3/29

There are some updates from the last few days. Tuesday, John was off the vent for the first time; he was off 6 hours. Wednesday, he was off for 13 hours and then on pressure assist where he is doing most of the work for the entire night. He had a lot of secretions and needed a lot of treatments. That all translated into him being very tired; his CO2 levels were also higher than they should be. The respiratory tech thought maybe he had to spend a little too much energy this early in the weaning process so they backed off yesterday and put him back on assist control where the ventilator is doing most of the work. Today, he is on pressure support and if he handles it well, he will go on the trach collar (off the vent) later. The nasogastric tube had to be reinserted twice in the last couple of days so John hasn't been fed for a while. His belly is also distended so the new nasogastric line can be reversed to let the built up gases push out some of the stomach contents. This should help at least a little. The arterial line isn't working well; this is where the blood is drawn for arterial gases and it is also used to monitor his heart rate, pressure and respirations so it is important. All of his other attachments seem to be functioning for the moment. One of John's recent upper respiratory cultures grew pseudomonas. Infectious disease is satisfied with his coverage (amphoterecin and pociconazole) for now. This could be a hospital acquired organism;it doesn't seem to be causing any problems so no new meds are being added. That can all change later if he starts having fevers or other positive indicators. Vancomycin and meropenum have been discontinued. John's lungs sound better (for him) and clinically he looks like he is making progress. There won't be a cat scan for a while to look for visual confirmation of improvement. He was quite awake, cooperative and comfortable this morning. We looked at some of the short videos, emails, picture attachments,cards and photographs that many of you have sent. Thank you! John was able to concentrate and respond with nods. The team had to use a little ativan when they inserted the nasogastric tube a little while ago so right now he is asleep. Renal is happy with John's abiity to maintain his pressure off medications for many days now and with his general improvement. For now, they are continuing the continuous dialysis but will reassess on Monday to decide if he is ready to try the intermittent dialysis. PT has been working on range of motion with John for the last several days; it is possible to envision a day in the future (not the immediate future) when John could be out of bed in a chair. The CMV numbers have started to climb again; they went from ~ 1100 to 1800; John is on foscarnet every other day so we'll see what, if any, adjustments need to be made. All in all, I'm happy to submit a pretty good report for the last couple of days. Have blessed holidays and please keep sending your good thoughts and prayers.