I am a big proponent of the chest wall stabilization for patients with severe chest trauma and flail chest. In my experience, it facilitates weaning from the ventilator, pain control and improves activity. Should it become the standard of care?

Severe chest wall injury and flail chest – those are very difficult injuries to treat. The greatest challenge is to wean those patients off mechanical ventilation and keep them off the ventilator. Pain control is a problem as well – often patients end up having epidural catheter for analgesia. The recovery is long and painful for the patients with severe chest wall injury. Not surprising, the functional capacity is diminished for many months after the discharge from the Hospital. There is a lot of literature out there about the treatment options of these injuries. In my practice, I have seen great benefits from a chest wall stabilization procedure (click on image above). In my experience it was easier to wean the patients off the ventilator, pain was better controlled and the patients, in general, did better from activity standpoint. Those are the observations from my practice. I do believe in this treatment modality and I hope to see it becoming the standard of care.

Traumatic brain injury (TBI) is a major health burden in US and worldwide. It’s shocking how many young people die or get disabled from TBI every year. One of the aspects of the management of these patients that I was always interested in is a decompressive craniectomy. The concept behind this procedure is to remove a part of the patient’s skull to prevent secondary brain damage from swelling and edema that often complicates brain injury.  Unfortunately, the evidence to support this treatment option is inconsistent.
Reviewing the Journal of Trauma I came across an article “Preemptive craniectomy with craniotomy: what role in the management of severe traumatic brain injury?”. I found it encouraging that patients treated with craniectomy (removing part of their skull) did at least no worse (adjusted for severity of illness/trauma) than the rest of the patients. It would be interesting to see any future trials on this matter to proof of disproof any benefits of this procedure.
Meanwhile should we be offering prophylactic craniectomy to our patients or not???