The vent. is down to 2 breaths/min. Virginia wants Bonnie to visit again this weekend. I will check to see if she can make a repeat visit. She is still in a wheelchair for much of her getting around.

10:25 tomorrow makes one week on the vent. Maybe this Sabbath they will call to say it's coming out! {enter prayer mode here}

That's it for this afternoon.

pt

Ventilator Tweaked Downward

Virginia's ventilator settings were edged down a little bit today. For the fans of technology her settings are:

Number of breaths/minute = 4 (was 6). She is breathing in the high teens which is good.
P Supp or Pressure support = 6 (was 8)
There is another setting I will introduce: the percentage of oxygen that flows in. She was changed to 40% (down from 45%). This good.

Keep the cards coming! They are very much appreciated.!

I am showing her the cards and reading them out loud.

I visited today at a time when her sedation was turned down. We had a good visit and I could read her writing. It makes a difference when she is not sedated. I was there two hours today when she finally waved good-bye. This was an unusually long visit.

Here's an idea: She can't talk but if anyone sends a recording I will play it for her.

Virginia is very slowly improving.

The nurses occasionally back off on the sedation to assess her. She is drowsy much of the time so as to heal. She expressed wanting the tube out but it is not safe yet.

Clinical Statistics:

I use numbers to understand and express to the reader her extent and speed of progress.

Ventilator: SIMV or Number of breaths/minute = 6 (was 8)
P Supp or Pressure support = 8 (was 10)

The goal is zero on both of these If she can tolerate zero she is close to having the tube out.

Blood glucose was reported good (Tuesday early night shift) about 102. Perfect "tight glycemic control" is under 110 (110-140) so this is good.

Her blood pH (from arterial blood gases) is 7.35 (normal = 7.35 to 7.45). She was 7.31 earlier (too acid).

Weening From the Ventilator

Virginia is still fairly drowsy much of the day. She was able to write with a sharpie marker to ask me to bring her glasses.

I can report on the ventilator. There are two settings worth monitoring here.

(1) SIMV or number of breaths per minute whereby the machine will assist in reathing. She was on a setting of 8 Monday morning and on 6 in the afternoon. Lower numbers are better.

(2) Pressure support. The pressure is currently on a setting of 10 (cm of H2O) and is scheduled to be turned down to 8 at 4am Tuesday morning. Lower numbers are better.

Her right foot post-surgical wound is now changed by the ICU nurses rather than the wound care nurse so I take that as doing quite well.

Visitation should still be limited to immediate family and two others I have listed in her room. Telephone calls are not practical yet. Remember ICU can not take flowers because if anyone in another room has a low white blood cell count they can not be exposed. Cards are still good!

Insulin Drip

Night shift put Virginia on an insulin drip (insulin via IV). Her blood sugar levels are getting better (170 v 200-250). I am hoping they can achieve what is currently called "tight glycemic control." This is where they attempt to achieve blood glucose levels of no more than 110 or maybe 110-140 as I understand what little I have read.

The night nurse reported she is on the ventilator 50%. It was explained to me that this means she is initiating breaths on her own 50% of the time. The rest of the time the ventilator delivers a breath for her.

She was somewhat awake (eyes open) when I visited about 6:30 am. She tries to write on paper but isn't able to do so legibly. The arterial line is located in her writing arm (at the wrist).


Some have asked "Is she awake?," or "Can she talk?". While she is on the ventilator she cannot talk. She couldn't talk while wearing the Bi-Pap mask on last week. As far as being awake, that depends on the medication. She is sometimes partially awake/aware during the day. They have her sleep at night.

Arterial Line & Blood Glucose

Sunday 16:00

Virginia is about the same as yesterday. As I understand her blood sugars of late are about 200-250. Medications, stress and the feeding solution all contribute to a higher sugar level. Her blood sugar (glucose) level is being checked every two hours and they will give her a bigger dose of her insulin this evening. I am going to check to see if they will really jump on these blood sugar levels and maybe do an insulin drip.


They are inserting an arterial line just now. This line will allow them to sample blood directly from the distal radial artery (wrist). She has to have arterial blood gases drawn daily while on the ventilator. When a person has blood drawn it often comes from a vein and it doesn't hurt much. However the arteries have more muscle and the blood is under higher pressure. So a poke into your artery is more painful. Thus the arterial line will mean she gets one poke that will save her getting re-poked every day. The side benefit is that they can monitor blood pressure via the line. The downside is another line to maintain. I hope it doesn't hurt while in or her pain meds keep it from hurting her.

I will hang out here and try to visit after the procedure. I also have to release the dogs before too long.

Re-Intubation

Virginia has been in ICU since Friday afternoon. She would have had to come down to ICU by Saturday am anyway as you have to be in ICU if you are on the ventilation. After 36 hours on the Bi-PAP she just wasn't progressing.

Virginia, you might be pleased to know your doctor is the "Purple Team." It is a good choice of color, your favorite.


I received a call at home a little after 8pm or so Saturday evening. I got the report that the intubation tube came out and please come right away. Fortunately I live very close.

I was not there at the time but the staff informed me of the events. Fortunately her nurse was in the room when Virginia apparently banged for help on the side rail. The bed was in the mode where it slowly rotates side to side. This helps prevent skin breakdown and encourages coughing out any “gunk” that would impede breathing. Apparently the bed was fully rotated one direction and tugged on the on the tube.

Now when you are on ventilation they have to sedate you and you are dependent on the machine for breathing. They re-established ventilation by hand (bag) and re-intubated her (re-inserted the breathing tube).

Her oxygen saturation dropped to approx. 60-79% for an roughly estimated five minutes. One of the physicians said Virginia likely has been living at a reduced blood O2 level for awhile and may be acclimatized to lower O2 levels. She has high CO2 levels in her blood. The physician is hopeful she has escaped significant damage. We may not really know about residual damage until her lungs heal enough to get her off the ventilation. Then we can ask her questions and have her perform tasks to ascertain her abilities.

Virginia's mom (Bonnie) visited today (Saturday) in the early afternoon. She stopped in the gift shop and bought Virginia a necklace and a small “charm” that looks like a silver lifesaver. It says “Daughter.”

Bonnie arrived at 1:40 pm and we visited for awhile. We left to let them reposition Virginia and then went back. Bonnie's ride came on the dot at 4:00 pm and she went home. The nurses said Mike (her brother), Michele and their two kids (that would be Jennifer and Scott) visited after I left at 5pm. Her brother John visited later in the evening.