10/25/06 - NICU Day #23

Nurse: Melissa, Maria

• Another eventful morning.
• Relatively stable overnight but the urine output tapered overnight along with Daniel's blood pressure. The team added back dopamine, increased his intravenous fluids, and restarted intravenous feeds. The potassium is 4.3 and the creatinine is 4.0.
• No bleeding. His platelets are 218 and hematocrit 38.
• He had a tension pneumothorax on his 7 AM film that did not respond to replacement of one of the chest tubes. After the chest tubes were retracted a little bit, the air collections drained. His FiO2 is down to 50%. If they can get him to 40%, then they will slowly wean the nitric oxide.
• Between 9:30 and noon, several changes were made. He was put back on the oscillator -- his "favorite" vent. He seems more comfortable on it. The mean airway pressure is being kept as low as he will tolerate (13) to try and give his lungs a rest. The dopamine was increased to 10 mcg/kg/min and his fluids were increased again. His nurse will monitor his blood pressand urine ouput and try to wean the dopamine.
• There is some concern that there may be a broncho-pleural fistula. Hopefully, if the current chest tubes will keep the lung up and the oscillator keeps the damage from getting worse, his lungs will heal without another intervention.