Safety and Risk Factors of Needle Thoracentesis Decompression in Tension Pneumothorax in Patients over 75 Years Old

Abstract

Background. There are very few professional recommendations or guidelines on the needle thoracentesis decompression (NTD) for the tension pneumothorax in the elderly. This study aimed to investigate the safety and risk factors of tension pneumothorax NTD in patients over 75 years old based on CT evaluation of the chest wall thickness (CWT). Methods. The retrospective study was conducted among 136 in-patients over 75 years old. The CWT and closest depth to vital structure of the second intercostal space at the midclavicular line (second ICS-MCL) and the fifth intercostal space at the midaxillary line (fifth ICS-MAL) were compared as well as the expected failure rates and the incidence of severe complications of different needles. We also analyzed the influence of age, sex, presence or absence of chronic obstructive pulmonary disease (COPD), and body mass index (BMI) on CWT. Results. The CWT of the second ICS-MCL was smaller than the fifth ICS-MAL both on the left and the right side ( P < 0.05 ). The success rate associated with a 7 cm needle was significantly higher than a 5 cm needle ( P < 0.05 ), and the incidence of severe complications with a 7 cm needle was significantly less than an 8 cm needle ( P < 0.05 ). The CWT of the second ICS-MCL was significantly correlated with age, sex, presence or absence of COPD, and BMI ( P < 0.05 ), whereas the CWT of the fifth ICS-MAL was significantly correlated with sex and BMI ( P < 0.05 ). Conclusion. The second ICS-MCL was recommended as the primary thoracentesis site and a 7 cm needle was advised as preferred needle length for the older patients. Factors such as age, sex, presence or absence of COPD, and BMI should be considered when choosing the appropriate needle length.

Traumatic Cardiac Arrest—A Narrative Review

“…Preferred needle location in children is the second ICS in the mid clavicular line, and the fourth or fifth ICS just anterior to the mid axillary line in adults. Based on studies, 45 mm needles appear too short in many adults [34], and longer needles (e.g., 70 mm [35]) should be available. However, whether decompression needle type and needle insertion location have relevance for patient outcome, remains questionable [36].…”

A Retrospective Analysis of Needle Thoracostomies at a Tertiary Level 2 Trauma Center

“…The definitive management of tension pneumothorax relies heavily on the decompression of the thoracic cavity [13]. The swift decompression of the pleural space alleviates the pressure by allowing air to escape and enabling lung inflation and function [13]. In the prehospital setting, the decompression of a presumed tension pneumothorax is done by needle decompression.…”

“…This is usually replaced with a formal chest tube after arrival at the hospital if pneumothorax persists [14]. Needle thoracostomy is performed in one of three common locations: the second intercostal space (ICS) at the midclavicular line (MCL), the fourth or fifth ICS anterior axillary line (AAL), or the fifth ICS midaxillary line (MAL) [13]. The second ICS MCL is the most common decompression location.…”

“…Discrepancies in the location used to perform needle decompression illustrate the varied practice patterns in the prehospital setting, necessitating a standardized and effective needle decompression protocol that ensures successful prehospital tension pneumothorax diagnosis and treatment with limited adverse effects. The current literature suggests an ongoing debate regarding the effectiveness and success of prehospital needle decompression [5,13,[17][18][19]. It is hypothesized that preclinical providers are performing needle decompression prematurely and unnecessarily.…”