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Sat Jan 31 12:47:34 GMT 2009

I've always liked the idea of such a study - but it needs to be a long-term
study looking at things like lung function @ 1 yr, not just immediate ICU
response etc.
I disagree that patients with massive lung injury tolerate the procedure
poorly.  It's essentially a body wall procedure.  The chest cavity is not
opened, it's relatively quick and there's minimal blood loss.   The main
concern is transfer from an ICU ventilator on an OR ventilator, which they
don't tolerate well.  We tend to do it later in the course prior to or
during weaning attempts, but have done it for severely stoved-in chests
earlier.  Having said that we don't do it very often at all (because of a
lack of clear indications)

Karim

2009/1/30 Gross, Ronald <Ronald.Gross at bhs.org>

> Bill,
>
> I heard you and Gage on the RibLoc webinar that one of my partners was also
> on.  I missed it live but got the link.  I am meeting with them in the next
> month, and I am hoping to gather a number (if not all!) of the Level I
> Trauma Centers in New England to move the study forward.  Gonna take a bunch
> of time AND MONEY, but I do think we could get this done!!!
>
> "Talk" to you soon, I hope!
> Ron
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org] On Behalf Of William Bromberg
> Sent: Friday, January 30, 2009 2:55 PM
> To: 'Trauma &amp; Critical Care mailing list'
> Subject: RE: Lung Contusion
>
> We have recently put in a purchase request for the Ribloc (TM) plates just
> for this very reason. We'd be very interested in participating in a
> multi-institutional trial on this subject.
>
> Bill Bromberg
>
>
> William J. Bromberg, MD, FACS
> Savannah Surgical Group
> 912 350-7412
>
> >>> "Gross, Ronald" <Ronald.Gross at bhs.org> 1/30/2009 2:35 PM >>>
> Terrific!  I look forward to hearing from y'all - and just maybe working on
> this together!
> Ron
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org] On Behalf Of Errington Thompson
> Sent: Friday, January 30, 2009 2:32 PM
> To: 'Trauma &amp; Critical Care mailing list'
> Subject: RE: Lung Contusion
>
> Ron -
>
> I think that it is a good idea.  We have a large elderly population.  They
> fell in the shower or down steps and get 4 - 8 rib fractures and are in the
> hospital for 10 days or more.  Stabilizing the chest maybe helpful.  Let me
> run it by the guys.
>
> E
>
> Errington C. Thompson, MD, FACS, FCCM
> Trauma/Surgical Critical Care
> Radio Talk Host - WPEK 880 AM
> Author - Letter to America
> Asheville, NC
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org]
> On Behalf Of Gross, Ronald
> Sent: Friday, January 30, 2009 8:37 AM
> To: 'Trauma &amp; Critical Care mailing list'
> Subject: RE: Lung Contusion
>
> Sure - the INITIAL damage has been done, but I am convinced that in the
> really nasty flails, or even in the really nasty multiple fractures with
> severe displacement of the fracture edges, (1) continued lung injury from
> markedly displaced fracture edges, (2) persistent abnormal chest wall
> mechanics, and (3) persistent and poorly managed PAIN!!! end up keeping a
> lot of people on vents for a whole lot longer than they should/need to
> be....
>
> Ron
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org]
> On Behalf Of thomas konig
> Sent: Friday, January 30, 2009 8:06 AM
> To: trauma list
> Subject: RE: Lung Contusion
>
>
> Hasn't the damage to lung parenchyma already been done?
> I understand that continued abnormal force from fractured rib may continue
> to injure lung is this damage as severe as the initial insult?
>
> Tom> From: Ronald.Gross at bhs.org> To: trauma-list at trauma.org> Date: Fri, 30
> Jan 2009 07:42:27 -0500> Subject: RE: Lung Contusion> > How 'bout repair of
> the fractures? Looks like this "antiquated" procedure is coming back into
> use - with initial results appearing to be impressive. Anecdotal but
> impressive. No LARGE studies to date, to my knowledge and this is why we
> are
> looking to put together a multicenter PRT to look at this very issue.> >
> Any
> takers?> > Ron> > Ronald I. Gross, MD, FACS> Chief of Trauma & Emergency
> Surgery Services> Baystate Medical Center> 759 Chestnut Street>
> Springfield,
> MA 01199> 413-794-4022 phone> 413-794-0142 fax>
> ronald.gross at baystatehealth.org> -----Original Message-----> From:
> trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On
> Behalf Of Jose Luis Danguilan> Sent: Thursday, January 29, 2009 6:19 PM>
> To:
> Trauma &amp, Critical Care mailing list> Subject: Re: Lung Contusion> >
> Dear
> Karim,> > Anything new in treating flail chest wi
>  th pulmonary contusion? Mechanical> ventilator (internal splinting),
> etc.?>
> > Thanks.> > Jose Luis J. Danguilan, MD> Manila, Philippines> > > On
> 1/29/09, Karim Brohi <karimbrohi at gmail.com> wrote:> >> > While I would
> agree
> with minimizing crystalloids and maintaining euvolaemia> > I don't think
> there's any evidence to support fluid restriction in these> > patients. A
> normal enteral fluid requirement should be adequate. No> > diuretics.> >
> Karim> >> >> > On 01/29/2009, KMATTOX at aol.com <KMATTOX at aol.com> wrote:> >
> >>
> > > You are correct. Lasix is probably contraindicated in> > > pulmonary
> contusion.> > > We would use fluid RESTRICTION to even almost no
> crystalloid
> fluid at> > > all. AVOID ALBUMIN at all cost. ONE doctor, not a team of
> multiple> > > consultants writing orders> > >> > > k> > >> > >> > >> > > In
> a message dated 1/28/2009 8:32:21 P.M. Central Standard Time,> > >
> errington at erringtonthompson.com writes:> > >> > > As a rule we don't use
> Lasix in pulmonary contusions. T
>  he goal in> > > caring for patients with pulmonary contusions is> > >
> euvolemia. Intubate early> > > if necessary. Head of the bed should be
> elevated. No prophylactic> > > antibiotics. Early tracheostomy.> > >> > >
> Guys, am I missing anything?> > >> > >> > > **************From Wall Street
> to Main Street and everywhere in between,> > > stay> > > up-to-date with
> the
> latest news. (> > http://aol.com?ncid=emlcntaolcom00000023> > > )> > > -->
> >
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