Evaluation of the Optimal Site and Needle Length of Needle Thoracostomy in Chest Trauma Patients.
- Author:
Mingyu KONG
1
;
Hyunjong KIM
;
Junseok PARK
;
Kyung Hwan KIM
;
Dongwun SHIN
;
Hoon KIM
;
Joon Min PARK
;
Woochan JEON
Author Information
1. Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea. drkim@paik.ac.kr
- Publication Type:Original Article
- Keywords:
Chest injury;
Needle thoracostomy;
Tension pneumothorax
- MeSH:
Emergencies;
Emergency Treatment;
Humans;
Medical Records;
Needles*;
Observational Study;
Pneumothorax;
Retrospective Studies;
Thoracic Injuries;
Thoracic Wall;
Thoracostomy*;
Thorax*
- From:Journal of the Korean Society of Emergency Medicine
2016;27(5):396-403
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Tension pneumothorax is a life threatening condition. As an emergency treatment, needle thoracostomy with 50mm angiocatheter at the second intercostal space on the mid-clavicular line (2nd ICS/MCL) is recommended in the current guidelines. However, another site has been suggested in some studies. The purpose of this study was to determine whether the current procedure should be changed, by comparing the chest wall thicknesses (CWT) at the 2(nd) ICS/MCL and the 5(th) ICS/AAL (anterior axillary line) of injured patients. METHODS: A retrospective observational study was performed in an emergency center between May 2009 and December 2011. Medical records and computed tomography (CT) images of 140 included patients were reviewed. CWT at the 2(nd) ICS/MCL was compared with the 5(th) ICS/AAL. Moreover, the relationship between BMI (body mass index) and CWT was evaluated. RESULTS: CWT of the 2(nd) ICS/MCL was 31.7±8.5 mm on the right and 31.6±8.8 mm on the left, with no differences (p=0.42). CWT of the 5(th) ICS/AAL was 28.1±8.5 mm on the right and 27.8±7.7 mm on the left, also with no differences (p=0.30). CWT of the 2(nd) ICS/MCL was thicker than that of the 5(th) ICS/AAL (p<0.001). Nevertheless, CWT of all sites were not thicker than 50 mm (p<0.001). BMI was positively correlated with CWT. CONCLUSION: There was insufficient amount of evidences shown in this study to change the current guidelines of needle thoracostomy. However, in case of obvious patients, a long needle and 5(th) ICS/AAL site should be considered for needle thoracostomy, because CWT tended to increase as BMI increased.
