great news, some explanation of the vent, and a first bath!

We have excellent news! Thank you, Jesus!!! Carson's liver ultrasound came back completely normal. All the vessels in his liver are patent (open) and have no evidence of any clots. The size of the liver has also normalized and is no longer enlarged. YEAH!!!! We are so thankful for this news. The neonatologists believe Carson no longer needs his Lovenox (the shot he gets every day to prevent the clot from getting bigger). We are so thankful because it is hard to watch the little fella get a shot each day. There was some talk of continuing Lovenox for 6 months as a precaution, but as long as it is safe for Carson, we would love it for there to be no more shots. 

The kidney ultrasound was completely normal as well. His tumor markers have gone from 3,000 to 300 now, so this is also fantastic news indicating no recurrence of the tumor.

As mentioned his blood gas was very good on Friday. As of right now, Carson has a rate of 5 on his ventilator, PIP of 24, PEEP 6, and PEEP plus of 8. His oxygen is at 30 to 35%. 

Ignore this if you don't care or already understand, but I have had several questions about what all this means on the ventilator. The rate of 5 is the number of breaths the ventilator gives every minute and each breath the ventilator gives is a pressure of 24 (PIP). Carson is breathing between 60 to 70 times each minute, so only 5 of those are fully from the ventilator. The doctors are just weaning the rate and when it gets down to 0 then the PIP won't matter because he won't have any ventilator initiated breaths. The other breaths Carson initiates, but the ventilator still provides support through the PEEP and PEEP plus. The PEEP is the peak end expiratory pressure (pressure left in the lungs at the end of exhalation) and makes sure Carson maintains open alveoli (where oxygen and carbon dioxide exchange occurs in the lungs or little lung sacs). According to Dr. Yang, this should not be a problem for Carson, because Dr. Yang does not feel Carson will have any problems with the collapse of his alveoli. Therefore, we don't have to be as concerned with weaning the PEEP. The PEEP plus is the pressure the ventilator gives each time Carson initiates a breath (all but the 5 breaths the ventilator gives each minute). It just helps him get the necessary tidal volume in each breath, or in other words, a deep enough breath. Room air (what we all breathe is 21% Oxygen) will be the goal with Carson, but he is requiring 30-35% oxygen (not bad at all, considering), but they will keep weaning that as they are able.

The plan right now is to wean this afternoon to a rate of 4 and then tomorrow to a rate of 2. Then, the doctors will start weaning his PEEP plus again. This plan has changed multiple times, so we will see, but essentially the weaning process is focused mostly on the rate and PEEP plus. After they get to an appropriate level (not exactly sure where that is b/c it isn't set in stone, but more of an overall feeling that Carson is ready), they will either do CPAP trial or "sprinting". CPAP would be continuous positive airway pressure and can also have added oxygen. "Sprinting" is where they will do a trach collar (no airway support) for an hour at a time and then put him back on the ventilator at his weaned settings. Gradually as he tolerates it, they increase the amount of time on a trach collar and decrease the amount of time on the ventilator until you wean away from the ventilator entirely. I am unsure if you can add supplemental oxygen to a trach collar, but I would think you would be able to. Hopefully, that helps explain the weaning process a little better.

There will be another blood gas on Tuesday to see how he is doing (planned blood gases are on Tuesdays and Fridays). This could be a very big week for Carson if he continues to make the progress that he has the last couple weeks. We may get to try something other than the ventilator. We will just wait and see. Thank you from all of the Clarks and Bunches for all your prayers.

Kellen has his doctor's appointment tomorrow, Monday, at 2:30 PM to talk to Dr. Yang about a hernia repair. We will keep you posted.

Posted by Sarah

I'm not so sure about this bath thing here, Dad!
(Carson having his first bath)