Aubrey and Paige: Days 6-8 - January 29-31, 2013

Sorry to combine days, but I don't remember what happened when. Let's talk about ventilation for a little bit. Both Aubrey and Paige were intubated with size 2.5 breathing tubes. There was substantial leak around each tube because they were a little bit too small for the girls. Aubrey was having a hard time maintaining oxygen levels, so the decision was made to re-intubate with with a size 3.0 breathing tube. Dr Sebald did this during morning rounds, so when the buzzers and alarms started going off during the re-intubation (buzzers and alarms are always going off, no matter what is happening), there were like 4 other doctors, 10 nurses, and like 5 respiratory therapists that wandered over to see what all the sound was about. According to Dr Sebald, it was a simple procedure; the crowd made it appear like Aubrey was on the precipice of the death. I think Dr Mir saw the concern in me generated from the large crowd, so she started to quietly shepherd out everyone that wasn't needed. I appreciated that.

The bigger breathing tube in Aubrey fixed the problem with the leak, but her oxygen levels still weren't behaving. The doctors made the decision to take Aubrey off of the conventional ventilator and place her on a high frequency oscillating ventilator (called an oscillator or HFOV for short). Sorry about the wikipedia link, but it describes it the best based on my short google search. If you don't feel like reading that link, I'll briefly describe. Oscillators differ from normal ventilators in that instead of producing the normal air in, air out at a normal breathing rate (around 40-70 in babies), they cause very fast, very small breaths, up to 900 per minute. This causes air in the lungs to be agitated around. Oscillators do not cause lung injury like regular ventilators, so they are considered to be lung protective. However, they do not allow the girls to breathe normally.

Once Aubrey was placed on the oscillator, her oxygen and other blood gas levels got a lot better.

A couple days later, the leak around Paige's breathing tube became pretty bad, so they gave her a size 3.0 tube. She was also eventually place on an oscillator, and her blood gas levels have improved since then. Because the oscillators are doing 900 breaths per minute for both girls, their bodies shake like they're on a vibrating bed. Both of their lungs have been looking better in X-rays since they were placed on the oscillators.

It's picture time after all that reading. Here's a picture of Paige right after her eye mask was removed one morning.