Flach-ability: Extubate, good times, Come On!

PLAN OF THE DAY!!!!

No more breathing tube!!! He was extubated this morning and is doing great. He is on 2L of oxygen through a nasal cannula and is having no trouble! Last night they turned off his morphine and versed at midnight and to help keep him comfortable while those drugs cleared from his system, they wanted to use a drug that is quick on and quick off through the night, that way in the morning, when the appropriate people were ready, they can wake him up easily. This sounded like a much better option to me than just taking him off the drugs and letting him wake up and be pissed off and have an awful night fighting against the ventilator and the handcuffs and withdrawal. The only setback is that the drug is not recommended for PICU use, they often use it in the OR and on adults, but a study done 12 years ago showed that long term use of this drug in children can increase their chance of dying due to an imbalance (unbalancing?) in their pH. So I had to sign a waiver saying I understood the risks, which is a pretty unnerving thing to do. The doctor assured me they do use this drug in the PICU and have had no issue with it and that they would be keeping a very close eye on him. They would not let him be on it more than 12 hours. This is the exact type of situation that I am never prepared for, I want what is best for Thomas and what will keep him comfortable without compromising his safety or jeopardizing a different aspect of his many diagnoses. I like to know enough to question and understand why the medical teams choose various routes and recommend different strategies, but at some point, you just have to trust them and that is when it becomes scary. I am always reading about spina bifida, hydrocephalus, chiari, etc. and this helps me be prepared for what might come our way, but my darling little boy has really enjoyed forging his own path, so when something unexpected happens and I don't have any background on it, I just have to trust these extensively educated strangers to take care of my baby and I hate it. I signed the release. The propofol helped keep Thomas comfortable and lowered his heart rate to slightly lower than we would like, but other than that, he was fine. They turned the propofol off at 10:25 and it took him about an hour to wake all the way up to a point where they were comfortable to extubate him. As he woke up he was absolutely upset about his current situation and kept coughing and producing more secretions to be suctioned. We listened to our very awesome playlist that we have compiled from prior hospital stays as we passed the time waiting for the team to come in. I am convinced that helped!! He was extubated at 12:05 and has been coasting ever since!!