Initially his sats and his volumes improved and then he got more wakeful, started coughing and retching and had a little dip in sats. It looked to me like he was working harder too so naturally I was concerned. The lower right and left hand side chest drains hadn't been working since last night so ultimately my big worry was that air was accumulating. His volumes stayed good though and his blood gas result was fantastic so I tried to relax, he was quite clearly starting to suffer drug withdrawals too which did affect his breathing and heart rate last time so there were numerous reasons for the dip in sats and they came back up gradually again.
At 10:45am the ventilator pressures were turned down to the lowest rate and his feeds were stopped in preparation for extubation and an X-ray was ordered to check there was no issues before proceeding, this was done just after 12pm and it was all good so sedation was reduced for extubation at 1.20pm, then came the waiting for it to fully wear off...
He was extubated at 5:30pm and put onto high flow oxygen and after an initial panic attack he settled down. His drug withdrawals are horrendous.. he is confused, distressed and generally not with it at all. It is making him work harder with his breathing, increasing his heart rate and his temperature and is all very upsetting to watch. It also makes it very difficult to see if there is a problem with his lungs as it is masking all his usual symptoms of pnemothorax so we are so on edge as are the doctors!
We have decided not to leave him tonight so we are taking shifts to sleep again, not purely through worry but also not wanting him to wake up confused and scared with neither parent there by his side. He is such an amazing brave boy <3
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