Brody is still in the ICU tonight but he is making progress

Brody is still in the ICU tonight.  He is still battling increased heart rate and still needs the BIPAP to help him breathe.

His blood pressure is much better today and has been normal for most of the day.    It improved fairly quickly after he got the hydralazine (a vasodilator) last night.   He isn't expected to need additional doses of the hydralazine at this point.   

The ICU team is still working towards correcting Brody's fluid imbalances.  His heart rate has improved since increasing fluids.  He still has a lot of edema and his albumin is low.  The increased fluids is helping to increase his blood volume.  He will start getting albumin soon too to help draw fluids back into the blood vessels where it is needed and help to improve the edema too.  It's normal to have a lot of edema following a major surgery.  They are being careful to not give too much fluids and potentially worsen the edema but giving enough to help increase the blood volume enough to keep him stable.  The amount of fluid he is losing through his NG tube is being tracked in eight hour time periods.  Then fluid is replaced over the next eight hour time period at an amount of half of the amount he is losing through the NG tube.  He also receives additional fluids on top of this that would normally be given to maintain euvolemia in patients not able to eat or drink.  (Euvolemia = normal blood volume).

The low albumin is also an indicator that Brody is malnourished.  He has not been able to eat or drink for about a week now and has been through major surgery.  He was started on a TPN today to provide him nutrition via IV.  

Brody had an X-Ray this morning that showed he has a partial collapsed lung (atelectasis).  We aren't sure what caused this but it is a common complication after surgery.  The atelectasis is part of the reason he is needing the BIPAP to help him breathe.   The pain medications have also contributed to his difficulty breathing.  Today he has been weaned off of his basal morphine.  He is only taking it in small amounts as needed now.  He is finding it easier to breathe since doing this.  He does not have pain anymore when just lying in bed.  He takes some morphine when he needs to move etc.  Now that his breathing is better and his blood volumes have improved, he is just being started on a drug called Precedex (dexmedetomidine).  This medication helps to keep him sedated and calm without depressing his respiratory function.  It's hoped that with this medication he will be more tolerant to switching to CPAP rather than BIPAP.  The CPAP provides a continuous pressure whereas the BIPAP delivers different pressures for exahale and inhale.  Brody was tried on CPAP earlier today.  He was very intolerant of it and caused him a lot of anxiety feeling that continuous pressure.   Since the CPAP machine provides continuous pressure, he would need to work harder on exhales.  It's hoped that with the CPAP if he works harder on the exhale that he will open his lungs back up.  Hopefully, with this medication on board Brody's second attempt to start on the CPAP will go better. 

Brody's number one concern is EXTREME thirst.  Unfortunately, he is not able to eat or drink yet.  He is allowed to have a mouth swab every 2 hours.  This is nowhere frequent enough for Brody nor close to thirst quenching for him.  Almost every word he has spoken today is a request for something to drink.  We keep letting him know that we want to let him have a drink but cannot do so.  We let him know the reasons why and that he is getting better and will get to drink normally again.  He calms down each time eventually.  But then a few minutes later the whole requests and explanations as to why he can't drink start all over again.  He is exhausted.  He keeps falling asleep but repeatedly keeps waking back-up every few minutes asking for something to drink.  It's heartbreaking to not be able to give him something.  He is far more frustrated and angry about the not being able to drink nor even swab his mouth when needed than anything else. 

It's been a long and difficult day.  We are getting through recovery from the surgery one step at a time but are certainly looking forward to being through this ordeal.  We are thankful that he is improving and making progress on being able to transition out of the ICU.