James wakes every couple of hours. He is alert and responsive with some disorientation. He doesn't always remember my presence. There is some confusion of circumstance. He isn't always able to place himself in time or space. This can lead to a restlessness, and lends itself to fears and anxieties. His sleep is also haunted by vivid dreams and nightmares. These border the edge of hallucination and delirium. All of this is completely appropriate to the level of sedation and analgesia in his system.
James has had some improvements to his respiratory status that allow for gradual weaning from mechanical ventilation. He seems to be stable enough to tolerate varying levels of support depending on a number of different factors. These factors dictate the level of aggression in the weaning process. His hemodynamics and oxygen requirements are also variable and dependent on James' level of alertness. The process is seemingly complex and dynamic, but James is trending in the right direction. This morning, James was able to tolerate an hour and forty-five minutes on minimal support. This is a noteworthy achievement for rehabilitation. It was a challenge for James, but as always, James demonstrates motivation and perseverance.