A few steps back again.

Joey crashed and burned early morning on 2/11/20.  He was cranky a few days prior and we weren't sure why. His oxygen sats were dipping on 2/10/20 very quickly. We gave him some atavan to calm him, and then he started working very hard in the middle of the night and his heart rate was increasing. They decided to move him back on vapotherm in the middle of the night at about 3:30 AM, and he has seemed pretty comfortable since then. We are weaning him down from vapotherm. He started on 8 liters at 60 percent, now he is on 6 liters at 43 percent oxygen. ENT is going to visit today to make sure that there isn't obstruction in the nose or inflammation.  He has had some secretions in his nose and sounded congested. We are trying to get to the bottom of this, but we are also questioning what his true baseline is.  The last time we tried to wean down, he had a skin infection and he crashed.  Prior to that, the wean was impacted by his surgery for his gtube, because he only got to stay on nasal cannula for a week and half before going to surgery.  This crash is either related to something going on with his nose, or he really can't maintain a lower flow of oxygen long term.  We are unsure, but we are going to try to give it a go to see if he can get down 750 ccs and stay there for a while before we go home. His lab cultures came back negative, so we are going to rule out infection.

Yesterday he did enjoy some play time, got a couple of squirts of Afrin, sat in an upright position and was loving life.