Doing Well

Nicholas has been on SIPAP for 24 hours and with the exception of 2 spells he's doing very well.  He had the 2 spells last night but his nose piece can't be put on his face tight and any time he picks his head up there's a chance it won't be on his face properly.  His nose piece can't be put on tight because that can break down his skin and could cause him to bleed.  It also can't be too loose because it needs to have a good seal.  Dr. Harlan said Nicholas will be on SIPAP for today and tomorrow (Sunday) and if he continues to do well they'll consider trying him on another device Monday.  His nurse thinks he will go to a nasal cannula.

Dr. Harlan also said that if Nicholas were to have any lung related issues they would've already happened.  Dr. Harlan is just hoping that Nicholas doesn't have any moments of apnea (which would just take time to get over if he does).

Nicholas' oxygen is currently at 30%.  Yesterday, when I went in the afternoon, he was at 41%.  The fact that they're able to wean him down is a good sign.  His pressure will be what dictates how quickly he goes from SIPAP to the next step. 

Here is the order they go in to determine what settings to use:

1. They turn down his oxygen.
2. If his saturated oxygen stays around 92-95% for long periods of time they turn him down some more.
3. If his oxygen goes below 40% they start to turn down his pressure.  When that happens his oxygen need may go back up because he's getting less support but usually he adjusts and they wean the oxygen back down.
4. Every 12 hours, sometimes sooner sometimes later, they give him a blood gas.  That shows the doctor and nurse if he's at the correct settings for his current needs.
5. These steps are repeated and tweaked until it is determined what type of support and what machine he needs.