When I left the NICU around 5pm last night Gabe's CO2 levels were beginning to rise a little and he was starting to show signs of labored breathing. Nurse "C" and I discussed two possible causes for this; the first, they lowered his vent settings a bit earlier in the day, so perhaps his lungs were having to work harder to get used to these new settings (that require his lungs to do more of he work) causing his CO2 levels to rise a bit. The second thought was the left chest tube, wich came out early AM on Tuesday, would need to be replaced because there was still fluid and it was beginning to build up and put preasure on Gabe's lungs.
When Jesse arrived this morning Gabe's numbers were not good and his breathing was very labored. He was also requring extra doeses of sedation/pain killers. Something he has not needed in several days. This mornings X-Ray showed fluid in the left plural cavity. It was decided that the left chest tube would need to be replaced. Early this afternoon the team came in and put the chest tube in. Instantly fluid started coming out. Hopefully this will do the trick. While there, the team put some TPA in the right chest tube to try and clear it out because it appeared to be clogged.
GI came up this afternoon and spoke with Jesse about trying an ultrasound and MRI to see if they can figure out where the leak(s) in his lymphatic system are. They feel it may be coming from him abdomenal area and then moving into his plural cavities. An ultrasound was done this afternoon (should have results by tomorrow) and we are still waiting to hear when G's MRI will be. Finding the source of the leak(s) may not change the course of action, we may still have to wait-it-out, but it may provide more info as to why it's leaking.
You may notice, in today's pic, that Gabe is looking a bit puffier (you can always see it in his face first). This is most likely due to the FFP he is receiving. He is not inflating as quickly as he has in the past, which is a good thing, but puffing is puffing, and it is really a bummer to see this happening again. I'm not sure what Dr "B" and NNP "A" have decided to do in regards to his Albumin levels, FFP and him puffing. I believe this issue is still out on deliberation. Another thing you will notice in today's pic is Gabe's left arm is not in his usual "muscle man" pose. Thank you nurse "L" for working with Gabe today and getting those arms stretched out. We would also like to thank OT "A" for coming down every day to work with Gabe and his mobility. The poor little guy is so stiff from not really moving since the day he was born. Hopefully with everyones hard work we can get Gabe's arms and legs more mid-line, opposed to the "frog" pose they have been in. Also, fingers crossed his hand splits will help to straigen his wrists and hold his fingers properly.