Lung Injury Score

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Well even if you have RTs, you would need a physician to do the vent
settings. l prefer anaesthetists/intensivists doing most of vent management.


2010/8/6 Dr Timothy Hardcastle <dr.tchardcastle at absamail.co.za>

> Rebecca
>
> One caveat for lung contusion:
> For the first three to eight hours try to recruit the lung with slightly
> higher Vt - 8ml/kg, before doing the lung-protective stuff.
>
> People are unduly scared of PEEP - I use PEEP = 1/5 of FiO2 with good
> results.
> Agree - ignore the pCO2 unless the pH drops - but I have not yet found it
> necessary to use Bicarb if the PEEP is adjusted to response.
>
> We also use a lot of PSV rather than SIMV now, with shorted vent times -
> patients prefer to adjust the vent to their needs, rather than have the
> vent fight them. We accept sats >90% in the previously healthy.
>
> Oh and Kieth - I agree: use early not as a rescue therapy! (We don't have
> Resp Tech in South Africa - the trauma surgeons and intensivists do the
> ventilating ourselves)
>
> Tim
> Dr T C Hardcastle
> M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
> Principal Specialist Trauma Surgeon /
> Honorary Senior Lecturer UKZN Dept Surgery
> Deputy Director - IALCH Trauma Service
> Durban, South Africa
>
> We do not prone!
> > What u do is try not to beat up the lungs to much UAE low pressure and
> low
> > peep and accept some degree of hypoxia.  Sats.  88 are ok as there are
> > plenty of copders and kids with congenital heart disease walking around
> > with lower sats and use permissive hypercapnia.   I had one or with co2.
> > 110. And sats 85.  He huffed propane.  He was this way for over a week
> > survived with no deficits.    It is hard Ro get peole to do this.   If ph
> > gets to low.  Give bicarb
> > Sent from my iPhone
> >
> > On Aug 5, 2010, at 5:40 PM, Ante Ćorić <ante.coric85 at gmail.com> wrote:
> >
> >> Well, l'm not sure how much proning is real helpful in longterm, besides
> >> clearing hypoxaemia better intially, no survival benefit is reported, as
> >> to
> >> my notice.
> >> If my patient has a lung contusions, l would start him/her on long
> >> protecitve strategy, or atleast a modification of it, not waiting for
> >> bad
> >> gas analysis to kick in.
> >>
> >> cheers,
> >>
> >> Ante
> >>
> >> 2010/8/1 Keith Lamb <lambrrt at gmail.com>
> >>
> >>> Does anyone use any of the "lung injury score systems" to help identify
> >>> patients who you anticipate will get "sicker", and use that info as
> >>> part of
> >>> their management strategy?
> >>>
> >>> Example: Lets say you have a trauma patient s/p MVC, multiple system
> >>> involvement. Lets say your patient had exp. lap, splenectomy, and liver
> >>> lac.
> >>> In addition your patient had some blunt chest trauma, including sternal
> >>> fracture, rib fractures, and unilateral pulmonary contusion.
> >>>
> >>> No significant gas exchange abnormality.
> >>>
> >>> Lets say you calculate your lung injury score, and then again 24 hours
> >>> later
> >>> and it is worse, BUT you still have no significant gas exchange
> >>> abnormalities.
> >>>
> >>> Doesn't it make sense to "prophylactically" institute a strategy that
> >>> is as
> >>> lung protective as possible? Example: more PEEP, less tidal volume,
> >>> maybe
> >>> even HFOV?
> >>>
> >>> Some times it a hard sell to institute these type of things before
> >>> there is
> >>> significant hypoxemia/respiratory failure.
> >>>
> >>> My experience has been that we tend to use such strategies (HFOV,
> >>> proning,
> >>> NO, etc.) as rescue therapies and tend to implement them in a last
> >>> ditch
> >>> effort to salvage the unsalvageable. Then we swear up and down that
> >>> these
> >>> therapies "don't work", because we have unfavorable outcomes.
> >>>
> >>> If you do use a scoring system, which one?
> >>>
> >>> Keith
> >>>
> >>> Keith D. Lamb RCP, RRT
> >>> Christiana Care Health System
> >>> Newark, DE
> >>> 302.983.6178
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>
>
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