List Archives

Wed Nov 4 05:26:39 GMT 2009

Or even earlier. If the patient is clearly going to need more than a 
week or two ventilation then the sooner the trache is done the better.
Ian

Ante C'oric' wrote:
> 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
>>
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or  unsubscribe  visit:
>> http://www.trauma.org/index.php?/community/
>> --
>> trauma-list :  TRAUMA.ORG
>> To change your settings or unsubscribe  visit:
>> http://www.trauma.org/index.php?/community/
>>
>>
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>>
>>
>>
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>> --
>> trauma-list : TRAUMA.ORG
>> To change your settings or unsubscribe visit:
>> http://www.trauma.org/index.php?/community/
>>
>>     
> --
> 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

Mechanical ventilation and flail chest