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Wed Jul 8 07:17:46 BST 2009

Zaf

Actually it was Kieth asking - my response was that I did not have
"off-hand" access to articles. I was home when replying! This article is a
good summary of exactly what I said originally to Christine.

As usual, articles sometimes fail in what they DON'T say - they report a
higher mortality in the intubated / ventilated group, BUT they don't give
a breakdown of the associated injuries apart from the chest injury,
neither do the quantify the extent of the lung contusion between the two
groups. It is well known that the patients with more extensive contusion
are more likely to be ETI and vented, and this group carries a higher VAP
rate. No ISS scores are given - useful in blunt trauma (as with these
cases), not in penetrating trauma. APACHE is known to be unreliable in
trauma as it is heavily weighted to head injury and renal dysfunction or
ARDS, which is confusing as the values for contusion and ARDS (PF ratios)
are similar, but the pathology and outcome is very different.

Thanks again for the article.

Tim
Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Lecturer University of KwaZulu-Natal Dept Surgery
Deputy Director - IALCH Trauma Service
Durban - South Africa

> Tim
>
> This attached article may be of interest to you.
>
> Zaf
>  
> Dr. Zaffer Qasim MBBS MRCS MCEM
> Specialty Registrar in Emergency Medicine and Critical Care
> Manchester, United Kingdom
>
>
>
>> Tim,
>>
>> Do you know of any data published regarding NIPPV and flail chest?
>> Impressive anecdotal experience. Thanks for sharing.
>>
>> Keith
>> On Tue, Jul 7, 2009 at 2:46 AM, Dr Timothy Hardcastle <
>> dr.tchardcastle at absamail..co.za> wrote:

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Non invasive Ventilation with Flail Chest