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Thu, 10 Jan 2002 00:23:13 -0000

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Dear Ken,
Please read my reply which clearly states that the hyperbaric effect was =
not for surgical emphysema but
rather an incidental benefit whilst being used as an adjunct to surgery =
in a
case of nec.fasciitis.
I would have hoped that list members would have appreciated that I was =
not
suggesting  this as a therapy, but more as an interesting observation of =
how
quickly the air can be cleared, under pressure.

Sadly, my experiences of thoracic surgical input in ITU patients with =
severe
surgical emphsyema has extended little further than 'put in another =
chest
drain', (often into patients who already have several functioning =
drains).

Frequently, as we have already discussed, such emphysema is little more =
than
a nuisance. However, when it does become a major problem thoracic =
surgery
often has little more to offer than the position that we are already in
(intensivists do understand chest drains!).

For the thoracic surgeons 'out there' when would you consider surgically
managing a BP fistula....indications??

and....what do list members currently favour for pleurodesis....blood,
tetracycline, talcum powder!??

Regards
Mark F

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<DIV>Dear Ken,<BR>Please read my reply which clearly states that the =
hyperbaric=20
effect was not for surgical emphysema but<BR>rather an incidental =
benefit whilst=20
being used as an adjunct to surgery in a<BR>case of nec.fasciitis.<BR>I =
would=20
have hoped that list members would have appreciated that I was=20
not<BR>suggesting&nbsp; this as a therapy, but more as an interesting=20
observation of how<BR>quickly the air can be cleared, under=20
pressure.<BR><BR>Sadly, my experiences of thoracic surgical input in ITU =

patients with severe surgical emphsyema has extended little further =
than 'put=20
in another chest drain', (often into patients who already have =
several=20
functioning drains). Frequently, as we have already discussed, =
such=20
emphysema is little more than a nuisance. However, when it does =
become a=20
major problem thoracic surgery often has little more to offer than =
the=20
position that we are already in (intensivists do understand chest=20
drains!). For the thoracic surgeons 'out there' when would you =
consider=20
surgically managing a BP fistula....indications?? and....what =
do list=20
members currently favour for pleurodesis....blood, tetracycline, =
talcum=20
powder!?? Regards Mark F</DIV></BODY></HTML>

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