BiPAP Mask

The doctors did a blood test on Thursday and found Roscoe's CO2 back up at 77. Since he's been getting large variations in the test results, the doctors decided to try out a CO2 monitor (similar to his current O2 monitor) so they can get a constant reading of his CO2. Since it's a less common monitor, they are going to validate the accuracy by measuring the CO2 at the same time when they take get blood test results. If the monitored CO2 value reasonably matches the blood test CO2 value, then they'll consider the CO2 monitor to be sufficiently accurate and will use it from now on.

They doctors also felt that Roscoe's CO2 might benefit from added breathing support, just to get the number stable into the mid-60's. They tried changing him to a new machine and mask called a BiPAP. This machine is the pediatric version of what some of you might use at home when you sleep to prevent apnea.

After a period of hating the new mask for about 60 seconds, Roscoe got rather used to it. It blocks his vision more than the old mask, but it has the added benefit of being softer gel material and appears to be made more for long-term use. I liked the mask more too, because the nozzle at the front is able to rotate (unlike the fixed bubble CPAP mask nozzle). This let me transition him from laying down on my chest to sitting upright much easier, and it also let me hold him with his back against my chest when I couldn't do that alone on the bubble CPAP.

Despite how much we both liked the new mask, as you can see in the videos above he was rather irritated. Some of the irritation was the rough day he had been having, due to what Alisha and I think is a sickness (click here to see the other blog post about his rough day). Part of the irritation came from the added pressure of the new machine.

The bubble CPAP was giving Roscoe a constant pressure of 7L/min (increased from 6L/min just 3 days ago). The new BiPAP machine would give him a constant pressure of 5L/min, with forced "breaths" at 10L/min at a periodic interval determined by the machine settings. Roscoe's body didn't like the new machine.

After he slept for a while on my chest, I laid Roscoe back down in his bed before his feeding. Before each feeding, the nurse checks how much food is left in his stomach. Typically this amount is between 0-5mL (meaning he digested all of the food), but this time it was 26mL. On top of that, after he got his next feeding, he vomited up (twice) about 20mL of it onto the bed. Luckily he was laying sideways and both the nurse and I were by his bedside when it happened. The food was undigested, so it didn't look like a stomach bug.

Throughout his rough day his oxygen requirements had been much more touchy, meaning that when he cried his O2 number would drop much more quickly than it had previously. This was another reason why Alisha and I suspect that he has an illness, because his body is using its reserve energy to fight the infection, rather than to store oxygen.

Roscoe's oxygen requirements on the new machine kept increasing and increasing. They started him on 5L/min of 100% oxygen and as he became frustrated or moved the requirements gradually increased to 10L of 100% oxygen, with his O2 measurement still sitting in the low 90's range. By comparison, just less than 2 months ago he was on 100mL/min of 100% oxygen and ready to come home, so this was an oxygen requirement increase of 100X.

I had a frustrating bout with the respiratory technician around 9pm. The new BiPAP machine kept triggering an alarm that said Roscoe was having an apnea, even though his monitors on screen showed he was breathing. The respiratory technician was convinced that it was merely a leak in the new mask, so he kept pushing the mask harder into Roscoe's face (even pushing the mask into his eye) with no pacifier in his mouth. Roscoe started screaming since his woke him up from sleeping. After I saw that he was doing this longer than a few seconds, I pushed his hand out of the way and put Roscoe's pacifier in his mouth to calm him down. Then muttered something about his lack of intellect under my breath as he walked back to the machine. It is incredibly frustrating to see someone value their machine setting more highly than your child who is supposed to benefit from that machine.

We had already called the doctor to the bedside to discuss why Roscoe's oxygen requirements were increasing, and so I explained that the vomiting and increasing required oxygen hadn't been necessary just 3 hours prior when he was on bubble CPAP. They changed the new machine settings from BiPAP (which varies from 5-10L/min) to CPAP (which gives constant 7L/min) and Roscoe calmed down and his oxygen requirements returned to "normal" (for that day).

I stayed until a little after 10pm as Roscoe slept in his bed to make sure he was okay. I also wanted to make sure that the respiratory technicians would do as little messing with him as possible, since he was now stable. When I left, they were planning to move him back to the bubble CPAP machine so that the BiPAP wouldn't keep having the apnea alarm and so the bubbles on the CPAP would be indicating that Roscoe was getting the breathing support he needed.