tuesday 7/23/2013

Ava has had a nice restful day today. She is completely off the vasopressin. The NICU fellow (a doctor in training after residency is called a "fellow") decided to keep her on the ventilator over night. However, Dr. , the attending, is on again tonight and he discovered that she was still intubated and didn't know why. He told the staff to extubate her. So they did at 11 pm (then called to tell me which made my heart jump since I don't usually get late night NICU calls). The nurse said Ava cried after extubation, which helped break up and clear some of the mucus in her lungs. So now she is on the high flow nasal cannula. We "pushed" to skip the CPAP and go straight to the high flow because she hates the CPAP set up so much. The nurse said she is doing great on the high flow, and now the challenge will be to wean the morphine, of which she has become kind of tolerant. Morphine levels, when intubated, weren't as much of an issue because if she were to stop breathing the machine takes over. She no longer has that safety net, so she can't be as sedated as she was. She might be a bit uncomfortable as the morphine is weaned.   Nurses heard bowel sounds today which means her gut is "waking up" and they may be able to start tiny amounts of breast milk again. Ava still looks "off" - kind of pale and swollen, but she has definitely improved. She is waking up occasionally and looking for stimulation.