When we left Tim last night he was looking very stable with a good rhythm, solid blood pressure and well on the road to being extubated today. Apparently he stayed that way for the majority of the night too, but at about 5:30 he developed a fever and his chest x-ray showed some fluid on the lungs. This all led the doctors to decide that it was best to slow everything down to try and get him further stabilized before getting him off the vent. The first step is to treat the pneumonia, which should be pretty easy since they had already started antibiotics yesterday when they weren't fully sure what caused his issue that landed him in the hospital.
At the moment Tim is very sedated in an effort to keep him as comfortable as possible as well as to keep as much strain off his heart as possible. Later in the morning today Tim's rhythm got a little funky which then led to his blood pressure dropping and his oxygenation dropping. The doctors were able to make adjustments with his pacemaker to fix this problem and since then his heart rate has looked pretty stable (at least to my eyes) and his blood pressure has returned to what we've been told is good but not great.
Tim's fever has broken since earlier this morning, but now the problem is his body is cold, particularly in his hands and feet. So the cooling blanket has been turned up to be a warming blanket to try and get him right in his sweet spot so he stays warm without being feverish. As all of this goes it is so hard because Tim has a very fine line his body needs to walk in order to stay stable. Every adjustment, to medications or anything else, needs to be done very carefully and precisely otherwise it could cause other issues to crop up.
Tim started getting some nutrition other than the IV fluids today. They needed to change the type of n-g tube they were using to accommodate the greater volume which in and of itself isn't a bad thing. However, since Tim was also started on Heparin yesterday to try and prevent clots from forming as a result of his arrhythmias he got a nosebleed when they pulled out the old tube. It has since stopped, but did cause dad a moment of panic.
The doctors are still hopeful that they can get Tim off the vent tomorrow, but slow and steady is going to win this race. All things being equal, the reality is that Tim is a pretty sick little boy, hence the reason he's going to be staying in the hospital. His fight is one that will be made minute to minute and hour to hour. So far he's been doing okay, but it could be going better. There are so many things that can go wrong, not just with his heart but with his brain, his kidneys, his lungs and so on. We of course want him to get well enough so we can talk and play with him again, but we also need him to get well enough so that when a heart becomes available he is in good enough health to accept it too. We all know what a fighter Tim is and we are sure he'll do all he can, but a few extra prayers won't hurt either.