I just got back from the hospital and spoke with the pulmonologist. On my way there, Alisha spoke with the neonatologist. Roscoe's instability began two nights ago, when apparently the IV which was delivering his pain killers came out. This left Roscoe without pain medication for 30-120 minutes (we heard different numbers). This event triggered his body to become hypersensitive, with his lungs tensing up due to pulmonary hypertension.
To counteract his hypersensitivity and to get his body to fully relax again, they tried increasing pain medication. When that didn't fully work (he kept having episodes), they gave him a paralyzing drug. When that didn't fully work (he kept having episodes), they changed his trach tube in hopes that the pulmonary hypertension was being aggravated by the leak around the trach tube site. That didn't fully work either, because he still had an episode just before 5am where they had to perform CPR (chest compressions) for 60 seconds.
When I got to the hospital, they had just started Roscoe on nitric oxide. Nitric oxide is something that's commonly used to treat pulmonary hypertension because it expands the veins in the lungs. They hadn't used it in Roscoe's case because with his pulmonary vein stenosis they didn't want to introduce extra stress on his narrowed blood vessel. The risk is that this extra stress would cause pulmonary edema (fluid buildup in the lungs). At this point, they said that the benefits of nitric oxide for Roscoe now outweigh the risks.
They started Roscoe on nitric oxide and he had a good reaction to it. His oxygen saturation went up and they were able to slightly lower the breathing support. We are waiting to see if it will result in greater stability and relaxation for Roscoe. Their main goal is to get his body out of the hypersensitive state (which is much like the state he was in shortly after he was born) and back to being relaxed and comfortable.
As always, please continue to pray.