Today has been a stressful one in terms of planning for coming off ventilation.
The day started with the plan to extubate Thomas. He was started as nil by mouth from 6am ready to extubate at 10am. After a lot of waiting around, it was decided at 3pm that he wouldn’t be extubated today so was started back on his feeds again.
At 4pm, his consultant came to give me the findings of the bronchogram, where she told me that unfortunately Thomas has suffered from something called ‘diaphragmatic palsy’ where basically his phrenic nerve running to his diaphragm was accidentally ‘nicked’ during his heart surgery, causing the left side of his diaphragm to become paralysed. This can only be corrected in surgery, called a diaphragmatic plication, so I consented for him to have this.
They have a slot in surgery available for tomorrow so he will be having it done then. The surgery should take about 2 hours where they will pull the diaphragm down, and stitch it to itself to make it tighter so it should be able to allow his lungs to fill more easily.
Not what I expected to be doing after such a calm and settled day.