some sunshine

James seems to have turned a corner! I write with cautious optimism, but also the enthusiasm of a renewed sense of hope. James is finally moving in the right direction. His resilience and drive have never been more evident (and I know I write that a lot, but James continues to amaze me).

James' respiratory status has improved significantly, along with his kidney function, fluid balance, and gastrointestinal status. A decision was made that James was finally stable enough to wean from all the sedation. He was calm and alert through the process, and was able to tolerate the wean without delirium or hallucinations. Subsequently, James was also able to come down on his ventilator settings. It will take some time for James to be able to breathe on his own, but I am already beaming with pride. 

Yesterday, James tolerated twenty-five minutes on pressure support without negative impact to his hemodynamics. His oxygen requirements have also improved with a need for fifty to sixty percent oxygenation. It is also important to also consider the role of muscle deterioration, including the muscles that are necessary to allow for breathing. James will have limited trials on pressure support to allow these muscles to rebuild in strength and endurance. These are all essential baby steps along this journey. We are headed towards James' independent breathing!

Do you want some more sunshine? James was also able to participate in physiotherapy yesterday! He dangled on the edge of his bed, and made two separate attempts at standing. How is that for heroics? This is very impressive for James' current health status. We were all beyond pleased.