A lot happened yesterday. As far as a day in the PICU goes, it was a good day. The doctors switched Rafi from an oscillator to a traditional ventilator. She was on an oscillator to increase her oxygenation. The way the vents work are very different and the differences would take me to long to explain here. The big difference is the oscillator keeps the lung expanded while the ventilator lets the lung expand and contract. The oscillator uses less pressure to expand the lung and is thus less traumatic on the lung. She did every well on the oscillator so now on to the ventilator.

Some of the current settings on the ventilator show that there has been improvement. For instance, her PEEP number is considerably down. A PEEP is a small blow of air that keeps the lung expanded as it is contracting. In a person who is just walking around everyday, the PEEP number is 5. When Rafi was originally on the ventilator, her PEEP setting was at 14. She required a larger blow of air to keep her lung expanded as it was contracting, this is important. The lung has to be expanded a little, even when exhaling and a PEEP allows this to happen. Right now the ventilator is set to provide a PEEP of 8. Also, about 5 days ago, in order to keep Rafi’s oxygen saturation rate above 94%, she required oxygen concentration of 100% to be blown into her. Room air has a concentration of about 21% oxygen. Currently, she is getting a 40% oxygen mixture blown into her and she has an oxygen saturation in her blood of 100%. So we have considerable improvement there as well. Her peak pressures are also much improvement. This means it takes less pressure to expand the lungs. Again, this is a very promising sign. There endeth the lesson as well as just about all the knowledge of ventilators and oscillators I’ve got.

She’s still a sick a little girl, but she’s getting better. She spiked a small fever this morning, 100.6, but Tylenol took care of it. Her white blood count is still elevated and there are some other numbers which indicate an infection (increased monocytes and increased eosinophils) so Rafi is still fighting the good fight. It is assumed she had a nice case of sepsis along with the pneumonia, even though all the blood cultures haven’t shown anything as of yet. Like I said earlier, we may never get an answer to the exact cause, because she has responded well to the antibiotics (fever is generally gone and lungs are improving) the assumption can be made that is was a bacterial infection.

Jackie and I really do appreciate all the words of encouragement and thoughts and prayers. It has made a very difficult time a little easier.