Viral Update

Here we are again at our home away from home the PICU.  Marc brought Riley up to the ER on Saturday night after he spiked a high temp and was struggling on his bipap.  They admitted him to the floor because he was still pretty stable at that point.  By now I should no better that the stable part only lasts so long.  They did a respiratory viral panel which came back positive for Human Metapneumovirus. It's a really nasty bug that can cause severe bronchialitis (inflammation of the small airways). They are seeing a particularly bad strain this year that is landing other wise healthy kids on ventilators.  This is not too promising for Riley.  He had a pretty hard night and early this morning we removed his bipap to suction and with in seconds his oxygen saturation dropped into the 70's and it required 11L oxygen into his bipap along with some cough therapy to get him up into the mid 80's. Finally after an hour his saturations were back into the 90's.  After that episode they decided to transfer him to the PICU.  Marc and I went home for a quick nap and a much needed shower. At 2:00 I called to see how he was doing and the nurse passed me off to the Doctor (never a good sign). She said that he had 2 pretty significant desaturations during his last treatment that required some bagging to get his saturations to come back up.  Here's where the frustration happens.  There are two ways to suction out the secretions 1 down his nose or 2 down his mouth.  Riley will not open his mouth for anything so the only other option is down his nose.  He's usually pretty difficult to get down his nose anyway but with this illness his nose is so inflamed that just can't get a suction catheter down his nose.  So no matter how much we were coughing him he can't cough it up enough for us to suction it out.  He was beginning to struggle and required some major increases in his bipap settings to the point where I called Abby, our SMA nurse, to get her opinion on what the proper course of action should be.  She said that it was time to consider intubation.  She called the PICU Attending and spoke with her and just gave her input.  Of course you always want to try avoid intubation but it was just not looking this way.  Well, the Doctor tried all this other stuff with his bipap to try to decrease his work of breathing.  That's all great but the problem was we had no way of clearing the secretions.  After dragging their feet for the next 4 hours they decided to finally just intubate.

So here we are tube and all.  The poor kid is just so worn out he really needed this.  After they got the tube in they were able to suction a large amount of secretions.  They just did a cough assist treatment with him and got a ton of thick yellow secretions.  Now he's spiking high temps again and they are concerned he might be growing another bug down in his lungs.  They sent a sample of his lung junk to see if it grows anything.  Now we just wait and let the illness take its course. The hard part is that this is just day two! This thing can last a while. I'm sure we won't be leaving this place any time soon.