Sunday, March 1, 2015

PICU Update

Last Thursday evening, FG was admitted to the hospital with RSV, bronchiolitis, a partially collapsed lung and a whole list of "could be, so we'll treat for it to be on the safe side" illnesses.  Initially put in an isolation room on the regular Pediatrics floor, the first several hours of treatment and attempted stabilization demonstrated that FG had a greater need for external support than the wing could provide and necessitated that he be transferred to the Pediatric Intensive Care Unit.  Moving over here first thing Friday morning, we've been camped out here ever since watching his little chest rise and fall.  I have yet to leave his side for more than the occasional trip to the bathroom (which is soberingly located over on the Pediatric Oncology Unit) while HB has made the long trek home a few times to check on Grandmama, GW and GV.  They, thank God, are hanging in tough with support from some wonderful local families (SP, you are an angel), but it's tough explaining to them what's happening here as things with FG are still quite tenuous. 

Beginning his treatment with 8 Liters of heated, humidified High Flow Therapy at 40% FiO2, the PICU Intensivists have explained that it's still too early to know where FG is in the 10 to 14 day life span of the Respiratory Syncytial Virus.   Knowing the worst symptoms typically come between days 5 and 7, the doctors are unsure if he's past the peak and will remain as he is for a few more days before progressively getting better or if the worst is yet to come...  as he is currently maxing the High Flow treatment option, we're playing the high stakes game of wait-and-see if escalation to the CPAP (Continuous Positive Airway Pressure) mask or intubation becomes necessary over the coming days. In the mean time, the doctors have started an EZPap therapy that uses positive airway pressure to force lung expansion and reinflate his collapsed lung as well as an almost constant routine of nasal and deep suction to remove excess mucus. You can imagine how miserable both of these treatments make FG... poor little guy.

We're also struggling to keep his feeding tube accurately placed in his stomach.  His many leads prevent him from wearing the hospital's mitten-onsies and, with his fingers exposed, his comfort position of his fists near his cheeks enables his ninja-like paddy paws to pull both the cannula from his nose and the feeding tube from his stomach.  And while I'm concerned about the bright red, raw color of his cheeks from the abrasion of his cannula's adhesive, the constant delivery of oxygen and his ability to stay hydrated and nourished trump the superficial irritation and have required some ingenuity with socks and careful use of A & D Ointment to address all of these concerns.  I'm sincerely hoping that the socks will at the very least save him from the unnecessary discomfort and additional radiation needed to insert the feeding tube for the fourth time.

One bit of good news at this point is that the final results of the spinal tap culture came in earlier today and the doctors now know that he is not sick with bacterial meningitis as they initially feared.  As illnesses of this kind of severity move incredibly quickly in babies this young, the ER doctors didn't want to loose critical days waiting for the results if the tests had been positive so they'd placed him on a multi-day course of a broad spectrum antibiotic that would kill any and everything that could possibly be making him sick.  As we're now certain the cause of all of this is viral, I'm thrilled he'll be skipping the next couple doses of medication as only time will tell how his body and the good bacterial will respond to such strong antibiotics.   

More to follow.  

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