A mended heart is a special heart!
Evan had a fantastic night and continues to do well. He is stable and still intubated and will stay on the ventilator until at least Monday.
Evan is currently on 49% oxygen and to give you an idea of how much oxygen that really is the air we breathe (room air) is 21%. Evan is also on nitric oxide in order to treat pulmonary hypertension. Pulmonary hypertension is when the blood pressure in your lungs is too high. During the cath they found that Evan responds well to nitric oxide (NO) and for those of you who have been following our journey from the beginning Evan was also on NO after his first surgery. NO is a gas that is produced in our lungs when we breathe and it causes dilation of the blood vessels in the lungs and increases the uptake of oxygen. He is currently on a level of 20 NO which is down from yesterday. They tried weaning him this morning but his lung pressure was higher than they liked so it will stay and they will start him on an medication called sildenafil which will eventually replace the NO. Sildenafil helps your body create nitric oxide. Interesting fact for the day is sildenafil is the same medication as Viagra and treating pulmonary hypertension is it’s primary use.
Evan has a central line in his neck, an arterial line in his left arm, and the PICC line in his right arm . He has two chest tubes in order to drain blood and fluids and pacing wires. His bleeding is minimal which they are measuring by the output from the chest tubes. He is currently on a pacemaker because his heart is in a junctional rhythm which is typical for him as he was in a junctional rhythm after the first two surgeries as well. They will keep him paced so that he is in a sinus rhythm because you use cardiac output in an irregular heartbeat. They did a trial this morning off the pacemaker and his heart rate was ok but his blood pressure was low so he will remain on that until they like what they see during the trials.
For pain medication he is getting a continuous morphine drip. I can assure you that he is not in any pain. He is completely sedated and looks peaceful. He is also receiving rectal Tylenol which helps with pain management as well as keeping fevers at bay. A fever is our body’s natural defense and after surgery are quite common. A fever can take a lot of out you and cause you to consume more energy and oxygen. The Tylenol combined with the cool room is keeping his body temperature at a normal range. I have also learned over the last couple of days that Evan is very sensitive to his environment so if he is covered with blankets and the room is warm he will spike a temperature very quickly. He is also on an antibiotic to ward off infection through his chest tubes and will stay on that until the tubes are removed. The tubes will most likely stay until after he starts eating so that they can monitor him for chylo which he developed after the first surgery. He is also receiving diuretics to help him remove extra fluid. He is not terribly swollen I can just see it in his sweet little feet and legs.
I think I covered all of the major things. The plan for today is for him to rest and no major changes to medications. We are going to have a nice quiet weekend. He is an awesome patient.