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Sun Nov 1 06:36:07 GMT 2009

Garbage! Many patients are perfectly okay on the ventilator without  
sedation, and don't report significant issues on long term followup.  
Other patients need significant sedation and analgesia. Assess your  
patients and treat them as appropriate. All our sedatives have their  
own lists of  potential problems. Benzodiazepines in particular can  
have very nasty long term neuropsychological complications.

Do what is right for the individual patient. And frequently reassess.

Ian Seppelt, Sydney.

On 01/11/2009, at 4:20 PM, parthasarathi goswami <parthasarathi013 at yahoo.com 
 > wrote:

> TO ALL LIST MEMBERS,
>
> LET US REMEMBER THAT BEING INTUBATED IS ONE OF THE MOST PAINFUL  
> PROCEDURES THAT HAPPENS IN THE ICU..ALTHOUGH NO BLOOD IS LET OR ANY  
> NEEDLE OR SCALPEL IS USED INTIBATION INCREASES THE STRESS OF THE  
> PATIENTS AND MANY RECOLLECT THAT AS ONE OF THE MOST PAINFUL MEMORIES  
> OF THEIR ICU STAY..ALL PATIENTS ON THE VENT OR INTUBATED MUST  
> RECCIEVE SOME SEDATION AND ANXIOLYSYIS.( DEXMEDETOMIDIDNE PROBABLY  
> FITS THE BILL NICE AND SQUARE)...IT HELPS CALM FRAYED NERVES..MAY  
> ALSO HELP US WEAN PATIENTS FASTER ..AFTER ALL NO ONE WANTS TO GO  
> HOME WITH A NORMAL PHYSIOLOGY BUT A PAINFUL THROAT.AND A BAG OF BAD  
> MEMORIES.
>
> DR PARTHASARATHI GOSWAMI
> CHIEF ICU COORDINATOR
> WOODLANDS HOSPITAL, KOLKATA , INDIA
>
> --- On Sun, 11/1/09, Krin135 at aol.com <Krin135 at aol.com> wrote:
>
>
> From: Krin135 at aol.com <Krin135 at aol.com>
> Subject: Re: Mechanical ventilation and flail chest
> To: trauma-list at trauma.org
> Date: Sunday, November 1, 2009, 12:45 AM
>
>
> Dr. Duchesne:
>
> having run into the problem in the past, I modestly recommend that we
> change "paralyzed and sedated" to "sedated and paralyzed," to  
> indicate that the
> sedation/analgesia is the more important phase of the treatment.  
> I've seen
> a  more than few cases (both medical and trauma) of patients on the  
> vent who
> were unstable (tachycardia, labile blood pressure, lousy blood  gases)
> until we increased their sedation. These patients were fully   
> paralyzed at the
> time. Most of them were lost to my follow up, so I had no way  to  
> ask them
> if they remembered any of the painful procedures (chest tubes,   
> Foleys) that
> they received while intubated.
>
> I have had more than a few patients in the last 35 years who could  
> relate
> *interesting* anecdotes from the discussions going on during their  
> general
> anesthesia...can be very embarrassing for the docs and nurses   
> involved!
>
> I've also seen many well sedated patients that did not need  
> paralysis to
> tolerate even painful ventilation.
>
> ck
>
>
> In a message dated 10/31/2009 11:44:56 Central Standard Time,
> jduchesn at tulane.edu writes:
>
> Dear  Matthieu:
> I have my own bias on what works for lung contusion with severe   
> chest wall
> injury (flail chest) and ARDS net is not the answer.
> I like to  use damage control ventilation using pressure control at  
> low
> rate with a 1 to  1 I:E ratioa. This works great in opening your  
> FRC. I
> identify the best PEEP  and then add Pressure above PEEP to give you  
> a Plateau at
> 33. For this  maneuver the patient needs to be paralyzed and sedated  
> in order
> to achieve the  best recruitment.
> I use this damage control ventilation mode for the first  72 hours and
> although I don't have our own data yet the CXR difference is   
> dramatic.
> Good Luck
> Duchesne
> CharityOne-New Orleans
> Sent via  BlackBerry by AT&T
>
> -----Original Message-----
> From: Matthieu G.  <mat.genz at gmail.com>
> Date: Sat, 31 Oct 2009 18:13:49
> To:  Trauma-List [TRAUMA.ORG]<trauma-list at trauma.org>
> Subject: Mechanical  ventilation and flail chest
>
> Dear list members,
>
> do you use a  specific mechanical ventilation strategy for patient  
> with
> flail  chest and underlying lung contusions, besides the lung
> protective  approach for patient with ALI/ARDS? For example, Moore's
> Trauma  textbook advocates the use of volume controlled over pressure-
> supported  mode, the rationale being that even the modest negative
> pressures  needed to trigger the ventilator cycle may destabilize the
> chest  wall.
>
> Thank you for your input.
>
> Matthieu  Gensburger
>
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>
>
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