Determining optimal needle size for decompression of tension pneumothorax in children – a CT-based study

Leonhard, Georg; Overhoff, Daniel; Wessel, Lucas; Viergutz, Tim; Rudolph, Marcus; Schöler, Michael; Haubenreisser, Holger; Terboven, Tom

doi:10.1186/s13049-019-0671-x

Cited by 13 publications

(16 citation statements)

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“…However, the effect size was low with a partial R 2 ranging from 0.31 to 0.4. Both our own previous data as well as Mandt’s data showed a large variability of CWT within an age group [ 2 , 3 ]. Given the at most moderate correlation of CWT with anthropometric data, the low effect size in multivariable regression analysis and the large variability within age groups, one seems to be able to roughly guess CWT from patient characteristics, but accurate prediction of the required insertion depth does not seem possible.…”

Section: Discussionmentioning

confidence: 66%

“…Due to the tiny spatial relationships, it carries a significant risk of injury to intrathoracic structures, especially in smaller children. Knowledge of chest wall thickness and width of the intercostal space enables the provider to choose the optimal decompression needle regarding length and bore but has only been investigated by few studies so far [ 2 – 4 , 9 ]. Especially the correlation of age and body dimensions with these values has not been well investigated.…”

Section: Discussionmentioning

confidence: 99%

“…One of the many possible complications of needle thoracostomy that has previously been described in adults is laceration of the intercostal vessels [ 13 ]. The width of the intercostal space has, to the knowledge of the authors, not received any attention in adult studies and, even though injury appears much more likely in pediatric needle thoracostomy, was only investigated in one pediatric CT-based study [ 3 ]. The results of this study match very well with the results of the ultrasound measurements presented here.…”

Section: Discussionmentioning

confidence: 99%

“…The chest wall is thin and the pleural space can easily be reached with common needles. In contrast to adults, intrathoracic structures like the heart, large vessels or the thymus gland are in close proximity to the insertion sites and can therefore be injured during needle decompression [ 3 – 5 ]. Laceration of the intercostal vessels by the decompression needle is a complication that has been described several times in adults and is even much more likely in the tiny intercostal spaces (ICS) in children [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, risk of injury by needle decompression appears to be a concern in children. Age-specific values for CWT and width of the ICS have been investigated before and showed a large variability within age groups [ 2 , 3 ]. Knowing the amount of correlation of these measures with anthropometric data like age, height, weight and BMI could assist in predicting required insertion depth of the needle and choosing the appropriate needle size in an individual child.…”

Section: Introductionmentioning

confidence: 99%

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Sonographic assessment of pediatric chest wall thickness and width of the intercostal space: correlation with anthropometric data and implications for needle decompression

et al. 2021

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Background Emergent needle decompression in children is a rare event for emergency medicine and critical care providers. Hereby, risk of injury of intrathoracic structures is high and knowledge of age-specific values of chest wall thickness and width of the intercostal space (ICS) is crucial to avoid injuries. Investigation of the correlation of chest wall thickness and width of the intercostal space with age and body dimension like weight and height could provide guidance on depth of insertion and choice of the needle. Methods We performed a prospective observational clinical trial in a pediatric surgery operating room that included a convenient sample of children aged 0–10 years undergoing elective surgery. Chest wall thickness and width of the intercostal space were measured with ultrasound at 2nd ICS midclavicular line (MCL) and 4th ICS anterior axillary line (AAL). Correlation of these measures with age, height, weight, BMI and Broselow color was calculated. Furthermore, intra-class correlation coefficient was calculated as a measure of reproducibility and the presence of vital structures (e.g., heart, thymus gland, large pulmonary vessels) at the possible insertion sites for needle decompression was investigated. Results Of 410 potentially eligible patients, 300 were included in the study. Correlation of chest wall thickness was moderate with weight (2nd ICS MCL: r = 0.57; 4th ICS MCL: r = 0.64) and BMI (r = 0.44 and r = 0.6) and was lower with age (r = 0.38 for both intercostal spaces), height (r = 0.42 and r = 0.40) and Broselow color (r = 0.42 and r = 0.38). Correlation of width of the ICS with anthropometric data was generally stronger, with height showing the strongest, albeit not really strong, correlation (r = 0.71 and r = 0.62). Intra-class correlation was excellent with an ICC of 0.93. Vital structures were significantly more often present at 2nd ICS MCL then at 4th ICS AAL (14 vs. 2 patients; p = 0.0042). Conclusions Correlation of chest wall thickness and width of the intercostal space with anthropometric data is at most moderate. Insertion depth and width of the intercostal space can therefore not be predicted accurately from anthropometric data. Ultrasound assessment of the thoracic wall appears to be a reliable technique and could therefore assist in reducing the risk of injury and increasing decompression success. Trial registration German clinical trials register, DRKS00014973, Registered February 11th 2019, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014973

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Section: Discussionmentioning

confidence: 66%