looking good

Sandra is looking much better today.  They had her weaning yesterday starting mid-day and she went 10hrs with no problem at pressure support of 10.  This morning she was weaning at pressure support of 8 and looking great.  Her heart rate was around 80(!)  And her peak airway pressures were also stellar at around 13 or 14.  Her weight was also up a bit at almost 50kg.  As I have said before It seems - and several of her nurses that I've spoken with agree - that she is really sensitive in regard to fluid level.  When her heart rate was so high at the end of last week I didn't see her weight but it was just over 47kg as of Wed, so it's now around 6lbs higher. 

The infectious disease person is supposed to call me with more detail later today but it looks like this recent infection was a staph in her lungs.  But it also looks like it has responded very well to the 2 new antibiotics they have her on, as she looks great now and is weaning well. 

I know it's way oversimplifying things but I can't help but be fixated by the interplay of the 4 numbers - heart rate, peak airway pressure, pressure support and body weight.  I feel like I could put these numbers into a spreadsheet and make a graph that would show strong correlations.  (Or maybe show that it's more complex than I think!)  With luck they'll keep dropping the pressure support by 2/day and on Friday she'll be at 4 again.  With that increased "work load" I'll be really curious to see how much her heart rate goes up if if her weight stays the same.  In any case, if it's say between 100 and 110, which I hope it will be, then I will feel much more hopeful than last week in regard to pushing on down to pressure support of 0 soon.  I may also lobby for some way to communicate to all the staff that she really needs her fluids balanced (if possible) to target a body weight of 50kg.  I feel tempted to put a note on the wall!  The nurses that work with her recently and/or often know this (Dianne and Mel, for sure) but I don't think the RT's know (or fully believe) this nor do many of the nurses.  I'm also not sure how easily they can control her fluid level (implied by body weight) even if they had a target goal like this.  Actually I'm going to call Ferrial, the head nurse about this. 

All that aside - it was great to see Sandra, and the numbers, looking so good today!  -Willem

Comments

[Kathy]

Thanks Will for tracking this so closely!

[Arie]

As are we all. Great posts bro.

[Thinking of you everyday!!!]

Wonderful to read :) Don't be afraid to be that positive squeaky wheel that needs to be greased! Let them know what you are thinking :)

[Tamara]

I just want you and Sandra to know that you're in my thoughts and prayers. Keep on Keepin' Willem and Sandra!!!!

[Sandy Riggers]

Great news Willem! I think the more you communicate with them about all of this the better. Take care and you're in my prayers.