Where do I begin. It has been a long weekend, and an amazingly stress-filled joyous/tiring/fearful day. First, we saw Emery on Friday night, and he was fussy. Daddy held him and Emery loved it. There was no bath that night because they were busy. Saturday I went up early because friends and family came on Saturday afternoon. I got to kangaroo Emery for the first ime. (Kangaroo is short for kangaroo care, where the mother holds the baby skin to skin against her chest.) Emery did really well with holding and kangaroo care on Saturday. On Sunday morning I called and talked to the nurse and Emery's vent settings were way down, and so Erik and I knew that at this point today was the day. The second attempt at re-extuabation. The NICU staff just plain kicked butt today. So, Erik and I got up there today and the docs came in to talk to us about the pla
ns for Emery. First, his feedings were cut back from 34 mL every 3 hours to 30 mL every 3 hours to keep him fluid restricted. The plan is to fluid restrict him, continue once-a-day steroid dosing after his last dose at 3 a.m. Monday, which means he'll recieve one dose Tuesday, one on Wednesday and one on Thursday. Then, the hope is to get him to inhaled steroids IF he stays off the vent. They said Emery, again, has a 50/50 chance of making it off of the vent, soooooooo Emery was extubated at 2:50 p.m. today and is still off the vent as of right now at 10:10. As we all know, he only made it 4-1/2 hours the last time with bad blood gases. This time he's tolerating it slightly better. His CO2 was 59, which is really good for him. Now, the tricky part. One of the reasons 
Emery failed off the vent last time, besides the obvious that he wasn't ready, was because he got so angry he finally couldn't handle it. Today, when they extubated him and put the tube in his nose, he got equally angry again. So much so that there was a point that he almost got reintubated. He cried so much and became so fussy that he desatted down to 48 (his goal is 80 to 95). He was given a lot of sedation before hand with the hopes of keeping him as fussless as possible. He also had a LOT of junk in his lungs, but he's been coughing it up. So, Erik and I held him and sang and patted his butt, the RT suctioned him and managed his O2 requirements, and the nurse helped calm him and the doc patiently waited to see if Emery would calm down. I could feel the moment when there was consideration of reintubation, but he was given a chance and is now over 7 hours off of the vent. Basically, Emery is fussy and uncomfortable so they are keeping him sedated around the clock and hope that he will adjust to the tube down his nose as opposed to his throat. Keep him in your prayers. Each time he gets fussy and angry he desats, but at one point the RT commented that he had surprisingly good reserve because he would desat and then come back up. He's been maintaining good saturations with fairly low oxygen requirements, but he's on about the highest settings that CPAP will allow, so if he doesn't tolerate this it's back to the vent, but for now he's already past the last time he was off. Dr. Winder said that any time off the vent is great because it helps strengthen his muscles of respiration. I can't tell you what Emery's long-term plans are, because right now everyone is very focused on the short-term. If he is reintubated he will go the jet ventilator, which is high-frequency ventilation (more gentle) and then to let him grow a bit more, do another steroid burst, and try to get him off the vent again. If he stays off, well then, we still let him grow. He's got a long way before he can make it to an O2 cannula. Before Emery was extubated Erik and I placed our hands o
n Emery and prayed to God to heal his lungs, to give him a chance. We do know this, Emery's lungs can work and do with a lot of help. Throughout the whole thing we continued to pray and God seems to be answering our prayers.
ns for Emery. First, his feedings were cut back from 34 mL every 3 hours to 30 mL every 3 hours to keep him fluid restricted. The plan is to fluid restrict him, continue once-a-day steroid dosing after his last dose at 3 a.m. Monday, which means he'll recieve one dose Tuesday, one on Wednesday and one on Thursday. Then, the hope is to get him to inhaled steroids IF he stays off the vent. They said Emery, again, has a 50/50 chance of making it off of the vent, soooooooo Emery was extubated at 2:50 p.m. today and is still off the vent as of right now at 10:10. As we all know, he only made it 4-1/2 hours the last time with bad blood gases. This time he's tolerating it slightly better. His CO2 was 59, which is really good for him. Now, the tricky part. One of the reasons 
Emery failed off the vent last time, besides the obvious that he wasn't ready, was because he got so angry he finally couldn't handle it. Today, when they extubated him and put the tube in his nose, he got equally angry again. So much so that there was a point that he almost got reintubated. He cried so much and became so fussy that he desatted down to 48 (his goal is 80 to 95). He was given a lot of sedation before hand with the hopes of keeping him as fussless as possible. He also had a LOT of junk in his lungs, but he's been coughing it up. So, Erik and I held him and sang and patted his butt, the RT suctioned him and managed his O2 requirements, and the nurse helped calm him and the doc patiently waited to see if Emery would calm down. I could feel the moment when there was consideration of reintubation, but he was given a chance and is now over 7 hours off of the vent. Basically, Emery is fussy and uncomfortable so they are keeping him sedated around the clock and hope that he will adjust to the tube down his nose as opposed to his throat. Keep him in your prayers. Each time he gets fussy and angry he desats, but at one point the RT commented that he had surprisingly good reserve because he would desat and then come back up. He's been maintaining good saturations with fairly low oxygen requirements, but he's on about the highest settings that CPAP will allow, so if he doesn't tolerate this it's back to the vent, but for now he's already past the last time he was off. Dr. Winder said that any time off the vent is great because it helps strengthen his muscles of respiration. I can't tell you what Emery's long-term plans are, because right now everyone is very focused on the short-term. If he is reintubated he will go the jet ventilator, which is high-frequency ventilation (more gentle) and then to let him grow a bit more, do another steroid burst, and try to get him off the vent again. If he stays off, well then, we still let him grow. He's got a long way before he can make it to an O2 cannula. Before Emery was extubated Erik and I placed our hands o
n Emery and prayed to God to heal his lungs, to give him a chance. We do know this, Emery's lungs can work and do with a lot of help. Throughout the whole thing we continued to pray and God seems to be answering our prayers.
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