Day 25: Bye, Bye Breathing Tube!

Vivienne was extubated this morning! The process itself was quick, but the transition was rocky. Viv's team decided to put her on a CPAP. Like a ventilator, the CPAP is able to deliver air pressure; however it doesn't breathe for her. Viv was guaranteed 20 breaths a minute on the ventilator, but she's on her own now. The team will be monitoring her respitory rate to ensure she's not working too hard. There is still a slight chance of having to intubate her again if things don't go smoothly, but it is unlikely (knock on wood).

The moment of extubation was both exciting and scary. We hoped she would do well, but she did end up having some issues. Her breathing was labored at first and she was having trouble dealing with her secretions. Viv has always had a lot of secretions in her mouth and lungs and required a lot of suctioning when on the ventilator. Now that she's extubated, she has to deal with those secretions on her own. This was problematic since she never really learned how to swallow. The first few hours after the tube was removed were full of choking, gagging, and crying.* Eventually she seemed to get the hang of it and was able to calm down.

The team decided to initially put her on a ram cannula CPAP:

Yay for being able to close my mouth and see my face!

However, her inability to calm herself and deal with her secretions led them to switch over to a mask CPAP:

Just kidding about being able to see my face, but I can still close my mouth!

Obviously the ram cannula is the more fashionable and comfortable option. Viv wasn't a huge fan of the mask, and it took her awhile to get used to it. Hopefully she can quickly wean off of it in the next few days and get back to the cannulas.

Eventually the CPAP will be replaced by regular high flow cannulas until she is either completely weaned off of all support or is sent home on oxygen if she can't be weaned completely.

Overall it was a very exciting day, and we think Viv enjoyed life without the breathing tube once she figured things out.


* Her vocal chords and throat are swollen, so she won't be able to vocalize fully for a few days. She sounded like a quiet frog during her many crying fits, though she was able to let out a few adorable coos during her happy moments.