ICU Day 15 - Back on the Vent

In my post yesterday, I reported that Shirley was taken off the ventilator and was breathing on her own.  That lasted just about twelve hours.  Last night, she got very congested in her throat.  She was too weak to cough and the congestion was too deep for the therapist to suction out.

They tried giving her heated moist air and a breathing treatment, to break things up.  They tipped the bed so that Shirley's head was down at about a 20 degree angle and then put it on a therapy setting that basically pounded on her back for about 20 minutes.  All to no avail.  As evening wore on, her oxygen saturation began dropping as she was not able to sufficiently exhale the carbon dioxide and was in need of help.  So just about 11 pm, they re-intubated her.

Being ventilated last night helped Shirley rest well overnight. Prior to my arrival this morning, she was trying to self-extubate using her tongue to push out the tube. In order to prevent this, they have her slightly sedated for the time being. 

Twice today, they set the vent to allow her to initiate her breathing and to give her lungs some exercise.  The morning session went okay and the evening session went quite well. But given what happened yesterday, I suspect it will be another day or two before they remove the tube again. 

Her kidneys are not yet functioning, but I spoke to the nephrologist this morning and he said when kidneys are damaged they need some down time to recover.  He estimates it will take a couple of weeks before she starts resuming normal urine output.  In the mean time, the dialysis yesterday made marked improvements based upon her blood tests this morning.  She would normally only dialyze every other day, but she is retaining fluids again, so they used dialyzed her today specifically to remove two net liters of fluids.  I asked if they could do that to me to drop a little quick weight...he didn't like my sense of humor.

While everything else has been going on, Shirley's feeding tube has been shut off or reduced volume for extended periods over the last week.  As a result, she is malnourished and some of her existing wounds are starting to deteriorate as her body isn't getting the protein needed to heal.  Nutrition was the number one goal for today and they now have her up to their target rate of 75 cc's per hour on a high calorie supplement.

Between getting some nutrition and getting the toxins out of her body (via both the successful surgery Saturday and the dialysis), Shirley's mental state is beginning to improve. There is a sparkle back in her eyes and she is attentive and tracks you as you walk across the room.  She will wiggle toes and squeeze hands on request, but she still isn't nodding to reply to questions yet. 

From what the doctors have said, I'm thinking she probably has at least another week in ICU.  Then probably more time on a medical floor and then likely back to rehab.