Wednesday evening

This has been one heck of a day. After the scary morning, we actually got a very reassuring report from the scoping- they were able to get in all the way, which they weren't able to do before. They suctioned some secretions, and observed the patch in action. It is still collapsing but with enough positive pressure from the vent it will stay open. They also suspect there could possibly be some granulation tissue or debris on the patch that could be narrowing the airway but the optics on this scope are not as good as on the rigid scope they use in the OR. They elected to put her back on the paralytic and keep the PEEP up on the vent to keep things open for a few days and reassess on Monday. So I thought we were just going to be riding it out... so wrong. After a really encouraging talk with the cardiac doc, we were feeling so good about everything. Then shortly after, her numbers starting declining. Her HR and BP are higher than they ever have been, and her vent stats are getting worse. She's getting more and more acidotic, and her belly has started to get enlarged again, with no good explanation. They pulled the abdominal drain since it wasn't draining much, and it was getting fibrin in it. Xrays and US didn't really show why her belly is so big. She's gotten so puffy overall through the day too. Then her cardiac doc had the idea that she's "air trapping" and the CO2 is building up in her lungs, she's unable to get it all out with so much pressure and it's leading to airway collapse (I'm having a hard time understanding the concept...). He suggested that we try to pass the ET down to her carina and let it act as a stent from the inside to allow things to stay wide open. He felt like the first part of the repair is the part that is most floppy and the airway past the carina is open and stable. The pig bronchus will be above the ET but will possibly still get some ventilation. He's not worried about it becoming atalectic for even a couple of weeks and has methods of getting around it anyway. So, they just placed another internal jugular catheter in case they need to hook her up to the bypass machine in an emergency, and they took her down to the OR just now. They're going to go ahead and assess with the rigid bronchoscope that has the better optics to allow evaluation of the patch and any granulation/debris to be removed, and then slide the ET down over the scope to the point where they want it. It sounds like a great idea but this is completely uncharted territory, and it's all speculation. We're so grateful to have such a great team of doctors working together on this and are hoping and praying this is the fix that will give us several good days to allow optimum healing to occur with the airway in the best position for scarring in place. It will be a little while before they're out of the OR, and until then we're waiting.