PICU - day 11

It is 2:55am. Emylie is working harder to breath (breaths per minute were in the 40's now 60-70's), she seems agitated, her heart rate and blood pressure are elevated. Her po2 on her blood gas is lower (68 to 58) and her chest xray looks a fair amount WORSE (either collapse or worsened pneumonia), especially on the right side.
The fellow doctor, Carrie said that they made and "aggressive" wean on her PEEP last night in order to try and minimize the air leak that is causing Emylie's face to swell. It is a fine line and they are trying to figure out how much PEEP will keep her lungs open without causing a lot of air leak. The radiologist and Carrie were discussing ideas...because the air is around her heart, in the mediastinal area, the radiologist believes that the main branches of the lung, the bronchi possibly were injured and that is where the air leak is. If this is the case it usually resolves on its own. How long does it take to heal....days to weeks. Carrie said it doesn't necessarily mean you don't see improvement in that time but it can take that long for it to completely heal.
Carrie's goal for the rest of the night is to keep Emylie comfortable, she is hoping that her work of breathing can become a little more relaxed. They increased the PEEP up to 10 (was 8) and dropped the size of her breath - which hasn't made a difference so far. She added a bolus of lasix because they also thought they saw more fluid on the xray. They have given her extra medicine for pain. They will repeat an xray at 8:00 am. Her temperature is up to 37.7C. Nate, the nurse thinks it will take a little time to see if there is improvement.