This is one of those words I think I could have gone my whole life without knowing and I wouldn’t have missed a thing. The first thing that pops up when Googled is a definition from UpToDate.com. “Extubation refers to removal of the endotracheal tube (ETT). It is the final step in liberating a patient from mechanical ventilation.” In Auggie’s case, the second half of that isn’t exactly true, but it does mean he’s one step closer.
When we first arrived at the NICU, August had a breathing tube going into his lungs. This was fairly common and expected. We were told that even after the tube came out, there was a chance the tube would go back in if there was a need. On just his second day, the doctors switched from the breathing tube to the non-invasive respirator. It was nice to see our boy breathing without a tube in him any further than his nose.
Once the infections began to show up, we were told the tube needed to go back in. We weren’t shocked by this news and knew that it was important for him to conserve his energy to fight the infections. Just before Christmas, the antibiotics were kicking in, the infections were slowing and Auggie was moving around a bit more. This was pretty good news, but there was one drawback. Overnight, Auggie decided to extubate himself. He moved is head just enough to pull the breathing tube out a little bit. Nothing went wrong, but it did need to be replaced. We didn’t ask much detail about that, so I don’t know if it was able to just get pushed back or if it needed to be removed and replaced. Either way, it was a lot for a little body to handle, but he made it through like a champ. He did, however, lose his tummy privileges at that point though. They didn’t want that happening again and lying on his stomach has the highest risk.
This morning, we called the doctor for an update and we got a familiar line: “Everything is ok, but we extubated August last night.” I didn’t ask if he had been on his stomach again, but they said the tube had been pulled up a little bit again, so they removed it completely. He is still on antibiotics, so they wanted to leave the tube in a little bit longer, but once it started pulling out, they decided to see how it goes.
So today August is on the NIPPV again, and probably will be for a few days before they lower the settings to a normal CPAP. There is still a chance the tube goes back in though, just like there’s a chance of anything else, but we’re going to hope for the best. He didn’t seem to like having the tube in, so hopefully he gain enough strength to keep it out.