Needle decompression of tension pneumothorax

Hecker, Matthias; Hegenscheid, Katrin; Völzke, Henry; Hinz, Peter; Lange, Jörn; Ekkernkamp, Axel; Frank, Matthias

doi:10.1097/ta.0000000000000878

Cited by 21 publications

(13 citation statements)

References 37 publications

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“…Clemency et al defined the acceptable theoretical success rate (catheter longer than CWT) for needle decompression at 95%, Hecker et al at 90% [2, 12]. In our study the theoretical rate of success in 0-year-old children was ≥96% for 22G/2.5 cm and 100% for 20G/3.2 cm needles at the investigated insertion sites.…”

Section: Discussionsupporting

confidence: 49%

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

Leonhard

Overhoff

Wessel

et al. 2019

Scand J Trauma Resusc Emerg Med

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Background For neonates and children requiring decompression of tension pneumothorax, specific recommendations for the choice of needle type and size are missing. The aim of this retrospective study was to determine optimal length and diameter of needles for decompression of tension pneumothorax in paediatric patients. Methods Utilizing computed tomography, we determined optimal length and diameter of needles to enable successful decompression and at the same time minimize risk of injury to intrathoracic structures and the intercostal vessels and nerve. Preexisting computed tomography scans of the chest were reviewed in children aged 0, 5 and 10 years. Chest wall thickness and width of the intercostal space were measured at the 4th intercostal space at the anterior axillary line (AAL) on both sides of the thorax. In each age group, three needles different in bore and length were evaluated regarding sufficient length for decompression and risk of injury to intrathoracic organs and the intercostal vessels and nerve. Results 197 CT-scans were reviewed, of which 58 were excluded, resulting in a study population of 139 children and 278 measurements. Width of the intercostal space was small at 4th ICS AAL (0 years: 0.44 ± 0.13 cm; 5 years: 0.78 ± 0.22 cm; 10 years: 1.12 ± 0.36 cm). The ratio of decompression failure to risk of injury at 4th ICS AAL was most favourable for a 22G/2.5 cm catheter in infants (Decompression failure: right: 2%, left: 4%, Risk of injury: right: 14%, left: 24%), a 22G/2.5 cm or a 20G/3.2 cm catheter in 5-year-old children (20G/3.2 cm: Decompression failure: right: 2.1%, left: 0%, Risk of injury: right: 2.1%, left: 17%) and a 18G/4.5 cm needle in 10-year-old children (Decompression failure: right: 9.5%, left: 9.5%, Risk of injury: right: 7.1%, left: 11.9%). Conclusions In children aged 0, 5 and 10 years presenting with a tension pneumothorax, we recommend 22G/2.5 cm, 20G/3.2 cm and 18G/4.5 cm needles, respectively, for acute decompression.

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Section: Discussionsupporting

confidence: 49%

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

Leonhard

Overhoff

Wessel

et al. 2019

Scand J Trauma Resusc Emerg Med

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“…Prior works pointed out the importance of the correlation between chest wall thickness and body mass index on proper selection of catheter length [13,19]. The BMI of our patients was less than 31 kg/m 2 and the pleural space could be reached in every patient with a regular 4.5-cm-long over-the-needle cannula.…”

Section: Technical Considerationsmentioning

confidence: 67%

“…We implemented the checklist and technical protocol published by Pasquier in 2013 [12]. The puncture site was the second intercostal space in the midclavicular line a safe distance from both the generator, which is placed more laterally, and the internal mammary artery, which is located medial to the intended puncture track [13]. All patients received nasal oxygen therapy using a face mask.…”

Section: Needle Aspirationmentioning

confidence: 99%

“…The BMI of our patients was less than 31 kg/m 2 and the pleural space could be reached in every patient with a regular 4.5-cm-long over-the-needle cannula. Also, the intended puncture track, i.e., second intercostal space in the midclavicular line, should be carefully located to minimize the risk of internal mammary artery injury [13].…”

Section: Technical Considerationsmentioning

confidence: 99%

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Needle aspiration for treating iatrogenic pneumothorax after cardiac electronic device implantation: a pilot study

Domokos

Szabó

Banhegyi³

et al. 2019

J Interv Card Electrophysiol

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Purpose Pneumothorax (PTX) following cardiac implantable electronic device procedures is traditionally treated with chest tube drainage (CTD). We hypothesized that, in a subset of patients, the less invasive needle aspiration (NA) may also be effective. We compared the strategy of primary NA with that of primary CTD in a single-center observational study. Methods Of the 970 procedures with subclavian venous access between January 2016 and June 2018, 23 patients had PTX requiring intervention. Beginning with March 2017, the traditional primary CTD (9 cases) has been replaced by the "NA first" strategy (14 patients). Outcome measures were procedural success rate and duration of hospitalization evaluated both as time to event (log-rank test) and as a discrete variable (Wilcoxon-Mann-Whitney test). Results Needle aspiration was successful in 8/14 (57.1%) of the cases (95% CI 28.9-82.3%), whereas PTX resolved in all patients after CTD was 9/9 (100%, 95% CI 66.4-100.0%, p = 0.0481). Regarding length of hospital stay, intention to treat time to event analysis showed no difference between the two approaches (p = 0.73). Also, the median difference was not statistically significant (− 2.0 days, p = 0.17). In contrast, per protocol evaluation revealed reduced risk of prolonged hospitalization for NA patients (p = 0.0025) with a median difference of − 4.0 days (p = 0.0012). Failure of NA did not result in a meaningful delay in discharge timing as median difference was 1.5 days (p = 0.28). Conclusions Our data suggest that in a number of patients iatrogenic PTX may be successfully treated with NA resulting in shorter hospitalization without the risk of meaningful discharge delay in unsuccessful cases.

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“…Therefore, in recent years, several studies examining chest wall thickness (CWT) at the recommended insertion sites have been conducted in adult patients and found commonly used cannulas being too short for successful decompression in a high proportion of patients [6]. This has led to the recommendation of using longer 7-8 cm catheters for needle thoracostomy in adult patients [7–9]. Even though this increases the likelihood of successful decompression, it also increases the risk of injuring underlying vital structures like large intrathoracic vessels or the heart because of the possibility of deeper insertion [9].…”

Section: Introductionmentioning

confidence: 99%

Chest wall thickness and depth to vital structures in paediatric patients – implications for prehospital needle decompression of tension pneumothorax

Terboven

Leonhard

Wessel

et al. 2019

Scand J Trauma Resusc Emerg Med

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Background Recommendations regarding decompression of tension pneumothorax in small children are scarce and mainly transferred from the adult literature without existing evidence for the paediatric population. This CT-based study evaluates chest wall thickness, width of the intercostal space (ICS) and risk of injury to vital structures by needle decompression in children. Methods Chest wall thickness, width of the intercostal space and depth to vital structures were measured and evaluated at 2nd ICS midclavicular (MCL) line and 4th ICS anterior axillary line (AAL) on both sides of the thorax using computed tomography (CT) in 139 children in three different age groups (0, 5, 10 years). Results Width of the intercostal space was significantly smaller at the 4th ICS compared to the 2nd ICS in all age groups on both sides of the thorax. Chest wall thickness was marginally smaller at the 4th ICS compared to the 2nd ICS in infants and significantly smaller at 4th ICS in children aged 5 years and 10 years. Depth to vital structure for correct angle of needle entry was smaller at the 4th ICS in all age groups on both sides of the thorax. Incorrect angle of needle entry however is accompanied by a higher risk of injury at 2nd ICS. Furthermore, in some children aged 0 and 5 years, the heart or the thymus gland were found directly adjacent to the thoracic wall at 2nd ICS midclavicular line. Conclusion Especially in small children risk of iatrogenic injury to vital structures by needle decompression is considerably high. The 4th ICS AAL offers a smaller chest wall thickness, but the width of the ICS is smaller and the risk of injury to the intercostal vessels and nerve is greater. Deviations from correct angle of entry however are accompanied by higher risk of injury to intrathoracic structures at the 2nd ICS. Furthermore, we found the heart and the thymus gland to be directly adjacent to the thoracic wall at the 2nd ICS MCL in a few children. From our point of view this puncture site can therefore not be recommended for decompression in small children. We therefore recommend 4th ICS AAL as the primary site of choice. Electronic supplementary material The online version of this article (10.1186/s13049-019-0623-5) contains supplementary material, which is available to authorized users.

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Needle decompression of tension pneumothorax

Abstract: Therapeutic/care management study, level IV.

Cited by 21 publications

References 37 publications

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

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

Needle aspiration for treating iatrogenic pneumothorax after cardiac electronic device implantation: a pilot study

Chest wall thickness and depth to vital structures in paediatric patients – implications for prehospital needle decompression of tension pneumothorax

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