We received a call at 7 am this morning from the neonatologist. They did another chest x-ray and blood gas at 4 am. The chest x-ray still showed no air in the chest cavity, however, they were still a bit hazy. They think there may still be some fluid in them, but think that the nemothorax is no longer an issue. However, the blood gas numbers decreased. They put her on nitric oxide gas to assist in circulating oxygenated blood throughout her body as well as utilize dopamine (a blood pressure medicine) to increase her body's circulation pressure. The example that was given to me was of a person my size trying to get through a hallway blocked by a 400 pound person. The nitric oxide would work to make the 400 person smaller and the dopamine would work to make me bigger. This would equalize the size of each person and allow the other to pass. So basically, both the nitric oxide and the dopamine are required to get the lungs arteries to open up to accept the blood from the heart and the dopamine is needed to get the blood out of the lungs and circulated through the rest of her body. It is starting to feel very desperate. While we aren't maxed out on the settings of the vent and meds, we are getting close to running out of options.
We went down for the 8 am "touch time," we were informed that the doctor decided to also put in a ventricular line. This would be used to inject medications as the IV's in her arms were too delicate to keep using. They also put her on a second blood pressure medicine to assist with the first called dulbutamine. She was also going to be moved to a quieter area in the NICU as her current location was a bit noisy and she did not tolerate stimulation well. We also informed that we could only see her during touch times and that it could only be Daddy and me. I left the Dandle Doll with Kenzie and the nurse also gave me the idea of putting pictures of the family in her bed. I left the NICU feeling very distraught and helpless. I felt like we were fighting a losing battle.
We anxiously awaited the 12 pm touch time, and when it finally arrived, we were met in the NICU with more chest x-rays. They had to administer the surfactant because her oxygen levels had fallen and they could not get them back up. They also changed the type of ventilator that she was on. She was originally on a conventional ventilator so they moved her to an oscillating or HI-FI vent. The new vent would use vibrations to help distribute air into her lungs instead of the single puff of air that the conventional vent provides. We left before the vents were changed and we didn't get to change her diaper or even touch her this time because of all the activity,
At 3pm, the neonatologist came to my room. She informed us that while Kenzie was "stable," she was not responding to the changes as quickly as they hoped. She felt like we needed to look into transporting her to Children's Medical Center in Dallas as soon as possible before she got worse and then transporting would be riskier. This was quite a shock because we really didn't realize that we were at that point or that it was even an option. Medical Center of Plano's NICU is one of the best ones around, turns out it was level 3, it was hard to believe that she would need to be moved to another hospital! She asked us to come down to the NICU so that we could be there while they prepared her for transport.
When we got to the NICU, we were informed that they would be transporting her by helicopter and they would be there in the next couple of minutes. I was terrified, we thought it was going to be by ambulance. The fact that they were doing it by helicopter means that it was more urgent, right? Once the transport team arrived, the paramedic reassured me that they used the helicopter because it was easier than the ambulance. This made me feel a bit better. I met the team and then they began to work on transferring everything. This process took 1 hour and 45 minutes! They had to transfer every medication, gas, machine that she was on, one by one. After each one, they would monitor her stats to ensure that she was stable and would tolerate the changes and she took each one beautifully. The biggest surprise of all was when they changed her vent, the very last thing to change. Her oxygen levels were below 100, around 75, on the old vent. As soon as they changed over to the portable one, they did a blood gas it was over 300! The paramedic even ran it a again to make sure it was right and it was under 300, but still very high. We viewed this as a sign that this was a good move. The loaded her up, let me say good-bye and took her off to Children's.
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