Day 63 - First Bath and Onezie! - Busy Day!!

Wednesday, March 3rd, 2021

Lots of photos and videos today!

Current weigh-in tonight: 2010 grams (4lb 6o

z) 💪👶

✔️ First Bath: Today James received his first bath given by Mom, his primary nurse, and a respiratory therapist. He really loved it and definitely was kicking his legs! It probably felt like the womb, except with a lot more room.

✔️ First Onesie: After Jimmy's bath, we picked out his first outfit. Actually the only one that fit was his smallest one! Thanks Tierra for the adorable little outfit! A tiny little onezie with micro-preemie pants. 

✔️ New Neobar: James also got his ET tube guard changed, which is great because it was pinching his little cheeks. He is growing everyday!

Today's Goal: Decrease his FiO2 and ventilator settings. Right now he is at 50 FiO2, with a peep of 11, a rate of 22, and a leakage of 75%. 

What that all means...

• FiO2: Defined as the concentration of oxygen that a person inhales. Ours is at 21%; his is 50%, so that he can reach that 85%-95% O2 range. We as adults normally breath closer to 100% but since his retinas are still developing studies have shown that keeping the O2 range lower than 100% will help the development of the eyes. 
• Peep: PEEP maintains the patient's airway pressure above the atmospheric level by exerting pressure that opposes passive emptying of the lung. Peep in layman's terms is the pressure. We would like to get this number down lower. Last week we tried 10, but that was short-lived and we are back up to 11. Although there have been cases where babies are put on a CPAP at a peep rate of 9 or 10, it is still very high and they would like that number to be lower.
• Rate: Right now his rate is at a 22 which was just recently increased today to help release the CO2 in his lungs. His blood gases have been increasingly higher, which means carbon dioxide is not being released. Carbon dioxide can be released through the lungs by breathing and also by the kidneys through urine.
• Leakage: Due to Jimmy's growth his current ET tube that provides oxygen is getting too small for him.  He graduated from a 2.5 to a 3.0 a few weeks ago but he has been growing everyday. He is currently in between sizes. 

Long-term Goal: To get the ET tube out and move to a CPAP machine. 

Obstacles ahead but possible opportunity: Right now, James is not ready for the CPAP according to his numbers. The ET tube is too small for him causing a leak and he is in between sizes! He has a very large leak, sometimes up to 80%. However a very positive take away from this is that although the ventilator says he requires an FiO2 of 50% he isn't really getting all that with an 80% leak. When the time comes when he gets upsized to a larger ET tube he will get a chance to have a CPAP test. This means, the tube is taken out and he is put on a nasal cannula. If he fails, they will intubate him and just put in the larger ET tube.

The hope is that he gets on a CPAP and shows everyone that he is actually doing better than these numbers show! 

What the leak sounds like...