Decompression of tension pneumothoraces in Asian trauma patients: greater success with lateral approach and longer catheter lengths based on computed tomography chest wall measurements
Introduction Our study aims to compare the anterior and lateral approaches for needle thoracostomy (NT) and determine the adequacy of catheter lengths used for NT in Asian trauma patients based on computed tomography chest wall measurements. Methodology A retrospective review of chest computed tomog...
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| Veröffentlicht in: | European journal of trauma and emergency surgery (Munich : 2007) 2018-10, Vol.44 (5), p.767-771 |
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| description | Introduction
Our study aims to compare the anterior and lateral approaches for needle thoracostomy (NT) and determine the adequacy of catheter lengths used for NT in Asian trauma patients based on computed tomography chest wall measurements.
Methodology
A retrospective review of chest computed tomography scans of 583 Singaporean trauma patients during period of 2011–2015 was conducted. Four measurements of chest wall thickness (CWT) were taken at the second intercostal space, midclavicular line and fifth intercostal space, midaxillary line bilaterally. Measurements were from the superficial skin layer of the chest wall to the pleural space. Successful NT was defined radiologically as CWT ≤ 5 cm.
Results
There were 593 eligible subjects. Mean age was 49.1 years (49.1 ± 21.0). Majority were males (77.0%) and Chinese (70.2%). Mean CWT for the anterior approach was 4.04 cm (CI 3.19–4.68) on the left and 3.92 cm (CI 3.17–4.63) on the right. Mean CWT for the lateral approach was 3.52 cm (CI 2.52–4.36) on the left, and 3.62 cm (CI 3.65–4.48) on the right. Mean CWT was shorter in the lateral approach by 0.52 cm on the left and 0.30 cm on the right (
p
= 0.001). With a 5.0 cm catheter in the anterior approach, 925 out of 1186 sites (78.8%) will have adequate NT as compared to 98.2% with a 7.0 cm catheter. Similarly, in the lateral approach 1046 out of 1186 (88.2%) will have adequate NT as compared to 98.5% with a 7.0 cm catheter. Obese subjects had significantly higher mean CWT in both approaches (
p
= 0.001). There was moderate correlation between BMI and CWT in the anterior approach,
r
2
= 0.529 as compared to the lateral approach,
r
2
= 0.244.
Conclusion
Needle decompression using the lateral approach or a longer catheter is more likely to succeed in Asian trauma patients. A high BMI is an independent predictor of failure of NT, especially for the anterior as compared to lateral approach. |
| doi_str_mv | 10.1007/s00068-017-0853-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1947098869</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1947098869</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-903d9d1d9c77e1abf07f175887c3b5b5e111ad49aa95b17a87ac9890150602ec3</originalsourceid><addsrcrecordid>eNp1kc1u1TAQhSNERUvhAdggS2zYhNrxTWyzq1r-pErdlLU1cSY3qRI7eBxV7ZPxeDjcUiQkVh7Z35kznlMUbwT_IDhXZ8Q5b3TJhSq5rmX58Kw4EbqRpTE78fyplvK4eEl0m2He1NWL4rjSRtWykSfFz0t0YV4iEo3Bs9CzhP53uXhc55CGEMEhsdGzcxrBsxRhnYEtkEb0iT6yfURIGBmtLoPE7sY0sGm7gonBssQAbmDgOzYFv8-ggzTgppjQ79NArAXCjmXPbZQ15TqFOewjLMM9cwNSYncwTWxGoDXivPm-Ko56mAhfP56nxffPn24uvpZX11--XZxflU6qKpWGy850ojNOKRTQ9lz1QtVaKyfbuq1RCAHdzgCYuhUKtAJntOGizsuq0MnT4v2hb_7HjzWPYueRHE4TeAwrWWF2ihutG5PRd_-gt2GNPk9nKyGU5EbUVabEgXIxEEXs7RLHGeK9FdxusdpDrDbHardY7UPWvH3svLYzdk-KPzlmoDoAlJ-2Jf-1_n_XXwU2svI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2117309152</pqid></control><display><type>article</type><title>Decompression of tension pneumothoraces in Asian trauma patients: greater success with lateral approach and longer catheter lengths based on computed tomography chest wall measurements</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Goh, S. ; Xu, W. R. ; Teo, L. T.</creator><creatorcontrib>Goh, S. ; Xu, W. R. ; Teo, L. T.</creatorcontrib><description>Introduction
Our study aims to compare the anterior and lateral approaches for needle thoracostomy (NT) and determine the adequacy of catheter lengths used for NT in Asian trauma patients based on computed tomography chest wall measurements.
Methodology
A retrospective review of chest computed tomography scans of 583 Singaporean trauma patients during period of 2011–2015 was conducted. Four measurements of chest wall thickness (CWT) were taken at the second intercostal space, midclavicular line and fifth intercostal space, midaxillary line bilaterally. Measurements were from the superficial skin layer of the chest wall to the pleural space. Successful NT was defined radiologically as CWT ≤ 5 cm.
Results
There were 593 eligible subjects. Mean age was 49.1 years (49.1 ± 21.0). Majority were males (77.0%) and Chinese (70.2%). Mean CWT for the anterior approach was 4.04 cm (CI 3.19–4.68) on the left and 3.92 cm (CI 3.17–4.63) on the right. Mean CWT for the lateral approach was 3.52 cm (CI 2.52–4.36) on the left, and 3.62 cm (CI 3.65–4.48) on the right. Mean CWT was shorter in the lateral approach by 0.52 cm on the left and 0.30 cm on the right (
p
= 0.001). With a 5.0 cm catheter in the anterior approach, 925 out of 1186 sites (78.8%) will have adequate NT as compared to 98.2% with a 7.0 cm catheter. Similarly, in the lateral approach 1046 out of 1186 (88.2%) will have adequate NT as compared to 98.5% with a 7.0 cm catheter. Obese subjects had significantly higher mean CWT in both approaches (
p
= 0.001). There was moderate correlation between BMI and CWT in the anterior approach,
r
2
= 0.529 as compared to the lateral approach,
r
2
= 0.244.
Conclusion
Needle decompression using the lateral approach or a longer catheter is more likely to succeed in Asian trauma patients. A high BMI is an independent predictor of failure of NT, especially for the anterior as compared to lateral approach.</description><identifier>ISSN: 1863-9933</identifier><identifier>EISSN: 1863-9941</identifier><identifier>DOI: 10.1007/s00068-017-0853-z</identifier><identifier>PMID: 28975363</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Aneurysms ; Catheters ; Critical Care Medicine ; Decompression, Surgical - instrumentation ; Decompression, Surgical - methods ; Emergency medical care ; Emergency Medicine ; Female ; Humans ; Intensive ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Article ; Pneumothorax - diagnostic imaging ; Pneumothorax - surgery ; Retrospective Studies ; Singapore ; Sports Medicine ; Surgery ; Surgical Orthopedics ; Thoracic Wall - diagnostic imaging ; Thoracic Wall - surgery ; Thoracostomy - instrumentation ; Thoracostomy - methods ; Thorax ; Tomography, X-Ray Computed ; Traumatic Surgery ; Treatment Outcome</subject><ispartof>European journal of trauma and emergency surgery (Munich : 2007), 2018-10, Vol.44 (5), p.767-771</ispartof><rights>Springer-Verlag GmbH Germany 2017</rights><rights>European Journal of Trauma and Emergency Surgery is a copyright of Springer, (2017). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-903d9d1d9c77e1abf07f175887c3b5b5e111ad49aa95b17a87ac9890150602ec3</citedby><cites>FETCH-LOGICAL-c372t-903d9d1d9c77e1abf07f175887c3b5b5e111ad49aa95b17a87ac9890150602ec3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00068-017-0853-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00068-017-0853-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,777,781,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28975363$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Goh, S.</creatorcontrib><creatorcontrib>Xu, W. R.</creatorcontrib><creatorcontrib>Teo, L. T.</creatorcontrib><title>Decompression of tension pneumothoraces in Asian trauma patients: greater success with lateral approach and longer catheter lengths based on computed tomography chest wall measurements</title><title>European journal of trauma and emergency surgery (Munich : 2007)</title><addtitle>Eur J Trauma Emerg Surg</addtitle><addtitle>Eur J Trauma Emerg Surg</addtitle><description>Introduction
Our study aims to compare the anterior and lateral approaches for needle thoracostomy (NT) and determine the adequacy of catheter lengths used for NT in Asian trauma patients based on computed tomography chest wall measurements.
Methodology
A retrospective review of chest computed tomography scans of 583 Singaporean trauma patients during period of 2011–2015 was conducted. Four measurements of chest wall thickness (CWT) were taken at the second intercostal space, midclavicular line and fifth intercostal space, midaxillary line bilaterally. Measurements were from the superficial skin layer of the chest wall to the pleural space. Successful NT was defined radiologically as CWT ≤ 5 cm.
Results
There were 593 eligible subjects. Mean age was 49.1 years (49.1 ± 21.0). Majority were males (77.0%) and Chinese (70.2%). Mean CWT for the anterior approach was 4.04 cm (CI 3.19–4.68) on the left and 3.92 cm (CI 3.17–4.63) on the right. Mean CWT for the lateral approach was 3.52 cm (CI 2.52–4.36) on the left, and 3.62 cm (CI 3.65–4.48) on the right. Mean CWT was shorter in the lateral approach by 0.52 cm on the left and 0.30 cm on the right (
p
= 0.001). With a 5.0 cm catheter in the anterior approach, 925 out of 1186 sites (78.8%) will have adequate NT as compared to 98.2% with a 7.0 cm catheter. Similarly, in the lateral approach 1046 out of 1186 (88.2%) will have adequate NT as compared to 98.5% with a 7.0 cm catheter. Obese subjects had significantly higher mean CWT in both approaches (
p
= 0.001). There was moderate correlation between BMI and CWT in the anterior approach,
r
2
= 0.529 as compared to the lateral approach,
r
2
= 0.244.
Conclusion
Needle decompression using the lateral approach or a longer catheter is more likely to succeed in Asian trauma patients. A high BMI is an independent predictor of failure of NT, especially for the anterior as compared to lateral approach.</description><subject>Aneurysms</subject><subject>Catheters</subject><subject>Critical Care Medicine</subject><subject>Decompression, Surgical - instrumentation</subject><subject>Decompression, Surgical - methods</subject><subject>Emergency medical care</subject><subject>Emergency Medicine</subject><subject>Female</subject><subject>Humans</subject><subject>Intensive</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Pneumothorax - diagnostic imaging</subject><subject>Pneumothorax - surgery</subject><subject>Retrospective Studies</subject><subject>Singapore</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Thoracic Wall - diagnostic imaging</subject><subject>Thoracic Wall - surgery</subject><subject>Thoracostomy - instrumentation</subject><subject>Thoracostomy - methods</subject><subject>Thorax</subject><subject>Tomography, X-Ray Computed</subject><subject>Traumatic Surgery</subject><subject>Treatment Outcome</subject><issn>1863-9933</issn><issn>1863-9941</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kc1u1TAQhSNERUvhAdggS2zYhNrxTWyzq1r-pErdlLU1cSY3qRI7eBxV7ZPxeDjcUiQkVh7Z35kznlMUbwT_IDhXZ8Q5b3TJhSq5rmX58Kw4EbqRpTE78fyplvK4eEl0m2He1NWL4rjSRtWykSfFz0t0YV4iEo3Bs9CzhP53uXhc55CGEMEhsdGzcxrBsxRhnYEtkEb0iT6yfURIGBmtLoPE7sY0sGm7gonBssQAbmDgOzYFv8-ggzTgppjQ79NArAXCjmXPbZQ15TqFOewjLMM9cwNSYncwTWxGoDXivPm-Ko56mAhfP56nxffPn24uvpZX11--XZxflU6qKpWGy850ojNOKRTQ9lz1QtVaKyfbuq1RCAHdzgCYuhUKtAJntOGizsuq0MnT4v2hb_7HjzWPYueRHE4TeAwrWWF2ihutG5PRd_-gt2GNPk9nKyGU5EbUVabEgXIxEEXs7RLHGeK9FdxusdpDrDbHardY7UPWvH3svLYzdk-KPzlmoDoAlJ-2Jf-1_n_XXwU2svI</recordid><startdate>20181001</startdate><enddate>20181001</enddate><creator>Goh, S.</creator><creator>Xu, W. R.</creator><creator>Teo, L. T.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20181001</creationdate><title>Decompression of tension pneumothoraces in Asian trauma patients: greater success with lateral approach and longer catheter lengths based on computed tomography chest wall measurements</title><author>Goh, S. ; Xu, W. R. ; Teo, L. T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-903d9d1d9c77e1abf07f175887c3b5b5e111ad49aa95b17a87ac9890150602ec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aneurysms</topic><topic>Catheters</topic><topic>Critical Care Medicine</topic><topic>Decompression, Surgical - instrumentation</topic><topic>Decompression, Surgical - methods</topic><topic>Emergency medical care</topic><topic>Emergency Medicine</topic><topic>Female</topic><topic>Humans</topic><topic>Intensive</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Pneumothorax - diagnostic imaging</topic><topic>Pneumothorax - surgery</topic><topic>Retrospective Studies</topic><topic>Singapore</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Thoracic Wall - diagnostic imaging</topic><topic>Thoracic Wall - surgery</topic><topic>Thoracostomy - instrumentation</topic><topic>Thoracostomy - methods</topic><topic>Thorax</topic><topic>Tomography, X-Ray Computed</topic><topic>Traumatic Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Goh, S.</creatorcontrib><creatorcontrib>Xu, W. R.</creatorcontrib><creatorcontrib>Teo, L. T.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Goh, S.</au><au>Xu, W. R.</au><au>Teo, L. T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Decompression of tension pneumothoraces in Asian trauma patients: greater success with lateral approach and longer catheter lengths based on computed tomography chest wall measurements</atitle><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle><stitle>Eur J Trauma Emerg Surg</stitle><addtitle>Eur J Trauma Emerg Surg</addtitle><date>2018-10-01</date><risdate>2018</risdate><volume>44</volume><issue>5</issue><spage>767</spage><epage>771</epage><pages>767-771</pages><issn>1863-9933</issn><eissn>1863-9941</eissn><abstract>Introduction
Our study aims to compare the anterior and lateral approaches for needle thoracostomy (NT) and determine the adequacy of catheter lengths used for NT in Asian trauma patients based on computed tomography chest wall measurements.
Methodology
A retrospective review of chest computed tomography scans of 583 Singaporean trauma patients during period of 2011–2015 was conducted. Four measurements of chest wall thickness (CWT) were taken at the second intercostal space, midclavicular line and fifth intercostal space, midaxillary line bilaterally. Measurements were from the superficial skin layer of the chest wall to the pleural space. Successful NT was defined radiologically as CWT ≤ 5 cm.
Results
There were 593 eligible subjects. Mean age was 49.1 years (49.1 ± 21.0). Majority were males (77.0%) and Chinese (70.2%). Mean CWT for the anterior approach was 4.04 cm (CI 3.19–4.68) on the left and 3.92 cm (CI 3.17–4.63) on the right. Mean CWT for the lateral approach was 3.52 cm (CI 2.52–4.36) on the left, and 3.62 cm (CI 3.65–4.48) on the right. Mean CWT was shorter in the lateral approach by 0.52 cm on the left and 0.30 cm on the right (
p
= 0.001). With a 5.0 cm catheter in the anterior approach, 925 out of 1186 sites (78.8%) will have adequate NT as compared to 98.2% with a 7.0 cm catheter. Similarly, in the lateral approach 1046 out of 1186 (88.2%) will have adequate NT as compared to 98.5% with a 7.0 cm catheter. Obese subjects had significantly higher mean CWT in both approaches (
p
= 0.001). There was moderate correlation between BMI and CWT in the anterior approach,
r
2
= 0.529 as compared to the lateral approach,
r
2
= 0.244.
Conclusion
Needle decompression using the lateral approach or a longer catheter is more likely to succeed in Asian trauma patients. A high BMI is an independent predictor of failure of NT, especially for the anterior as compared to lateral approach.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>28975363</pmid><doi>10.1007/s00068-017-0853-z</doi><tpages>5</tpages></addata></record> |
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| ispartof | European journal of trauma and emergency surgery (Munich : 2007), 2018-10, Vol.44 (5), p.767-771 |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Aneurysms Catheters Critical Care Medicine Decompression, Surgical - instrumentation Decompression, Surgical - methods Emergency medical care Emergency Medicine Female Humans Intensive Male Medicine Medicine & Public Health Middle Aged Original Article Pneumothorax - diagnostic imaging Pneumothorax - surgery Retrospective Studies Singapore Sports Medicine Surgery Surgical Orthopedics Thoracic Wall - diagnostic imaging Thoracic Wall - surgery Thoracostomy - instrumentation Thoracostomy - methods Thorax Tomography, X-Ray Computed Traumatic Surgery Treatment Outcome |
| title | Decompression of tension pneumothoraces in Asian trauma patients: greater success with lateral approach and longer catheter lengths based on computed tomography chest wall measurements |
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