Determination of the chest wall thicknesses and needle thoracostomy success rates at second and fifth intercostal spaces: a cadaver-based study

Özen, Can; Akoğlu, Haldun; Özdemirel, Rifat Özgür; Özpolat, Çiğdem; Onur, Özge; Büyük, Yalçın; Denizbaşı, Arzu

doi:10.1016/j.ajem.2016.08.038

Cited by 2 publications

(1 citation statement)

References 21 publications

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“…Cadaveric studies and radiological studies with computed tomography (CT) have shown conflicting results on chest wall thickness anteriorly and laterally. [4][5][6][7] Studies measuring chest wall thickness on CT in Asian populations have shown lower chest wall thickness in general. 8,9 A recent ultrasound study in the United States showed significantly higher lateral chest wall thickness than anterior.…”

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confidence: 99%

Sonographic evaluation of chest wall thickness in Chinese adults in Hong Kong: Should the updated (10th edition) Advance Trauma Life Support guidelines on preferred site of needle thoracocentesis in tension pneumothorax be adopted in the Asian population?

Lau

Mok

2020

Trauma

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Objective To compare the anterior with lateral mean chest wall thickness measured by bedside ultrasound in Chinese adults in order to suggest a preferred site for needle decompression in tension pneumothorax. Study design This was an observational cross-sectional study conducted in a regional hospital over three months. Subjects were recruited by convenience sampling. Chest wall thickness at the second intercostal space, mid clavicular line, fifth intercostal space, anterior axillary line and fifth intercostal space and mid axillary line was measured using ultrasound on both sides. Range, mean values and confidence intervals were calculated. Results One-hundred and fourteen subjects were recruited. The mean anterior chest wall thickness was 2.62 cm (at second intercostal space, mid-clavicular line) and mean lateral chest wall was 2.68 cm (at fifth intercostal space, anterior axillary line) and 2.87 cm (at fifth intercostal space and mid-axillary line) respectively. Chest wall thickness at fifth intercostal space and mid-axillary line was significantly greater than second intercostal space, mid-clavicular line ( p < 0.01). Chest wall thickness was greater than 5 cm in 3.5% of the study population. Conclusion There is a need for population-based guidelines. We recommend needle decompression at the second intercostal space, mid-clavicular line with a 50-mm angiocath for Chinese patients with tension pneumothorax. A lateral approach at the fifth intercostal space, anterior axillary line may be considered as an alternative in case of failure. Prehospital point-of-care ultrasound may be a useful adjunct in managing such patients.

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