The day was moving quite well till around 6pm. Two nurses were cleaning and repositioning her when suddenly the ventilator started beeping a little more than usual. The ventilator was telling that the volume of air she was getting was in the 30s rather than the setting of 300s. The nurse also noticed that the windpipe was a little out of place. She quickly disconnected the ventilator and started manually using a pump and noticed that air was leaking from her mouth. That when the nurse said ‘She’s extubated, I need help’. In a few seconds there were 10+ people in the room, they pulled the tubes out, they put a large oxygen mask on her, were constantly looking at the numbers, and paged a few other doctors. A minute later a couple of others doctors came in, they spoke within themselves and then one of them escorted me out of the room to talk. He explained that her tube had to be pulled out as it got dislodged, her numbers were still ok without the tube so it was a judgement call to put a new tube back in or just leave her without a tube as she was breathing ok. They decided to put a new tube back in for two reasons, 1) She was partially sedated and not fully awake for a few days and there was a risk that she could choke on her spit, and 2) her ventilator numbers were at a point where she could get better on her own but there was a chance that she’ll need help a couple of days later and then they’ll have to put the tube back in and lose momentum from the past few days of progress. So, they temporarily paralyzed her and put a new tube in. The procedure was quick; but the 10-15 mins, where there were 10-15 people in the room, was intense.
In spite of the extubation and the re-intubation episode, Rachana still made some improvement today. Her ventilator setting went down further and now stands at 40% for O2 and 8 for Peep. Also they had switched off the sedatives around 11 am and she was without sedatives till the re-intubation happened. She was surprisingly calm all all; see was moving her hands and head and opening her eyes but not agitated or aggressive. It felt like she was hearing me and was calm. I’m hopeful we’ll continue to see the ventilator settings go down further the next two days and they might try a breathing test towards the end of the week.