” mode which means that the vent was no longer initiating breaths for Lucas.  The tube remained in place throughout the day, but Lucas had to take spontaneous breaths, with the machine still assisting him through extra pressure and oxygen.

Lucas took the change in stride, occasionally taking breaks from breathing for up to 7-8 seconds (which had his parents holding our breath along with him), and occasionally experiencing periods of takipnia (or rapid breathing).  But the oxygen saturation in his blood remained stable through it all, and he made it through the night with flying colors.

Based on his performance over night, the docs said this morning that he was ready to have his ET tube pulled.  The next step, they decided, involved a funky contraption called this SIPAP (prononced CY-PAP and meaning “Synchronized inspiratory positive airway pressure”).  This noisy sucker works similarly to the ET CPAP mode of the ventilator, but without a tube sticking down his windpipe.  Rather, a smaller dose of pressure and oxygen (a “burst of air”) is pushed in through a couple of prongs in his nose, but he only takes breaths when he decides to, and mostly using his own energy to breath in.

Lucas went at it on the SIPAP for a couple hours but from the beginning it didn’t seem like a good fit.  The air going through his nose was often escaping through his mouth, making it hard for the air bursts from the machine to do the job of assisting him.  The only way to keep the air in was by putting a pacifier in his mouth, but after a while he got tired of sucking on it.  At around 3 this afternoon he started looking like he was working too hard, his whole body straining with each breath.  The extra effort to take breaths in didn’t translate into powerful exhales, and not pushing enough CO2 out of his system led to his oxygen saturation level dropping, a bad sign.  Finally, the doctors decided to put the tube back in and let Lucas rest.   Round 2 lasted more than a day, but we’ll have to wait a little while longer for the tube to come out permanently.

It’s tough to see him struggling like he was, and discouraging that he had to go back on the ventilator, but rather than feel down we’ll take our cue from Lucas, and frankly he seems to be in pretty good spirits.   Two hours after the re-intubation he’s wiggling around more than before, looking up at us with one wide eye, and already gearing up for round 3.

Tired out..but at least I got all that stuff off my face for awhile!

Lucas rides the SIPAP machine