A lung CT scan this morning revealed that Linda's right lung was completely collapsed, due to a mucous plug located in the right bronchus just below the tracheal bifurcation. As a result, fluid accumulation on her chest was continuing at a rate of about 2 liters per day, and additionally there was an air pocket which developed near the top of her right chest cavity, further inhibiting reinflation of her right lung. In order to clear the mucous plug, at 5:30 this evening the pulmonary doctors performed a bronchoscopy and sucked out the plug. They also rinsed the interior of her right lung and cultured the fluid for possible infection. She was intubated for the procedure and will remain on the ventilator overnight to maintain her oxygen level and respiratory effort while, hopefully, her right lung reinflates.
The lung doctors say they hope the air pocket will be relieved by application of suction on the chest tube she already has, because it seems like the air pocket at the top of her right chest cavity communicates with the fluid pocket in her right lower chest. If they are right, her right lung will reinflate soon and she will be breathing well enough to go back to rehab. If not, she may need a second chest tube to relieve the right pneumothorax in order for her to have full use of both lungs. The chest CT was also suspicious for pericardial effusion, which the cardiac doctors will evaluate tonight or tomorrow morning with an echocardiogram to see whether they think her heart function is being compromised by the excess fluid.
Tonight all anyone can do is maintain her blood pressure and keep her breathing on the ventilator to see what will happen with her right lung. So far no infectious agents have been cultured out of the fluid drained off her chest, which is a very lucky thing.
Linda's oxygen level today has been perfectly adequate, but her shallow breathing resulting from her compromised right lung resulted in increased carbon dioxide levels in her blood, making her very drowsy most of the day. Once the right lung reinflates she should regain her usual feisty alertness, and she will want to get back to work on her rehab ASAP.
I haven't been back to RHI yet to pick up Linda's belongings there, but I understand they are holding anything any of you sent that was delivered after the ambulance took her away. It's unclear how soon we will be going back there, but hopefully it won't be more than a couple or three days from now.
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