Extubation and Continued Good News

Madeleine is off the vent and is doing great. Here are the details:
- She is breathing on a nasal canula with a relatively high flow (6 mls). They started her back at 100% oxygen but have already reduced to 60% and will go down to 40% soon. They'll continue to wean throughout the day with the eventual goal of eliminating all breathing support. (We're probably weeks away from removal of all support.
- The ostomy is working well-- she is getting output into the bag (a lot of output after surgery) and is now stooling (one of my favorite hospital words) as she is feeding on small amounts of breastmilk.
- They've removed morphine from Madeleine and will give her Tylenol 3/Oxy Contin via her NG tube (feeding tube). I'm not sure how long they'll continue the pain medication-- probably for a few days.
- They weaned off a heart medicine-- I forget the name-- and she is doing great.

Next Steps include:
- Removal of the last cardiac monitor-- there is one wire remaining inside her heart. This will likely be removed by tomorrow.
- Weaning from breathing support.
- Slow increase in feeds.
- Continued weaning from Laseks-- a diuretic administered after surgery.
- Transfer back to the NICU-- she is still in the Cardiac ICU. This could occur as early as Saturday.

Once Madeleine is back in the NICU and has established regular feeds while weaning off breathing support, we'll sit down with her doctors to determine her path moving forward. In order to come home, the benchmarks are still the same: She must be off all medical support, must be able to maintain her own temperature, and must be able to feed on her own from a bottle. Once we've met these three benchmarks-- or at least have a general idea of when these three could be met, we'll have to determine when it is best to re-attach her intestines. It is possible that we could bring Madeleine home with the colostomy bag and then would return when the doctors are more comfortable re-attaching. It is also possible that we'd schedule the surgery while she is still in the NICU. Generally, the surgery is scheduled 6 weeks after the last gut surgery. If they stick with this timeframe, Madeleine would have surgery around June 1.

In any case, those are all issues for another day/time. Today is a day to smile and celebrate! Thanks for your support.

Brent and Kirsten