Atelectasis...?

As usual the recovery from CDH is a rollercoaster.  Goods days followed by scary days....and this week was no exception!  The night after being extubated and officially weaned from her pain meds and sedation completely, Makenna had a very rocky night.  She began throwing fits and became inconsolable (possibly as a result of withdrawing from the medicine).  The nurses tried everything, but they just couldn't get her to calm down.  With a healthy baby, this wouldn't be a big deal, but Makenna's lungs still didn't have the strength to handle crying for extended periods of time.  Her SPO2 sats began to drop and her rate of breathing began to increase.  A healthy baby might breathe 30 to 40 times a minute, whereas a baby with lung issues like Makenna is expected to breathe faster (about 50 to 60 times), but she was actually breathing between 100 to 130 times a minute. 

They ordered an X-ray to see what was wrong and realized that her left lung (the "good" lung) was experiencing "atelectasis," aka it partially or fully collapsed.  They said that most babies get passed around a lot and experience sitting and laying in different positions (in swings, bouncers, car seats, etc.), but sick babies spend a lot of time laying in one position, especially when they've been on ECMO for 1/3 of their life, so it is not unusual.  They also said that her good lung had to work harder to compensate for the other lung and that puts more strain on the lung which can make it get tired and stop functioning correctly.  They began patting her on the back every few hours and using a vibrator to shake her lungs.  They also started positioning her mostly on her right side to relieve pressure off her left lung and set her comfort flow to 4 liters (this provides a flow of air to help keep her lungs open).  I helped by holding her a lot and keeping her as calm as I could so that her lungs could concentrate on breathing, rather than recovering from being worked up after fussing and crying. 

By the next morning her stats were back up and her respiratory was a little lower (in the 60 to 70).  There amazing techniques worked again!  Makenna is so lucky to have such an amazing staff taking care of her!