Kiera has a pretty bad pneumonia in her right upper lobe of her lungs and is culturing out pseudemonas and possibly strep. After 6 failed attempts at an IV yesterday, they did intramuscular shots of 1 atibiotic for the strep. Then they managed an IV today (YEAH!) and started a dose of antibiotics for the strep and another for the psuedemonas. She had a bedside brochoscopy today and her pulmonologist was able to put some mucomyst down her trachea to focus on bad areas to break up her mucous. She is currently on continuous nebulizers, and after a short bit back on the LTV, is back on the big 840 vent today on much higher support than before...a rate of 40 and 60% O2. They also changed her to pressure controlled ventilation instead of tidal volume controlled. I'd explain...but I'm wiped out.
On the plus side...Kiera was off her feeds today and only getting Pedialyte, so when I got out a juice box, she was so excited she strained to get off her boppy to get my juice. I gave her maybe a dozen tiny sips pipeted through the straw. Then I asked for a popsicle, and she went at it gainbusters...like she's been eating forever. She got orange juice from the popsicle all over her face, trach dressings, and bed. She was pulling it to her mouth. I think she liked being able to control her food. She took SMALL bites off the tip of the popsicle and didn't freak out too much. She let it melt in her mouth and swallowed. I think her face is permanently stained orange now. Maybe I'll have to convert all her food to "on a stick" form. :) She also had a great echo today and is going to stop her Sildenafil (viagra). So does that mean the leftover meds are for us? :) Or should I start spamming all of you?
In that she is on the big vent, high O2, and IV antibiotics, it looks like she'll be in the hospital at least another week making this her longest readmission since her discharge in January. Last night was cute...the male nurse that had her told me that that night was his one year anniversary in the PICU, and Kiera was his very first patient when he was new, so it seemed appropriate that he had her again. He'd been away, and didn't even now she was readmitted till he got his assignment that night. Kiera used to flirt with him before so we say he's her boyfriend. Sure enough, she flashed him a smile when she saw him. I think she likes his red hair. Another funny thing: I was talking to a friend the other day, and I found it funny that my perspective lets me think that ONLY 4 hospitalizations in 6 months is a GOOD thing. What a different world I live in!
Therese
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I'm just curious have they always used tidal volume control or has it previously been pressure control and then switched to tidal volume? I ask because our pulmos always said that they didn't use tidal volume control because it wasn't safe with pediatrics. Then again doesn't Kiera have a cuffed trach? That was also something our pulmos said was unsafe with pediatrics. I know every doctor has their own theory on things and their own way of doing things and what they feel is "safe" and not so I'm just curious if you know.
Okay that comment was totally not meant to sound like Kiera is in danger or something, merely me wondering if you know why some doctors use those settings/trachs and others don't.
I hope she's feeling better soon, now that the abx have been started. Has she ever been on Tobramycin nebulizer treatments at home?
Toby nebs don't work for her. She has regemin of Amakacin nebs, 28 days on, 28 days off, which she just stopped on the 2nd. Usually on the 840 and in NICU she was always on pressure control. However, as far as I understand it they always do volume control on the LTV's. Not sure about safety issues of cuffed vs. uncuffed in pediatrics. I think they just have to do what works for certain kids, and I think she needed cuffed because of the pressure support necessary for her bad lungs. I also know that they overlook high pressures a lot of the time on her, because her lung tissue causes higher pressure than would be safe on a healthier lung.
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