Just breathe...

Thanks for the post title, Cousin Faith. 

Leigh Greer, this post's for you!

Becca's doing well.  She's up to 1020 grams - that's 2 pounds and 4 ounces!  John's giving her her daily bottle right now.  She's up to 15cc's on her feeds, which is more than she's ever had!  She's just under full feeds (which will be somewhere around 18cc's), and she's back to getting a bottle once a day (after a weekend off to let her catch up on breathing).  I forgot to mention in my last post that she had come off the vapotherm, but since then, she had to go back on it.  Now she's off of it again, for now at least.  She may have to go back on it, but there is a massive vapotherm shortage in the NICU right now, so we're hanging out with the nasal cannula. 

Let me try to help you make some sense out of everything I just said.  I have been avoiding explaining the intricasies of her respiratory care because I cannot manage to wrap my brain around it, but I'll give it a go.  All you friendly medical folks out there can clarify for me if necessary. 

The highest level of respiratory support involves being intubated and connected to the ventilator.  There are a couple of kinds of vents that I've seen around here.  Some of them basically breath for that baby, and others send quick puffs of air at a really high rate.  I think some of them are cued by the baby's attempts at breathing, and others just breathe at a regular rate.  They are really complicated, and I know very little about them because I never even saw Becca on one, as (thankfully!) she was only intubated for less than a day (when I was still chained to my bed in the recovery room).  So let's not worry any more about them.

Becca quickly moved to vapotherm, which is kind of a modified C-PAP that is delivered through a nasal cannula.  It looks basically like a regular cannula (not the fighter pilot mask that you may have seen some folks wear to sleep), but it gives a continues flow of air at a rate of x liters per minute.  The "vapo" part is that the air is humidified (even more so than most nasal cannulas), which helps keep things moist.  When she first went on vapotherm, she was on something like 3 liters per minute.  Eventually she weaned down to 1/2 a liter, and they switched her to oxygen "from the wall."  That happened before we moved over to the children's hospital.  When her infection popped up, though, they had to put her back on the vapotherm so that she wasn't working as hard to breathe.  They almost had to intubate her (again, not because she wasn't breathing, but to give her some support while she was feeling so puny), but she stayed strong enough not to have to do it.  After her infection, it took longer than before (or so it seems to me) to wean down again, but last week they were able to take her off the vapotherm and switch to a regular low-flow nasal cannula.  Then, like I said, she had to go back on it, and now she's off it again.  Pirate ship, anyone?

After you come off vapotherm, you get hooked up to the wall (literally), from whence is delivered either pure or blended oxygen.  Becca's on the blended version, meaning they can control the amount of oxygen in the air that is blowing through her cannula.  They can also control the flow.  At the moment she's on 1.5 liters of flow, with her oxygen level at nearly 40% - which tells me that she's likely to be back on the vapotherm as soon as one becomes available.  She's "satting" high, meaning that the level of oxygen in her blood is high (which is good, unless it hangs out too high for too long, which can damage her eyes - weird, I know), but she's usually on around 25% (room air is 21% oxygen), so it looks like the cannula isn't cutting it yet.  The air from the cannula is humidified a little bit, but not much, so if she continues to require this high a flow for a while, drying her out becomes a concern as well (but not a big one, I think). 

Before she goes home, she'll have to be off of all of it.  I think some babies are sent home on oxygen, but since she doesn't have any structural issues or (at this point) chronic lung disease (from being on oxygen too long), she really shouldn't need to be discharged on oxygen.  Overall, she's done very well with her breathing, but she has consistently needed some sort of flow (or pressure), even when she's been just on room air.  Theoretically, she should be growing out of her oxygen needs soon (as in, a baby born at her current gestational age probably wouldn't need much - if any - support), but she's not there yet.  As usual, she'll tell us when she is.  And I'll be thrilled to mark that off our "to do before Becca can go home" list.  Then she's got to take the bottle and hold her temp.  But we're getting there.  I don't see her going home by the end of the month, though, like we had started to think might be a possibility (though a very optimistic one).  So she's made a lot of progress, but she's got more to do...and my patience is running short.  But we'll take her whenever.  She's a keeper.  And I love her!