The coughing began around midnight. As Natalie aptly described, by morning Aaron was becoming exhausted and discouraged. He could barely take 10 breaths between fits of coughing. There was considerable discussion and attempts at resolving suspected culprits, but no success. “Could it be irritation from the trach tube?” we wonder.
The trach tube is a small “L” shaped tube, abut the size of a ½ inch copper pipe elbow. One end of the elbow protrudes from the throat. A soft silicon rubber flange around the protruding end is stitched to the skin of the throat to hold it in place, and a band around the neck further secures the flange so this plumbing bypass will stay put. Around the opposite end of the elbow (which goes down the trachea) is a small, inflatable doughnut…like a miniature inner tube. After the trach tube is installed, the doughnut is inflated, forming an airtight seal between the outside of the tube and the inside of the trachea and forcing all the breath going in and out of the lungs to go through the tube and not through the mouth. It also prevents fluid and gunk in the mouth from dripping down the trachea and into the lungs.
A clever design feature of humans and other creatures makes double use of our breath: From “Freude schöner Götterfunken” to “I wanna hold your hand”, our voice is provided as a second thought by our breath on its way out after servicing the lungs. The trach tube, unfortunately, sidetracks the breath, bypassing the upper throat, so the larynx languishes in breathless silence.
However, if the doughnut is deflated, breath may course along its designed path, and voice is possible without removing the tube. When the doughnut is deflated, fluid and gunk as well as breath may course from the mouth down the trachea.
We ask if deflating the balloon might reduce the irritation. Kamala answers from years of experience that it would make things worse. There seemed to be no solution to the coughing.
Then came the angel from Respiration. Suction around the inner tube, inflate to a higher pressure, and voila, the miracle: no more coughing. Kamala was right about the irritation getting worse if the doughnut is deflated….but no one suspected it might not have been not properly inflated in the first place. A question comes to mind: If your car starts coughing, should you check your tire pressure?
As part of the ongoing weaning, Aaron is completely removed from the ventilator for a couple hours; he does well. He spends most of the day resting and not as responsive as the last 2 days.
The pesky fever returns. Anne and Natalie help Awesome Donna (night nurse with oncology experience) help make Aaron comfortable and cool him the old fashioned, and much more effective than the cold-blanket technotraption, way….wet washcloths.
It works, and by midnight, the fever is gone.
We get no word on the enemy.
