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Mon Jun 21 12:53:09 BST 2010

Sadly, very few of the patients that receive a decompressive crani in our shop ever come off the vent.  In fact, the vast majority of them eventually succumb to their injuries.  Jus the same, these patients all will get trached because it just isn't safe to extubate someone with a GCS of <8.
Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Keith Lamb
Sent: Saturday, June 19, 2010 3:03 PM
To: International Critical Care Medicine Group; Trauma & Critical Care mailing list; Respiratory Care Professionals World Forum
Subject: Decompressive craniectomies

How often do you see patients who have undergone decompressive craniectomies
eventually get extubated, NOT trached?

We often do not extubate these folks even though we cannot "pinpoint" a
reason not to. They have good spontaneous respiratory parameters. They have
good intact airway reflexes, but they do not follow commands, and have
minimal purposeful movement. The majority of ours wind up trached without a
trial of extubation.

Experience?

Keith
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Decompressive craniectomies