Today could be a big day for Tyler. He may be switched from the Oscillator to a conventional ventilator with APRV settings! APRV cycles between high lung volumes and low lung volumes and will allow Tyler to breathe spontaneously at either level. This is opposed to the Oscillator which does not allow Tyler to breathe at all; in fact, he has to be paralyzed so that he won’t attempt to breathe. The APRV vent will allow them to take Tyler off the paralytics. This will be a tricky process as they reduce both sedation and paralytic, because Tyler could end up not sedated but paralyzed, which would be traumatic.
A concern that arose last night is Tyler’s neck became very swollen. This resulted from air leaking from his vent tube into the soft tissue of his neck. As long as the air in his tissue doesn’t migrate down and compress his lungs, it is expected to resolve on its own when he is ultimately extubated. In the meantime, Tyler’s neck is as wide as his head is.
Tyler has also been hypertensive during the past 24 hours, so he’s on a medication to lower his blood pressure. Because his platelets are low and he’s on defibrotide for VOD (which can cause internal bleeding), they have to make sure his blood pressure doesn’t get too high.
Tyler’s kidneys are doing very well on the CRRT dialysis – unexpectedly well. We’re getting concerned about his liver, however, as his bilirubins are inexplicably up again. This has to be watched closely now.
With all the ups and downs, Tyler is still moving in the RIGHT direction. He continues to get excellent care from the ICU team. The move to the APRV vent will put him one step closer to being on conventional vent settings, from which he can ultimately be weaned. Also, once he makes it to conventional vent settings, they can reduce his sedation enough to allow him to communicate with us again. What a day that will be!