Needle Thoracostomy: Implications of Computed Tomography Chest Wall Thickness

Abstract

Objectives: To determine the length of catheter required to perform a needle thoracostomy, as determined by chest wall thickness, to treat the majority of patients presenting to the emergency department (ED) with a potential tension pneumothorax. Methods: A convenience sample of 111 computed tomography (CT) scans of the chest in trauma and medical resuscitation patients at a military Level 1 trauma center in San Antonio, Texas, was pooled, and the chest wall thickness was measured at the second intercostal space, midclavicular line, to the nearest 0.1 cm. Results: The mean chest wall thickness in the patients studied averaged 4.24 cm (95% confidence interval [CI] = 3.97 to 4.52). Nearly one fourth (25) of the study patients had a chest wall thicker than 5 cm. Women, on average, have thicker chest walls than men (4.90 for women; 4.16 for men; p = 0.022). Conclusions: In this study, a catheter length of 5 cm would reliably penetrate the pleural space of only 75% of patients. A longer catheter should be considered, especially in women.

Trauma Associated with Cardiac Conduction Abnormalities: Population-Based Perspective, Mechanism and Review of Literature

“…It is well known that chest-wall thickness increases significantly with age and that the thickness of the thorax wall is about 1 cm greater in women than in men [40,41]. Not surprisingly, we also found that patients who suffered from BCI were older and more likely to be female.…”

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

“…This rate is lower compared with other published studies (66.4%-94.3%) except 3 trials [8,11,13,15,17]. A recent meta-analysis, which also includes our prior CT-based trial [17], concluded that an optimally placed 5-cm-long catheter would have enough length to decompress 72% of the cases [24].…”

“…Various needle lengths and locations were proposed and fifth intercostal space (ICS) emerged as the most popular alternative. Because it is unethical and nearly impossible to perform a randomized controlled trial comparing the success and complication rates at second ICS mid-clavicular line (MCL) to fifth ICS MAL in TPX patients, secondary ways were sought, and imaging-based chest wall thickness (CWT) measurement has emerged [1,5,[7][8][9][10][11][12][13][14][15][16][17][18]. In those imaging-based studies, CWTs of the locations were compared with the length of typical needles (4.5, 5, and 6 cm) to estimate the success rate [9,19].…”

Average chest wall thickness at two anatomic locations in trauma patients

“…3 In 3 separate retrospective trials, Givens, Zengerink, and Stevens also found that a 4.5 cm catheter would not be adequate for needle thoracostomy at the 2nd ICS/MCL as assessed with CT scanning but these studies did not report chest wall thickness at the 5th ICS/ AAL. [10][11][12] More recently, Sanchez also found that a 4.5 cm catheter is inadequate in both the 2nd ICS/MCL and 5th ICS/AAL and also found that chest wall thickness is significantly greater in the 5th ICS/AAL. 5 However, this study did not report BMI thereby making it difficult to determine if the data can be applied in various regions.…”