PICU D+25: Forget Atkins, try CVVH

Ryan looks like the 'after' picture from a Weight Watchers add. He was down to 18.2 kg this morning, which is >4kg loss over three days. His arms and legs are almost back to normal. His belly, on the other hand, is still pretty big. I'm not sure what is going on there, but it's much softer (which is a good thing) than it was yesterday. The BMT docs would like to see Ryan back at his weight at admission, which was in the neighborhood of 16kg. The funny thing is that aside from Ryan's belly, I have no idea where that extra 2kg is going to come from.

Other than the continued weight loss, today was pretty uneventful. The amount of pressure that the vent requires to deliver air into Ryan's lungs has decreased dramatically over the last couple of days. We are seeing peak pressure values in the low 30s now. On Monday, the vent was routinely hitting high 60s. There are two reasons for this improvement: (1) losing 4kg (~20%) of weight makes your lungs a lot more compliant, (2) vent settings have been reduced/tweaked.

There's one more thing I would like to point out. In the past, we have called out the respiratory therapists on a number of practices that we thought were, uh, suboptimal. I am happy to report that the RT staff has been fantastic over the last week. Not only have they responded to our concerns, but they have actively advocated on Ryan's behalf. When Ryan's peak pressures were rising into a range that made Cheryl and I nervous, I witnessed a number of different RTs brainstorming with the doctors and nurses to try and come up with some alternate settings/modes for the vent. Well done.

BTW, Ryan's white count hit 2.7 today. Not exactly a breakneck speed, but I'll take slow improvement over no improvement any day of the week.