Needle thoracostomy (NT) is a valuable adjunct in the management of tension pneumothorax (tPTX), a life-threatening condition encountered mainly in trauma and critical care environments. Most commonly, needle thoracostomies are used in the prehospital setting and during acute trauma resuscitation to temporize the affected individuals prior to the placement of definitive tube thoracostomy (TT). Because it is both an invasive and emergent maneuver, NT can be associated with a number of potential complications, some of which may be life-threatening. Due to relatively common use of this procedure, it is important that healthcare providers are familiar, and ready to deal with, potential complications of NT.
Severe respiratory failure may develop in the trauma patient as a consequence of direct lung injury, in response to trauma-associated systemic inflammatory response syndrome SIRS , as a result of infection, or at times as an unintended consequence of the life-saving management of the acute traumatic injury. "pproximately . % of all adult trauma patients develop some form of pulmonary dysfunction along the acute lung injury "LI acute respiratory distress "RDS spectrum, with the incidence of severe respiratory failure reaching % in multisystem trauma victims. Of concern, mortality in patients with acute respiratory failure who go on to develop severe pulmonary dysfunction can be as high as % with the use of conventional therapeutic modalities. Extracorporeal membrane oxygenation ECMO has been proposed as a rescue strategy when less invasive primary or adjunctive attempts fail. Numerous case reports and single-center studies demonstrate potential benefits of early implementation of veno-venous VV -ECMO for the treatment of severe respiratory failure associated with trauma or sequelae of trauma. In this clinical context, VV-ECMO can be employed to correct for both ventilatory and oxygenation failure while allowing the treating physician to provide much needed rest to the patient's lungs and permit healing to take place. The use of ECMO mainly veno-venous, with limited use of veno-arterial circuits for cardiac indications has been described in patients with severe chest injuries, traumatic pneumonectomy, bronchopleural fistulas, and various forms of respiratory failure refractory to conventional therapies.
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