Wednesday, 3/30

Whew. A big day today! Dinky had his bronchoscopy which took about an hour and a half. He was fighting the procedure so they had to sedate him quite a bit. Poor thing was out of it the rest of the day. The "bronch" did give us some new information which will hopefully be helpful in getting him off this ventilator! I will try my best to explain it...

1. A "pouch": At the area near where they fixed his fistula (the connection between his trachea and esophagus) there is a little "pouch" into which air goes rather than traveling on down the trachea into his lungs. It's a "waste" of air because it pools in there, along with secretions, making it harder for him to effectively breathe. So, they pushed his ET tube down below this pouch so the air won't continue to hang out in that little pouch.

2. A lot of secretions: Another feature of the bronchoscopy is you can suction out secretions more deeply than you can with other techniques. She was able to get out quite a bit so this really cleared him up.

3. A collapsed bronchus. A bronchus is "one of the large air tubes leading from the trachea to the lungs that convey air to and from the lungs. The bronchi (the plural) have cartilage as part of their supporting wall structure". So because his bronchus is collapsed, air has a very hard time getting to his left lung. Therefore, his left lung is almost always in some state of collapse. So, they have increased the pressure setting on his ventilator and made several small changes that will try and keep this bronchus open. The goal is to "mechanically" keep it open until his cartilage is repaired enough that it can sustain it on its own. If this doesn't work (they couldn't give us a time frame on how long it might take) he'll need a "stent" placed. This is basically a piece of plastic that would keep the bronchus open allowing air to fill up the lungs.

Whew! So there you have it. I have to say it was pretty remarkable the change in him after this procedure. Before the "bronch" his left lung was almost comletely collapsed. Shortly after the bronch it was completely open. He probably had one of the best x-rays he's ever had. He was also at 98-100% (his oxygen saturation rate) with only 21-25% oxygen. That's quite a change!

Another exciting thing (maybe) about his x-ray is that his diaphragm appeared equal on both sides. Remember that the rigth side of his diaphragm is paralyzed so it has consistently appeared much higher on the right. It could just be the timing of the x-ray but there is that small chance that the nerve that controls the diaphragm could regenerate so we're hoping that's what we're seeing. As the doctor said, "He deserves a break", and this would certainly be a major one. We'll keep our fingers crossed.

Tomorrow he will go have "dye studies" where they will put dye down his esophagus and "trace" it to make sure there's not another connection like the one that was repaired right after birth. This will be another "field trip" as he has to leave the unit to have it done. The procedure itself should be pretty minor but this "trip" is always a bit nerve-wracking.

I know this has been long, but it was a long day :) Hopefully we are coming up to the corner that we really need to turn!