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trauma-list Digest, Vol 77, Issue 4

Ian Seppelt seppelt at med.usyd.edu.au
Thu Nov 5 10:30:23 GMT 2009

I think you are misrepresenting Mark's comments. I practice pretty  
much the same way as Mark - every patient who can be confidently  
predicted to need more than 7 - 10 days ventilation will get a  
tracheostomy, and the earlier the better. However where there is some  
doubt, I wait.

We are not talking about young soldiers here - they are unlikely to  
need 7 - 10 days ventilation for their flail unless they have ARDS as  
well - my chest trauma population is more likely to osteoporotic  
smokers with emphysema and they are a very different kettle of fish.


On 05/11/2009, at 7:36 PM, "E.J. Pasman" <E.J.Pasman at amc.uva.nl> wrote:

> 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
> <E.J.Pasman.vcf>
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