Chest wall thickness and decompression failure: A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy

Laan, Danuel V.; Vu, Trang Diem N.; Thiels, Cornelius A.; Pandian, T.K.; Schiller, Henry J.; Murad, M. Hassan; Aho, Johnathon M.

doi:10.1016/j.injury.2015.11.045

Cited by 102 publications

(73 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Multiple reasons for such ‘failure’ in adults have been proposed in adults, focussing on technical challenges to enter the pleural cavity. These include introduction of the catheter into subcutaneous bullae (which may cause false positive impression of a ‘hiss’), cannula obstruction, insufficient cannula length and increased chest wall thickness either because of patient habitus and/or subcutaneous emphysema . The safety of needle thoracocentesis is debated, and devastating injuries including those to the underlying cardiopulmonary vasculature have been reported …”

Section: Discussionmentioning

confidence: 99%

“…Until recent years, the standard of care for emergency pleural decompression in trauma has been needle thoracocentesis, for example, in the management of tension pneumothorax, massive haemothorax and traumatic cardiac arrest. However, in adult practice at least, concerns have been raised as to the efficacy and safety of needle thoracocentesis to both achieve and sustain pleural decompression, with associated high failure rates and morbidity because of cannula (or catheter) dislodgement, inappropriate length, occlusion and inability to penetrate the pleura . These important clinical misgivings are supported by clinical, cadaveric and animal studies, highlighting high rates of needle thoracocentesis failure.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Thoracostomy in children with severe trauma: An overview of the paediatric experience in Victoria, Australia

Quinn

Palmer

Bernard

et al. 2019

Emerg Medicine Australasia

View full text Add to dashboard Cite

Objective Thoracic trauma is a leading cause of paediatric trauma deaths. Traumatic cardiac arrest, tension pneumothorax and massive haemothorax are life‐threatening conditions requiring emergency and definitive pleural decompression. In adults, thoracostomy is increasingly preferred over needle thoracocentesis for emergency pleural decompression. The present study reports on the early experience of thoracostomy in children, to inform debate regarding the best approach for emergency pleural compression in paediatric trauma. Methods Retrospective review of Ambulance Victoria and The Royal Children's Hospital Melbourne, Trauma Registry between August 2016 and February 2019 to identify children undergoing thoracostomy for trauma, either pre‐hospital or in the ED. Results Fourteen children aged 1.2–15 years underwent 23 thoracostomy procedures over the 31 month period. The majority of patients sustained transport‐related injuries, and underwent thoracostomies for the primary indications of hypoxia and hypotension. Two children were in traumatic cardiac arrest. Ten children underwent needle thoracocentesis prior to thoracostomy, but all required thoracostomy to achieve the necessary definitive decompression. All patients were severely injured with multiple‐associated serious injuries and median Injury Severity Score 35.5 (17–75), three of whom died from their injuries. Thoracostomy in our cohort had a low complication rate. Conclusion In severely injured children, thoracostomy is an effective and reliable method to achieve emergency pleural decompression, including in the young child. The technical challenges presented by children are real, but can be addressed by training to support a low complication rate. We recommend thoracostomy over needle thoracocentesis as the first‐line intervention in children with traumatic cardiac arrest, tension pneumothorax and massive haemothorax. [Correction added on 23 September 2019 after first online publication: in the second sentence of the conclusion, the words “under review process” were mistakenly added and have been removed.]

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Thoracostomy in children with severe trauma: An overview of the paediatric experience in Victoria, Australia

Quinn

Palmer

Bernard

et al. 2019

Emerg Medicine Australasia

View full text Add to dashboard Cite

show abstract

“…Therefore, a 3.25-in.-long (8.25 cm) puncture needle (No. 14) is recommended by the Committee for Tactical Emergency Casualty Care (C-TECC) [ 18 , 19 ]. The recommended site for needle thoracentesis is still at the second intercostal space in the midclavicular line [ 13 , 20 , 21 ].…”

Section: First Aid On the Battlefield For Current Wartime Thoracic Inmentioning

confidence: 99%

Chinese expert consensus on echelons treatment of thoracic injury in modern warfare

et al. 2018

View full text Add to dashboard Cite

The emergency treatment of thoracic injuries varies of general conditions and modern warfare. However, there are no unified battlefield treatment guidelines for thoracic injuries in the Chinese People’s Liberation Army (PLA). An expert consensus has been reached based on the epidemiology of thoracic injuries and the concept of battlefield treatment combined with the existing levels of military medical care in modern warfare. Since there are no differences in the specialized treatment for thoracic injuries between general conditions and modern warfare, first aid, emergency treatment, and early treatment of thoracic injuries are introduced separately in three levels in this consensus. At Level I facilities, tension pneumothorax and open pneumothorax are recommended for initial assessment during the first aid stage. Re-evaluation and further treatment for hemothorax, flail chest, and pericardial tamponade are recommended at Level II facilities. At Level III facilities, simple surgical operations such as emergency thoracotomy and debridement surgery for open pneumothorax are recommended. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.

show abstract

“…Furthermore, chest wall composition is different in swine than in humans. There is relatively increased musculature and reduced subcutaneous fat as compared to what may be encountered in the general human trauma population (13). This limitation significantly reduces the possibility of subcutaneously placed TT, a complication not uncommon during TT insertion (6).…”

Section: Limitationsmentioning

confidence: 99%

“…The inability to see these critical structures creates a potential for development of a TT related complication or placement in an incorrect location. This potential may be increased in the emergent or urgent setting as well as by the habitus of the patient (12,13). …”

Section: Introductionmentioning

confidence: 99%

Visually guided tube thoracostomy insertion comparison to standard of care in a large animal model

Hernandez

Vogelsang

Anderson

et al. 2017

Injury

Self Cite

View full text Add to dashboard Cite

Introduction Tube thoracostomy (TT) is a lifesaving procedure for a variety of thoracic pathologies. The most commonly utilized method for placement involves open dissection and blind insertion. Image guided placement is commonly utilized but is limited by an inability to see distal placement location. Unfortunately, TT is not without complications. We aim to demonstrate the feasibility of a disposable device to allow for visually directed TT placement compared to the standard of care in a large animal model. Methods Three swine were sequentially orotracheally intubated and anesthetized. TT was conducted utilizing a novel visualization device, tube thoracostomy visual trocar (TTVT) and standard of care (open technique). Position of the TT in the chest cavity were recorded using direct thoracoscopic inspection and radiographic imaging with the operator blinded to results. Complications were evaluated using a validated complication grading system. Standard descriptive statistical analyses were performed. Results Thirty TT were placed, 15 using TTVT technique, 15 using standard of care open technique. All of the TT placed using TTVT were without complication and in optimal position. Conversely, 27% of TT placed using standard of care open technique resulted in complications. Necropsy revealed no injury to intrathoracic organs. Conclusion Visual directed TT placement using TTVT is feasible and non-inferior to the standard of care in a large animal model. This improvement in instrumentation has the potential to greatly improve the safety of TT. Further study in humans is required.

show abstract

Chest wall thickness and decompression failure: A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy

Cited by 102 publications

References 24 publications

Thoracostomy in children with severe trauma: An overview of the paediatric experience in Victoria, Australia

Thoracostomy in children with severe trauma: An overview of the paediatric experience in Victoria, Australia

Chinese expert consensus on echelons treatment of thoracic injury in modern warfare

Visually guided tube thoracostomy insertion comparison to standard of care in a large animal model

Contact Info

Product

Resources

About