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Unstable cervical fracture

situations and it is difficult for the clinician to be certain what it reflects in any specific circumstance. It also necessitates the imposition of an inspiratory pause, a manoeuvre which may not always be appropriate from a purely therapeutic point of view and may not be possible in certain modes of ventilatory support. Moreover, the facility to measure pause pressure simply. is not incorporated into all ventilators. Our method does not suffer from these limitations. Finally, we take issue with the idea that pause pressure may be better related to barotrauma than peak pressure. There are in our view insufficient data available to draw valid conclusions on this issue. There is clearly a need for a large prospective study to investigate the relationships (if any) between airway pressures measured by different methods (peak and mean pressures measured directly in the airway, peak and mean pressures calculated by our computer method and peak, mean and pause pressures measured in the ventilator breathing system) and the incidence of barotrauma. We are in the process of setting up such a study and will report our findings in due course.