Yeah…like, how do you forget to mention a little detail like that??
:):)
-D/a
Yay!!!
Excellent news!
Been out of town, am so glad there is so much good Schmoopie news for me to catch up on!
Oh, was it that important? (Not really being snarky: I didn’t know it was that significant.)
More woo-hoo: he’s down to 7% PEEP and 35% oxygen.
Not-so woo-hoo: we’re back to the full mask/gown/etc. extravaganza. There was “a miscommunication” between some of the nurses and the infectious disease folks, and since in cases like this everyone defers to Mr. Head Honcho Big Cheez Doctor (the head of the ICU) and since he is - understandably, I think - playing it safe rather than sorry, we’re back on the full precautions. We just won’t tell them I gave him a big kiss last night, eh? 
Yes, it’s a very, very big deal. It also may not last, so don’t freak out if they have to rejigger with the settings. It takes a whole lot of energy for your brain to remember to breathe when you’re as sick as he’s been, and it takes all sorts of coordination from various receptors in the lungs and blood vessels, too. Sometimes these things, as I’m sure you’ve already realized, are indeed two steps forward, one step back. Just keep dancin’!
Ah. Thank you! 
Well, for the statisticians and data miners playing along, there’s another* number on his monitor: “P supp.” It is currently at 17%. The Resp. Tech Extraordinaire ™ said that when it can stay at 16% with Shoe tolerating that, they can start moving his PEEP down. It’s currently holding steady at 7. Their goal is 5.
I will now bow out and leave it to the most excellent WhyNot to translate that into something us mere mortals can understand better.
Regarding the on-again-off-again precautions – The acinetobacter is indeed dying off in his lungs and the infectious disease team is indeed feeling better about his bacterial load but the main ICU head is saying that, basically, they don’t know a whole helluva lot** about this particular bug, and - again, very understandable - would prefer to play it safe WRT possibly spreading it around.
- Ok, there are a whole bunch of them. Sensory overload. I ignore what I can’t understand.
** It apparently wandered over stateside during the mid 2000s after the second Iraq war, using returning veterans as a vector. I’d post cites (other than “a couple of nurses told me that”) but a quick 'Net search brings up a disturbingamount of scaremongering, so I’ll defer here. (Minor warning: that first link is red-text-on-black-background and made my eyeballs bleed.)
Well it still sounds overall positive - things are looking up!
Now, to be honest, I’m in a little over my head. Sorry, I haven’t worked ICU yet, so I haven’t learned a lot about ventilators (and even in ICU, most of the time the nurses don’t mess with the vent much when we’ve got awesome Respiratory Techs who know way more than us.)
I know it stands for Pressure Support. And it’s, more or less, how hard the ventilator is blowing air in when he takes a breath. This is, he’s in control of starting the breath, and how long the breath takes, but when it senses him starting to take a breath, the machine pushes the air a bit harder to make it easier for him to get the air in. I think the % means the percent of peak flow, but I’m not sure if it’s peak inspiratory (inhale) flow or peak expiratory (exhale) flow. Either way, it means the machine isn’t moving the air as hard as a full breath; it’s just assisting, not doing *all *the work for him.
When he doesn’t need it to push very much then he’ll be able to try breathing with less of the PEEP setting (and yes, it’s just 1 number down, but respiratory folks see huge differences in these numbers!).
PEEP stands for Positive End Expiratory Pressure, and while it’s on, it means the machine never stops blowing entirely, even when he’s exhaled all the way. Even when he’s stopped exhaling and makes that pause before starting his next breath, the machine is gently blowing air in. Bigger number means blowing harder. This keeps the tiny little air sacs (“alveoli”) in his lungs open just a little bit all the time. That way, they don’t gum up with mucus and get stuck shut, forcing air to the less gummed up places and overinflating them, causing lung damage. As he gets stronger and breathes more regularly, he shouldn’t need this as much - he’ll get back into a strong rhythm of inhale-exhale and there will be less gunk to gum things up.
tldr: P. Supp is how hard it’s blowing in when he’s inhaling. PEEP is how hard it’s blowing in when he’s done exhaling.
Did that help at all? If you’re really curious, let the Respiratory Tech know you’d like to understand more, and maybe when he’s got a few minutes between patients he’ll come teach you more than you ever wanted to know about ventilators! (And then you can teach me!)
Holy crap! No, that was extremely helpful - thank you! I think that may be all I can absorb for now anyway, but it is nice to know what’s going on instead of just nodding politely. Really, that was perfect. 
16% P Supp and 30% oxygen all day today. He can wiggle his toes just a bit stronger, I think.
looks around house Man, oh man. We live in a little house with no garage, and the storage shed out back is disintegrating and, besides, is full. I just don’t know how a dude in a wheelchair would manage moving around. I think if I put two chairs from our living room into a little storage unit it would help make some maneuvering space but I hate to spend the extra money. Harrumph! One of the initial goals when we moved into this house was to replace the storage shed but boy has that fallen by the wayside. I dunno if that thing will survive another winter (assuming we get what most folks call a “winter” since last year was mild as hell thus exacerbating the mosquito problem this year.)
One other small thing to go with WhyNot’s stellar answer.
The reason they are so focused on getting the PEEP down to 5 is that’s considered physiological. In other words, it’s what we all walk around with.
YEAH!! for the 30%. Just a few days ago he was at 55%. That’s a HUGE improvement!
StG
Ooh! Thank you, I didn’t know that, and wondered why the specific goal is 5. makes mental note
Geez. I go to Dallas for work and sit around wondering what is going on with TOH across town but can’t check due to work-only computer and a phones-off policy that kept me only checking on stuff for way too little time during the day.
I arrive back home to the news that while I was ignorant of TOH happenings while in Dallas, across town TOH is kicking butt on bacteria.
YAY! Way to go!
Thanks. I got nothing more than that right now, but I mean it. I really can’t believe so many people keep taking the time to follow what’s turning out the be one helluva long-ass thread. A tiny part of me is briefly surprised each time I go outside (“Why isn’t it hotter?”) because everything stopped in mid-August and I’m just waiting for the world to pick back up again.
Infectious disease doc came by this morning, seemed pleased (according to his report - we weren’t there). She also has not changed anything - assuming I understood him correctly - which my undereducated ass is taking as a good sign. I mean, that must indicate that the current combo is working, right? I think he may have said something about her moving towards taking down the amount of each one, but at that point he started mouthing too fast for me to follow and he got frustrated and gave up.
He rolls his eyes whenever I mention ASL. I can’t tell if he’s just being cranky or if it’s some way of believing that he’ll get that talking valve sooner rather than later. Or that he’ll get better faster than the docs say and he’ll walk and talk his way out of the ICU, thumbing his nose at the naysayers who said he’d need physical rehab. Whatever, I showed him that I know how to spell “ice” (that’s usually what we sign through the window the most: “I’m coming in! Do you want a fresh cup of ice?”) and did it today through the window and he motioned that no, he was OK, and he’s just gonna have to like that we used rudimentary ASL anyway! pbbbbbbth
(I don’t know any ASL myself besides the whisker-stroking sign for “cat” and most of the alphabet. In a row … I have to mentally go through the whole series to remember a particular letter.)
You’re right. Isn’t that bizarre, that I need to be reminded of that? Anyway, I did, so thank you.
Off for a short walk - it’s breezy but humid - and then a sweet potato for dinner. I did finally manage to hit up the grocery store on the way home for fresh stuff, and — oh, and it’s trash night. *Sigh *- gotta go. grumbles off to do chores
Of course we are checking this thread daily, we think you are a very special person and because you love TOS, we do too.
I don’t know just how dinky your place is, but could you push the extra chairs against the walls and stack your occasional tables on the chairs? It won’t look nice, but TOS will need the room, and he won’t be in the wheelchair forever. Do his folks have room in their garage for extra stuff? This is just a temporary solution, but its only a temporary problem. Mr Shoe seems pretty motivated and that helps a lot when someone is recovering.
After Bill’s heart surgery, he was motivated. I know that when I was posting about it, I said it was just because of hawt sex with me, but that really wasn’t accurate. Bill wanted to get back to 100% and did everything he could to get there.
Shortly after I came back home (after hawt sex), a younger friend (younger than Bill, not me) had a triple bypass. The friend wasn’t nearly as motivated and didn’t work at his recovery. He spent a couple of months using a walker and didn’t try to climb stairs at all. Its been almost 8 months and my friend is only at about 75%.
I’m just sharing this to tell you that TOS’s motivation and drive will make so much difference in his recovery.
Bumping flatlined out of last poster place.
'nother long time thread follower here. Go Schmoopie!
This, exactly.
Translation - offer him lots of hawt sex 
Also checking in to say I’m still following this too, and I’m glad to see the progress is good. Thinking of you, purple-family!