Nosey

Archer's blood gas test today showed that he still had too much acid in his body (acidotic). He had an I.V. line put in so he could be given more sodium bicarbonate to help combat these issues.  The staff also ran a test on his poo because acidosis can also lead to tummy problems. The test came out negative, though they are giving him formula with his feedings, half and half, instead of the concentrated fortifier, to see if that will help.
Archer went down another NAVA setting overnight last night to 2.2 because his CO2 had looked good. But he ended up taking a lot more steps than just weaning down a ventilator setting...
The nurse practitioner decided it was time for him to try to move off the ventilator and onto a CPAP. This is a nasal oxygen system that gives pressure to the lungs and helps inflate them. As expected, he did not like this big change. Archer was on this for a brief moment shortly after he was born. After about an hour of fussiness the staff decided to try something else...
Archer then moved up from a CPAP to a nasal cannula. The cannula is much smaller, and more flexible, than the CPAP. Though the cannula supplies oxygen, it does not help inflate the lungs. Archer tolerated this much better and eventually settled down.  After a short time a nurse tried closing Archer's mouth to see if he would do better and keep so much oxygen from escaping.  His breathing statistics did go back up, so other methods were taken to help keep his mouth closed. He received a wrap around his head.  His oxygen level was brought down to 75%.
Throughout all of this, Archer's voice could barely be heard. His vocal chords were most likely swollen from the endotracheal tube, and they are also not fully developed. He will most likely bounce back and forth from the cannula to the ventilator until he gets used to breathing through his nose and his lungs get healthier. Even if it's just a few hours, it's good for him to be off the ventilator, as it can give his lungs and vocal chords a beating. His upper lip has also taken a beating from all the tubes being forced into his mouth. We were assured that this will eventually grow back into a normal form.