My Favorite Part

My favorite part of her being quasi awake (she’s still on a ton of fentanyl and versed)……….

holding my hand.  :)

Evening rounds are complete.  We have lost our position of “sickest kid in the ICU.”  I feel bad for that child’s parents.

One of the evening shift doctors was asking about Bella’s PEEP (which is 9.0) and the attending and fellow both jumped and said don’t touch it.   She is down from 12, but she likes a high PEEP.  He said she is like a kid with bronchial mylasia.  Of course, a new term means I’m researching – and I agree, she is like a kid with bronchial mylasia.

It's a problem with the lungs in which the airways literally do not stay open they way they should, because they are mis-shapen or too weak.  Malacia literally means "soft", and in this case, the lungs are too not stiff in places they should be.
For instance, usually, a person's trachea has ring-shaped cartilage that keeps the lung passage ways open in between the contractions of taking a breath; when someone has traceal bronchial malacia, the trachea aren't elastic and stiff enough to bounce back to their correct shape when they should.
The same thing can happen with other structures in the lungs, including the tiny air sacs that should swell open and closed with each breath.  If they don't change their shape properly, they may be malformed -- bronchial malacia.
Typically bronchial malacia happens in premature babies, whose tissues haven't matured sufficiently to perform necessary functions for breathing.  Most of these cases have a good chance of sorting themselves out as the child matures -- if the child can be kept alive long enough.  Bronchial malacia can also happen due to chronic long-term disease or chemical exposure.  Genetic causes would be unusual but not impossible.