Some Answers

This morning's chest x-ray was better, and they have continued down the road of possible extubation (keep reading to see why I say "possible extubation") by weaning the heavy hitter drugs and continuing the CPAP trials. Ayden has done exceptionally well on CPAP trials.

Okay, the other side of things...

Ayden's sputum culture revealed infection, some form of tracheitis, most likely caused by staph. Ayden got this infection from being intubated/extubated. They have started Vancomycin, a generic antibiotic, until they can determine the exact infection. They have taken a blood culture and are working to determine white blood cell count, etc. He does NOT have a fever and shows no outward signs of infection. It is possible (there's that word again) that he has failed extubation due to the infection.

Perhaps the more likely culprit is that Ayden has right diaphragm paralysis, which keeps Ayden's right lung from fully inflating. Apparently, it is difficult to see paralysis in a chest x-ray because Ayden is getting big enough breaths on the ventilator to cause his diaphragm to move. The diagnosis was determined by an ultrasound done this afternoon. Dr. Bichell inadvertently cut a nerve during surgery to create the paralysis. This paralysis can heal on its own, but it takes months to do so, and they obviously do not want to keep Ayden in the hospital that long. The situation is easily fixed with a plication. The surgeon makes a small incision on Ayden's right side, sutures down the diaphragm, and sews him back up. The thirty minute procedure is less risky than a catheterization and more risky than putting in chest tubes. Dr. Bichell makes the call on when or if this procedure happens. He may want to see if Ayden fails another extubation before doing so. He may want to wait to hear more about the infection. Dr. Bichell gets out of a Norwood surgery around 3:00, and Ayden will be addressed then.

While Bryan and I hate that Ayden has an infection and diaphram paralysis, we are grateful that the doctors now have something they can easily treat. They won't just be putting him through another failed extubation without going in to the situation more informed; instead, they will be addressing the problems. For the first time this week, I feel like Ayden is on his way home, even if he has a few hurdles to overcome before we get there. *BIG SIGH*