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karma
04-26-2009, 07:19 AM
Hi our son Arjun is in PCICU since last one month.He had his open heart surgery.
This week they extubated him and he is on a Trache.
He is having enormous secretions they have to suction him every 10 min in ICU.
Is this normal ?.Do kids have lots of secretions after they are extubated.
He had alwasy been on Heated Mositure all his life for last 9 months.
Is there a way to reduce these secretions.We are really confused...

Niff
04-26-2009, 08:07 AM
I think every kid is different when it comes to their secretions. Anytime you go from being on a vent with constant pressure to being without, you'll work up a lot of secretions. The pressure from the vent pushes the secretions down, so when you don't have that pressure you are able to cough them up easier. It's actually really good to get those secretions moving, especially if they're coming up and out. During our initial trach collar trials when we were going from SIMV ventilation to trach collar, we were suctioning Mackenzie literally every 2-3 minutes.

They do make a medicine to help dry up the secretions and it's something you can ask your pulmonologist about - he/she would better be able to decide if that's the right step for Arjun.

Did the surgery go well? Big :hug: to you and your family.

karma
04-26-2009, 08:24 AM
He had rocky first week after the surgery we almost lost him last week.We has saturating in 50% on 100% O2.His lungs were wet from Open Heart surgery.Since then he is more stable and improving.He is on lot of oxygen.
1 day back they extubated him.And we are getting lots of secretions.Next week he might come home so we are nervous about these secretions.

Niff
04-26-2009, 08:29 AM
What kind of respiratory support is he on right now? I'm not a trach pro by any standards, but I would think mobilizing his secretions right now is a good thing.

JWorthington
04-26-2009, 11:33 AM
I'm not an expert on vents by any means, we have never had to use one for long periods, but secretions I've seen a ton of! When Sam was first discharged we were suctioning every 10 minutes for many months, it was exhausting. Also,if he was intubated there's probably going to be quite a bit of gunk hanging around that needs clearing. is Arjun able to cough up his secretions at all? I would suggest holding back on the suctioning for a minute or two just to see if he manages to cough them up on his own. the more you suction, the more secretions you create so if the child is able to cough then it's best to let them try to clear them. also it takes the body time to get used to a 'foreign body' in the airway so that creates more secretions at first. it does get better with time, and as Arjun gets stronger he will get better at getting rid of them himself. There are things that can be done if secretions are a problem but you need to speak to the pulm about this, and it may not be what the doctors advise at present. Good luck!

Julie

saywhatyouwill
04-26-2009, 01:48 PM
am i right that he isn't on the vent?

emily had a lot of secretions when she was ventilated, but even more when she was sprinting, because the PICU insisted on having warm (quite hot i thought) humidity through a trachymask. it was ridiculous because like you we were suctioning pretty much constantly and it was mostly just water coming up!!

eventually we managed to get them to switch the stupid humidity down.

as niff (i think) said, you can also get meds (via a patch i think??) that reduce secretion levels, but it's not appropriate if there is an external cause.

Ainsley's Mom
04-26-2009, 03:40 PM
Ainsley had a LOT of secretions for a very long time. She was not on a vent. The doctors were never willing to use anything to dry them up. Each case is different but I think Ainsley's was due to swollen airway tissue due to reflux. Hers only improved after a fundoplication. And we recently tried Botox to the salivary glands since we think she was aspirating saliva.

I am very concerned for you that you are saying he just got the trach and they are thinking about sending him home next week. Normally they would arrange to get you training, nursing support for home. That takes time and shouldn't be rushed. I will tell you that it is extremely demanding to bring home a child that needs suctioning every few minutes. Get the support you need before you leave the hospital.

Christamae
04-26-2009, 04:48 PM
A new trach is a foreign body and the secretions are a way for the body to try and reject. I had suctioning every five minutes for four months after my trach. Things improve over time. There are also medications to help.

drct1245
04-26-2009, 06:13 PM
Our experience is that when ever anything changed - like going on the home vent from the hospital vent, coming off the vent, downsizing, upsizing, etc, they all caused more secretions. The biggest fear is if they are not moving those secretions properly or when they change color or consistancy. Even when Ayden was younger, he had much more secretions than when he got older. It usually took Ayden about a week, maybe 2 max to normalize (if there is such a thing :) ) his secretions.

Did he go from being on humidity to no humidity? If so, he could have secretions to compensate for being too dry. (?) Just a thought....

karma
04-26-2009, 06:17 PM
He was Trached when he was 2 months old .He had been on the ventilator till now.It was only after his third heart surgery he was extubated from ventilator.But he is still on Trach.
So it looks like from the discussion that it might be normal for him to have secretions as he is recently been extubated.
Do they imrpove over time ? from the discusion it does look that most of you have gone through this period when the secretions are enormous.
Yes he is able to cough things up.But its a constant noise that we can hear when he breathes and goes away one he is suctioned.And 5 minutes later starts to haunts again...
But yes we will try to reduce the suctioning and encourage him to cough more.
Does this pahse really pass .....if we work towards his decanulation does this is an important factor that can delay decanulation....
Does a child has to pass swalloing Test to be decanulated.....

karma
04-26-2009, 06:19 PM
He had been on heated humidification when he wsa vented.Right now he is only on thermovent.

Niff
04-26-2009, 06:24 PM
Yes, it gets better. :) The amount of secretions will change depending on environment, humidity, illness, and a host of other circumstances. So you may notice that the secretions get better and then when Arjun gets sick they increase again.

I've never heard of having to pass a swallow study for decannulation. From what I gather, tolerating secretions is a big part of the decannulation process, but that also depends on why the child was trached to begin with.

bryantem
04-27-2009, 12:14 AM
Addisyn usually has a lot more secretions when she is on the hospital mist system. For some reason, the mist is pretty low this time.
________
Mark x zio (http://www.toyota-wiki.com/wiki/Toyota_Mark_X_Zio)

karma
04-27-2009, 07:14 AM
Arjun does not tolerate cool mist mask.Moment we remove his HME he start to desaturate.He does fine on HME though.if he is only on HME round the clock wont it dry him up.isnt mist humidification a must have atleast for few hours every day.
He just does not tolerate the humid mist mask.
Are they any way that we can have more humidification on HME .....

saywhatyouwill
04-27-2009, 07:18 AM
But its a constant noise that we can hear when he breathes and goes away one he is suctioned.And 5 minutes later starts to haunts again...

hi again. obviously i can only speak for emily, but when her secretions are really, really watery it's okay to just leave them in the tube for a bit, even though you can hear them constantly. unless she complains, obviously, but it doesn't appear to bother her. meaning just because we can hear them doesnt' always mean we have to suction right away.

karma
04-30-2009, 09:41 PM
He has developed 104 fever in the ICU ......They have put him on CPAP with 40% o2

Ainsley's Mom
04-30-2009, 11:49 PM
Arjun does not tolerate cool mist mask.Moment we remove his HME he start to desaturate.He does fine on HME though.if he is only on HME round the clock wont it dry him up.isnt mist humidification a must have atleast for few hours every day.
He just does not tolerate the humid mist mask.
Are they any way that we can have more humidification on HME .....

Have you tried warm mist? Maybe he doesn't like the cold air blowing into his trach. How about room air? What happens then?

karma
05-01-2009, 06:55 PM
We have not tried warm mist.We will ask the doctor to try that.He has some infection brewing in his lungs.We are waiting for the sputum Test.