"The Plan for Ayden"

"So here we have Mr. Ayden. Hypoplastic left heart. Had a difficult course with the Norwood, experiencing SVTs and eventually coding to ECMO... He is post-Glenn... Last night he was extubated at approximately 5:30. He was on Vapotherm 100% oxygen with a 10 flow when extubated. This morning he was 35% with a 12 flow. His lungs sound clear, but his chest x-ray this morning seems to indicate some collapse in his right lung... He was supposed to start feeds overnight, but the nurse pulled 14ml gastric at the start of his shift, so feeds were held. At 2:00AM, Ayden only had 2ml gastric, so his bowels appear to be waking up..."

At morning rounds, the PCCU nurse practitioner rattles off the events of the day before. After reminding everyone of Ayden's current situation, he/she takes a deep breath and begins, "So... the plan for Ayden..." They must teach that phrase in medical school because all present seem to wait for that to be their cue to participate.

"So the plan for Ayden from head to toe... wean him off Melrinone... continue hit therapy and PRN Albuterol treatments. Wean his Methadone and Ativan so that he will be awake to better inflate his lungs and break up secretions. Wean the Vapotherm to possibly transition to the nasal cannula. Take an afternoon chest x-ray, and if it's worse, try the Aladdin for the higher pressures to inflate that right lung. If things continue to go poorly, we will have to reintubate. If things stay the same or get better, and his blood pressures are good, remove the ART line... start his feeds at 5ml with a slow increase to see if he tolerates the feed...."

Basically, they are just trying to see what Ayden's lungs will do. He is currently breathing comfortably, and his saturations have been good. They have been weaning his oxygen support fairly aggressively, and he continues to do well. He has been coughing on his own, but he has been unable to get the secretions out on his own, so they have been helping that with suctioning. He is trying to suck on a pacifier, but his coordination is not quite there, and the Vapotherm nasal cannula makes it difficult to keep a pacifier close to his face. He has been very interactive. I have been able to play with him and hold him. He does occasionally look a bit stressed and near tears, but if someone talks to him, he usually holds it together. A lot is happening today, and I am trying to be positive that he will continue to progress so that I can see my little one smile more often. (He has begun to smile in his sleep.)