"I want you to KNOW joy, so TOGETHER we will practice GRATITUDE. I want you to FEEL joy, so TOGETHER we will learn how to be VULNERABLE." -Brene Brown

The current goal is to slowly wean Lana from Oxygen and Nitric Oxide support. Right now she is receiving 93-96% Oxygen (FiO2) from the ventilator. They will decrease this number by 2% (all the way down to 60%) as long as she is able to tolerate it. At one point she got to 86% FiO2, but required more support later in the day.

Her pulmonologist stopped by today to examine her. We discussed her current condition, and raised some possibilities as to what may have occurred. Her last ECHO seems to indicate that her pulmonary hypertension is starting to resolve, but her dependence on the vent seems to remain unchanged. Here are some things to be factored in:

Her chest x-ray still shows haziness, which could indicate pulmonary effusion, pulmonary edema, or pneumonia.

Did the Sildenafil do too good of a job in lowering pulmonary vascular resistance that her lungs got flooded?
Her labs have been negative for pathogens, but today they found pseudomonas in her endotracheal culture although it appears to be localized. However, being on a ventilator increases risk for pneumonia.

Antibiotics will be started again and once the sensitivity panels come back, a more suited antibiotic will be used (if necessary). My spidey-sense is telling me that Lana probably has an infection. That could explain as to why she started to require more oxygen support and mechanical ventilation. Lana tested negative for Mycoplasma pneumoniae but pneumonia can also be caused by other organisms. We should find out soon as they do more tests.