List Archives

Sun Feb 1 21:47:01 GMT 2009

Trial size.  If we take the Tokyo data as baseline, you get the following
approximate (total) sample sizes:(apha 0.05, power 0.9)

Vent days 11 vs 18 : 50
ICU stay 17 vs 26 : 92
Incidence of pneumonia 24% vs 77% : 42
Work at 6 months: 32 (!!)

100 patients or so should be ample for a strong signal
Sign us up!
Karim

2009/1/31 Karim Brohi <karimbrohi at gmail.com>

> Trouble is, there is a randomised trial showing efficacy.  Its relatively
> small, but shows a potential positive effect for the intervention.  Further,
> there are no RCTs which show it doesn't work / does harm.  Now, I don't
> think we should accept a single small trial as gospel.  But we should
> attempt to do the definitive trial.
> K
>
> J Trauma. 2002 Apr;52(4):727-32; discussion 732. Links
> Surgical stabilization of internal pneumatic stabilization? A prospective
> randomized study of management of severe flail chest patients.
>
> Tanaka H, Yukioka T, Yamaguti Y, Shimizu S, Goto H, Matsuda H, Shimazaki S.
> Department of Traumatology and Critical Care Medicine, Kyorin University,
> Tokyo, Japan. htanaka at gol.com
> BACKGROUND: We compared the clinical efficacy of surgical stabilization and
> internal pneumatic stabilization in severe flail chest patients who required
> prolonged ventilatory support. METHODS: Thirty-seven consecutive severe
> flail chest patients who required mechanical ventilation were enrolled in
> this study. All the patients received identical respiratory management,
> including end-tracheal intubation, mechanical ventilation, continuous
> epidural anesthesia, analgesia, bronchoscopic aspiration, postural drainage,
> and pulmonary hygiene. At 5 days after injury, surgical stabilization with
> Judet struts (S group, n = 18) or internal pneumatic stabilization (I group,
> n = 19) was randomly assigned. Most respiratory management was identical
> between the two groups except the surgical procedure. Statistical analysis
> using two-way analysis of variance and Tukey's test was used to compare the
> groups. RESULTS: Age, sex, Injury Severity Score, chest Abbreviated Injury
> Score, number of rib fractures, severity of lung contusion, and Pao2/Fio2
> ratio at admission were all equivalent in the two groups. The S group showed
> a shorter ventilatory period (10.8 +/- 3.4 days) than the I group (18.3 +/-
> 7.4 days) (p < 0.05), shorter intensive care unit stay (S group, 16.5 +/-
> 7.4 days; I group, 26.8 +/- 13.2 days; p < 0.05), and lower incidence of
> pneumonia (S group, 24%; I group, 77%; p < 0.05). Percent forced vital
> capacity was higher in the S group at 1 month and thereafter (p < 0.05). The
> percentage of patients who had returned to full-time employment at 6 months
> was significantly higher in the S group (11 of 18) than in the I group (1 of
> 19). CONCLUSION: This study proved that in severe flail chest patients,
> surgical stabilization using Judet struts has beneficial effects with
> respect to less ventilatory support, lower incidence of pneumonia, shorter
> trauma intensive care unit stay, and reduced medical cost than internal
> fixation. Moreover, surgical stabilization with Judet struts improved
> percent forced vital capacity from the early phase after surgical fixation.
> Also, patients with surgical stabilization could return to their previous
> employment quicker than those with internal pneumatic stabilization, even in
> those with the same severity of flail chest. We therefore concluded that
> surgical stabilization with Judet struts may be preferably applied to
> patients with severe flail chest who need ventilator support.
>
> 2009/1/31 <KMATTOX at aol.com>
>
> Assuming your statement is scientifically sound I would use and teach  it.
>> I have desperately looked for more than Class 5 data to support  their use
>> (WAG).    There is now a long list of gadgets and  drugs that have been
>> heavily
>> marketed and later found to even be  harmful.    Everyone on this list has
>> been
>> and some even now are  guilty of continuing to use such fads.
>>
>> k
>>
>>
>> In a message dated 1/31/2009 8:23:23 A.M. Central Standard Time,
>> Krin135 at aol.com writes:
>>
>> if  indeed this new rib plate makes
>> rib fixation without violating the  pleura practical thus  speeding return
>> to
>> physiological normal, at  what level of evidence will you  start
>> using/teaching
>> the  procedure?
>>
>>
>> **************From Wall Street to Main Street and everywhere in between,
>> stay
>> up-to-date with the latest news. (
>> http://aol.com?ncid=emlcntaolcom00000023)
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>
>

List Archives

For your convenience, find the Trauma List Archive Below

Lung Contusion