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Tue Nov 3 14:27:25 GMT 2009

what about time limit? do you trach after 2 or 3 weeks? l've heard someone
doing it after only 1 week? Do you keep ETT longer in children?
Ante

2009/11/3 Mark Forrest <atacc.doc at btinternet.com>

> Simple solution.... Tracheostomy! The question is when, early or late?!
> We tend to go early, and once the FiO2 is 0.6 or less. Then sedation off.
> I wait to be convinced that we are wrong in our timing!
> Regards
> Mark F
> UK
> Ps next question, who if anyone is surgically fixing flails and when? Great
> presentation on this by Ron at the weekend.
>
> Sent from my iPhone
>
> On 1 Nov 2009, at 05:20, 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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Mechanical ventilation and flail chest