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Thu Nov 5 08:36:10 GMT 2009

Do I understand correctly, that our well known colleague in the UK, Mark F., does perform an Tracheostomy on every patient with a flail chest and a lungcontusion? Forgive me my ignorence but that's in my humble opinion a little bit overdone. I would love to see the results of investigation between the two strategies: tracheostomy verus conventional GOOD ventilatory strategy (but what is a good strategy). For as I know there are different schools for this discussion and I am in favour of the strategy of emeritus professor Lachmann (google his name and you will see briljant ventilatory research). We also can learn from the army with a lot of this problems and for as I know there are not many tracheostomies performed in soldiers with flailchest and luncontusion......and the results are satisfactory. Hope to hear new ideas from all you academics out there, evidence based or experienced based...

Edward J. Pasman, MD
Anesthesiologist, area of attendance: Trauma-Anesthesiology and disaster management
Department of anesthesiology
Academic Medical Center (AMC) Amsterdam
H1-room 150
Tel.: 020-5663633/56662533
Beeper: 64034
e-mail: e.j.pasman at amc.uva.nl

-
> 
> 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
> 
> 
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