Round two (a.k.a. PICU is the new NICU)

If you hadn't noticed from lack of blogging, life got a whole lot busier once Elyse came home almost five months ago now.  It has been wonderful watching her grow and thrive, and most days her time in the NICU is just a distant memory.  That was, until last week.

Thanksgiving weekend

 

Having an almost-three-year-old brother in preschool means that Elyse has already had her fair share of runny noses and colds.  But when this one progressed from runny nose to fever and laboured breathing in the span of a day, we decided to take her in to the CHEO emergency room to be checked out (just for peace of mind, we said).

They obviously don't mess around with breathing issues, because after checking in at triage we bypassed the waiting room altogether and saw our first doctor less than 5 minutes after that.  Since her oxygen saturation level was low, they started her on oxygen and gave a few epinephrine masks to help open her airways.  She was admitted for the night, and continued to receive epi masks and suctioning every few hours.

the first of many epinepherine masks

 

The next day, Elyse continued to require support to maintain acceptable oxygen levels.  She fluctuated between loving the mask and falling asleep, to fussing the whole way through -- definitely not a happy camper.  Because of her rapid breathing, she was taken off feeds due to fear of aspiration, which certainly didn't help matters.  Testing came back with a diagnosis of bronchiolitis due to Respiratory Syncytial Virus (RSV) -- a common virus which, in most people, manifests itself as a common cold but hits babies and preemies much harder.

the one upside: no roomates

 

When it became apparent that current procedures just weren't cutting it, they decided to transfer her down to the Pediatric Intensive Care Unit (PICU) for more advanced support.  There they started her on a CPAP machine, which maintains a low level of air pressure to help keep the airways open and make it a little easier to breathe (she had used one on several short occasions in the NICU as well).  She responded well, but needed a small amount of sedation to stop her from constantly trying to pull the mask off her face.  The benefit was that she was finally able to rest comfortably, which we were all in need of.

back on the CPAP machine

 

In true dramatic Elyse fashion, we were supposed to be leaving the next day for a very dear friend's wedding in Guelph, in which I was honoured to be a bridesmaid.  With Matt's support and blessing I was still able to make the trip, while he stayed at the hospital and provided lots of updates.  I knew she was in the best of hands, and it was a joy to be a part of their beautiful day.

The doctors warned us that RSV is a nasty virus that tends to peak between days 5-7ish, which certainly seemed to be the case over the weekend.  As she continued to fight the virus and the secretions in her lungs made it hard to breathe, her oxygen saturation continued to drop.  It was decided to switch her over to a ventilator and give her even more of a chance to rest and recover.  During the procedure a small amount of air leaked into the chest cavity, which required the insertion of a chest tube on either side to help relieve the pressure.

pumpin' ain't easy

After a day on conventional ventilation they then switched to high frequency oscillatory ventilation, which is what she is currently on.  She is completely sedated and receiving a plethora of drugs, most of which I can not even pronounce let alone spell -- there are sedatives, muscle relaxants/paralytics, a diuretic, steroid, and antibiotic, to name a few.  At last count there were seven infusion pumps running and a large collection of wires and tubes  -- an NG and NJ for feeding/venting, two chest tubes, three monitoring probes, pulse oximeter and CO2 monitors, temperature probe, central IV line, arterial line and of course all the ventilation equipment.  When they say this virus is nasty, they sure aren't kidding!
 

her current setup on the oscillatory ventilator

(with a picture from Emmett taped to the monitor)

The good news is that the doctors remain optimistic that although she is on the sicker end of the spectrum, it is not alarming or unexpected and she should make a full recovery.  Right now it's just a matter of waiting for her to turn that corner.  It meant a lot to us having so many people thinking and praying for Elyse the first time around, if you have a few extra to send her way again it would be very much appreciated.  Hope to report back with a positive update soon.