Sunday: Abigail still stable

Abby remained stable and had a comfortable night Friday into Saturday and we slept well at the hospital. Yesterday (Saturday) proved a bit of a mixed bag.

First of all, the PICU unit had a difficult day with emergency admissions and very sadly at least one child who lost their own fight. With it being the weekend with lots of families and visitors around, there was an uneasy atmosphere in the hospital and a very difficult mix of troubled, grieving and 'just visiting' people in the family room.

Abigail continued to be stable throughout the day, although she did seem to have a little bit of trouble maintaining her oxygen saturation and needed to be 'bagged' manually every now and again to return her sats up to something approaching 100%. It is interesting how doctors no longer choose to deeply sedate patients who are being ventilated any more. This is because it can then prove very difficult to wean them off again later if their natural reflex to breathe has been eliminated for so long. Nurses are constantly monitoring and adjusting Abby's medication to reduce her dependency on the ventilator (if she's ready) and to maintain her sedation at an optimum level. Too much sedation and she'll be difficult to wean off, too little and she'll wake up, panic and fight the ventilator.

At one point when Abby's nurse had taken her off the automatic ventilator and was 'bagging' her manually, she tried just stopping for a few seconds. Abby responded by breathing on her own for a minute or so. Her respiration was rapid and she couldn't really maintain her O2 sats, but it proved that her reflex was still there. It must be stressed that this isn't really progress in any way, more an indication of the level at which they're keeping Abby asleep.

Indeed, the ventilator being used for Abigail is clever enough to offer a pre-programmed set of breaths per minute, but to allow Abby to take more on her own if she wants. When Abby takes a breath of her own the machine will recognise that and help her, rather that continuing with it's rigid preset pattern. For most of yesterday, the ventilator was set at 20 breaths per minute, but Abby was actually breathing 40-45.

Abby also woke up a little bit at one point which required a slight increase in sedation, but it was good to see her moving about a little. Doctors are finding that Abby's respiration is performing better in a 'prone' position, lying on her tummy. Unfortunately she can't stay in this position all the time and must be turned occasionally. It was just bad luck that not long after we'd helped nurses move Abby onto her tummy and got her settled and free of tube and wire tangles, the radiologist turned up to take her daily x-ray and we had to move her back onto her back.

Yesterday's x-ray remained essentially the same in terms of the infection and damage to Abby's lungs. The consultant said she was tempted to say that it was a little bit better, but that was probably just her wanting it to be better! In truth, it was the same but no worse.

The only slight worry yesterday was that the consultant said the performance of Abigail's kidneys had deteriorated quite a bit overnight. Abby's urine output was low too. It was explained that some drugs would be given to rectify this and kick-start the kidneys into full working order again, but that if this didn't work, it could be an indication that her kidneys were beginning to shut down. That still isn't confirmed yet but is a concern. The consultant said that if she had to make a choice either way, she'd say that Abigail had taken a tiny turn in the "wrong direction" yesterday. Abby remains very ill indeed. This morning (Sunday) Abby is pretty much the same: she had a comfortable night and we await today's chest x-ray and any indications on the kidney concern.