Here I am again with the next installment of "Holy cow I'm in Africa and I can't figure out what to do!" Today's topic: tracheomalacia.
I have a 5 month old baby at the moment (4.6 kg ... he's just a little thing) who had a large cystic hygroma removed about ... oh, 12 days ago. Failed extubation on POD 3 or 4, reintubated for another couple days, finally extubated. After extubation, got tired about 2 days later and then spent 36 straight hours awake and gasping. Finally got moved back to the ICU where we rigged up CPAP with a Servo 900 vent and a facemask (I still do'nt know how this is staying on). We give him little breaks whenever he seems awake and feisty enough, but I've never seen a kid so stridorous without running for the intubation box, honestly. We're thinking his tracheomalacia goes rather far down, since he occasionally collapses his right lung with no provocation.
Question of the day: any ideas? Any solutions or fixes you've all seen for dang bad tracheomalacia short of traching him? It's not an option because there's no way to get supplies or followup (we leave in 5 months) and living on a dirt floor in the village in rainy season is a sure recipe for disaster. We can't just take him off the CPAP and let him fly, because he works so hard to breathe that he's going to starve to death; he doesn't absorb feeds at ALL when he's on nasal cannula.
We're at a loss here.