Last night Paul and I were surprised to hear them talking about extubating today. I guess with a positive bronchoscopy there is no need to keep Hana intubated. What concerns all of us (me, Paul and my parents) is their lack of a plan. The last two extubations obviously did not go well and afterward there was lots of talk of “next time we will do this”.
One time Hana failed extubation primarily because of upper airway the edema – which can be treated with steroids if you give them about 10 hours beforehand. But the attending physician on this weekend doesn’t believe she had upper airway edema which would be the opposite conclusion of the doctors who were present at that time including the one who had to reintubate her. This sounds shortsighted to me and it worries me that some precautions will not be taken. In general I refrain from saying anything negative on this blog about any of the medical professionals.
The second time Hana failed extubation she was going through intense withdrawal and she was having to deal with breathing with one lung and reduced cardiac output. This time her cardiac function will be supported by the Berlin Heart and she should have more use of her left lung. But she will still have to go through withdrawal and their “plan” to manage that hasn’t impressed me. I guess there aren’t too many good options especially since Hana has had to have such high doses of sedatives. So, we start to take away sedatives today to start the withdrawal and we (me, Paul and my parents) will have to be ready at bedside to console her. The nurse and NP and attending physician will just have to manage her sedation very carefully. Hopefully they are playing close attention. It has never been more obvious to me than now at how much personality plays a role in practicing medicine.
The plan is to extubate tomorrow as long as Hana’s chest X-ray in the morning looks okay and she is tolerating the ventilator changes. It will be a very busy few days where someone may need to be at Hana’s bedside around the clock. My dad even delayed leaving so that he could help. For the next several days we will be in all hands on deck mode.