Well, That was Interesting

Ginny had a good night last night. Starting with evening rounds,  we began reducing the amount of support on the ventilator to eight breaths per minute,  and we reduced the NO from 20 to 10 ppm, with instructions to reduce by two ppm every few hours. By the time morning came around,  she was down to two ppm NO.  The secretions in her lungs were breaking up and coming pretty easy when we used suction.  Her oxygen saturation was sitting nicely in the low 90's. We almost thought we could start preparing for extubation. (We'll have to adjust her meds for 24 hours before we can discontinue her sedation.) And then....

Ginny decided she wanted to make things interesting. At 5 a.m. Ginny got her dose of viagra for her pulmonary hypertension.  (You try explaing to your insurance company why you're giving a man-sized dose of viagra to a 3 year old girl.) At 6 a.m. she got her diuretic.  Before 7:30 she had loaded two diapers (just wet). By 8 o'clock, all of her numbers looked good, except her blood pressure was dropping,  and approaching the dangerous range (like64/38...).  Some quick action by the PICU nurses and ARNP to get her some fluids and adjust her meds, and we were back in the green. Kind of a scary 45 minutes or so.   (Not kind of... it was.)

Rounds went well despite her antics.  We are weaning her sedatives, reducing ventilator support to 6 breaths per minute and getting rid of th nitric oxide altogether. (It's called babycrack for a reason.  She might need a little blow now and then before she kicks it.)  It is likely that we are 24 hours from extubation.  That is, if we can get her to stick to the plan.