Bump in the Road

Thursday night and Friday morning, Lively's breathing became more of a problem. He had a chest X-ray, which evidently looked pretty normal. His oxygen saturation was normal. Around 3 am Friday morning I fell asleep next to him. At 5 am I woke up to the sound of his rapid breathing and found his nurse, the resident on call, and the respiratory therapist standing over us. They had already given him a breathing treatment (which had not woken me up) and it hadn't helped. I sat in his bed and held him and tried to help him change positions to make him more comfortable. Nothing worked. I called Pete to come in.

Things quickly got worse. His respiratory rate was in the 40s, then the 50s. I could tell that he was working really hard to breathe. Pete arrived and the room filled up with people as the rapid response team arrived. Pete traded places with me and held Lively as the team wheeled the bed to the pediatric intensive care unit (PICU). When we arrived, Lively was breathing 60 times per minute and he was clearly getting tired. He had stopped crying and looked very sleepy.

The doctors intubated Lively to protect his airway. This means that he has a tube in his throat and a ventilator helping him to breathe. Friday afternoon, the ENT surgeons (ear, nose, and throat) took him to the operating room to evaluate his airway. They saw that he has tracheomalacia, which is a narrowing of his upper airway. From what I understand, this isn't a problem for him unless he gets an infection of the airway or some other injury that causes swelling; a small amount of swelling can become a big problem for him.

We don't really know what triggered this event for Lively. He may have contracted a virus or bacterial infection. The ENT doctors think that when he vomited Thursday evening, he aspirated some of the stomach secretions, which can cause a chemical injury to the airway. I tend to think this is what happened also, because the onset of his respiratory symptoms coincides with an episode of vomiting.

This morning, the team tried to extubate him. His lungs sounded clear, and he had been on minimal ventilator settings all night. He must have still had too much swelling in his upper airway though, because he immediately had distressed breathing again when the tube was removed. So he was quickly reintubated. They're not going to try to take him off the ventilator again for at least 2 days.

Here's a picture of him that I took yesterday.

The plan for the next few days is for him to rest and heal. He is stable right now. The doctors here say he's going to be OK. I have to believe them.

I'll write about his IV dramas later.