3/30

Today started out well then went a bit downhill. John was awake this morning and got to see Michael and Meredith who have come to visit this weekend. John was on the trach collar for 7 hours today breathing on his own without the ventilator. As it turns out, when he gets tired, he isn't exchanging gases as well as he should. His CO2 levels went up and he was really knocked out. So, he is back on the ventilator on pressure support where he controls the rate of breathing but gets enough of an assist to help him breathe out the extra CO2. His pressure dropped quite a bit this afternoon so he is back on a pressor for a boost. The rate of fluid withdrawal through continuous dialysis was decreased and he received a 500 cc bolus of saline to help him get the pressure up. It is all working right now and he is awake again. The pseudomonas levels have increased quite a bit. Vancomycin is being restarted and additional antibiotics ceftab and amikacin are being added as well. Treatment with amphoterecin also continues for the pneumonia. The doctors feel dad's ability to breathe off the vent is a good sign that dad's original pneumonia is improving and they want to jump on this pseudomonas infection before it gets really established. John still has a distended belly but it is a little better with the reversed nasogastric tube and a med to reverse the sluggish effects of narcotics. A cat scan is still being considered to determine what is causing the blockage. No feedings until this problem is solved; in the meantime, John gets a banana bag every day - a liter bag of bright yellow fluid full of electrolytes and minerals. That's the news for today.