Caltong’s Story, Part Two: Breathing on His Own

Four-year-old Caltong Liu had arrived in the Stanford Hospital Emergency Department barely able to breathe. Now, a few hours after a car accident crushed his chest and left him with 20 bone fractures, the little boy had been transferred to the pediatric intensive care unit at Lucile Packard Children's Hospital.

Caltong was in a fragile state – on a respirator, sedated and heavily bandaged – when his parents, mom Chunhui Li and dad Yuming Liu, first glimpsed their son in the PICU. They hadn't seen the hard work of the pediatric trauma team in the Emergency Department; Yuming, who was also in the accident, had been receiving treatment for his broken leg, and it took police a few hours to call Chunhui to the hospital.

"The first night in the hospital, we were very unsure if he could walk or talk again," Chunhui said. At first, no one could predict the lasting effect of Caltong's injuries. But with expert care from a dozen different specialties and a few days of careful management, the physicians were soon confident Caltong could recover.

"He was very lucky that he didn't have any significant injuries to his vital organs," said pediatric intensivist Felice Su, MD, who cared for Caltong. His brain and heart were fine, and his lungs were supported by the respirator."Kids have an ability to recover pretty impressively," Su said.

Still, problems remained. The biggest risk was taking Caltong off the respirator, a necessary milestone before discharge from the PICU. If the pain from Caltong's 14 rib fractures was too intense when he inhaled on his own, he might require so much pain medication that it would hamper his tenuous breathing.

The respiratory, anesthesia and plastic surgery teams collaborated to devise a unique solution. Caltong needed a skin graft to repair a deep burn on his left leg. After the surgery, while still in the operating room, the anesthesiologists injected a painkiller into the epidural space around Caltong's ribcage. Giving the drug directly to the injured area provided good pain relief with less medication, and thus less risk of interfering with breathing. Then, still in the operating room, the respiratory therapy team carefully transitioned Caltong to breathing on his own.

"The OR was the safest place to extubate him," Su said. "Having so many specialty teams who were able to co-ordinate Caltong's care in a global way was really important. It's an amazing strength of Packard."

Read part three of Caltong's story

Part 1	Part 2	Part 3