When Trish told me she went ahead and bought an extended parking pass here at UCLA last week, I wondered whether it would be cost-effective. Well, turns out it was as we’re going to be here a bit longer. Rudy’s o2 sats have continued to be low throughout the day and he hasn’t been able to wean off of oxygen. The culprit is atelectasis, a fancy word for a kind of partial collapse in his lung. Not as scary as it sounds, but it really would be best to send him home breathing room air (21% O2), he’s at 30% right now.
The best theory I’ve heard for the pathology of this is that he very likely had some kind of virus (indicated by high fever) which ran it’s course but left him needing to recover his respiratory function. Dr. Mary said that the average baby is sick 40-50% of their first year with some kind of bug or another, but since Rudy is a bit compromised they can upset his system more than normal kids. In addition, the trach doesn’t allow him to maintain pressure in his lungs like the rest of us can, so this can cause some of those small passages in the lungs to close down. But all of them need to be working to bring sufficient oxygen into the blood.
The good news is that Rudy doesn’t appear to need a major intervention (like the vent) to push air in. He does get regular breathing treatments and suctioning, but the key treatment is known as “Chest PT–Q3”. Bypassing all of the sophisticated technology and highly trained people here in the ICU, Chest PT is essentially the act of playing the bongos on Rudy’s chest and back for five minutes every three hours to loosen up his lungs. I politely listened while Nurse Carlin gave me my orientation and was pleased with how quickly I caught on–there’s even a rubber percussive thingy I can use if I want to change up the sound. Rudy actually really likes it and just lays back and closes his eyes while I thump around. So far there isn’t a written policy about impersonating Ricky Ricardo, but if I keep it up it may fast become a guideline. So, this is how we will combat our newest foe: Atelectasis, you have met your match–Babaloo!!!!
It’s just past 9PM on Monday and I’ll give Rudy his night bottle and then make the drive home in order to change assignments with Trish. Please pray that we’ll get over this hiccup and be back together at home again soon.