ICU Day 71 – Breathing Trials

I really really really, really hope that last Saturday was the lowest point in her recovery, when the doctors asked us if we want to keep going. Since then Rachana has made a remarkable comeback.  She’s not out of the woods yet but is progressing quite well.

Early this week her CO2 came back to near normals levels and she started being more awake. Then as her numbers started looking better, the doctors started to slow down the ventilator settings and her sedatives. By Tuesday, she was looking quite stable and I decided to spend a night with the kids. The next morning she was almost fully awake and was actually talking.

The trach has a balloon that tries to seal the windpipe to let the ventilator be in control of how much air goes in and out of her lungs. But in Rachana’s case, she has an air leak around this balloon that’s allowing some air to escape. The doctors tried a different size trach and also tried over-inflating the balloon to see if that help but they were fearing damaging her windpipe by doing that. They finally decided that they were ok with the air leak and that was a blessing in disguise. The leaked air was enough to travel to her vocal cords, allowing her to actually talk and not just mouth words. And boy did she want to talk! Initially she had some delirium from all these weeks in a room, not really knowing day from night and the medicines. She was seeing and imagining things, was constantly asking me to do stuff for the kids, wanted to get up and leave, and was asking the nurses to do stuff. This took a couple of days to slow down and now she is more aware and mentally more stable.

On Friday, the doctors wanted to do a breathing test and she flatly rejected it. She was scared of not being able to breath on her own. They cancelled the test and said they’ll try again the next day. One of the respiratory therapist here was helping me understand how truly frightening this could be for her. He was saying that there is nothing more scary than not being able to breath, while being aware of it. Imagine that, you wanting to breath and not being able to. That is the fear Rachana has to overcome, in her already fragile state. It’s good that she was feeling better and talking, so I spent some time negotiating with her about the breathing test and how soon she could be home if she tries this. I assured her that she will be safe and if she feels uncomfortable, we’ll end the test. She agreed to try it on Saturday morning for 30 mins. The ventilator was switched to a ‘spontaneous’ mode that allows her to breath on her own, while the ventilator assists a tiny bit. She did well for 30 minutes, then an hr, then two and just kept going for 4.5 hrs. The doctors were impressed but stopped the test to make sure she was not overly exerted. She was probably using some of her muscles after a long time, was exhausted and just slept for most of the day.

The doctors are very encouraged with her progress and say that if she keeps up with this trajectory, they can start thinking about removing the ventilator during the day and let her breath with some assistance using a O2 pipe around her neck. We are probably a week away from that. The only setback this week was fever showing up again. She was detected with e-coli but the doctors are not very worried about keeping that under control and hope to have the fevers subside in 2-3 days. If the fever persists beyond the next few days, then we might have a problem that needs more digging.

Compared to last week, this week was fantastic!