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

Authors :
Ozen C
Akoglu H
Ozdemirel RO
Omeroglu E
Ozpolat CU
Onur O
Buyuk Y
Denizbasi A
Source :
The American journal of emergency medicine [Am J Emerg Med] 2016 Dec; Vol. 34 (12), pp. 2310-2314. Date of Electronic Publication: 2016 Aug 20.
Publication Year :
2016

Abstract

Introduction: The purposes of this study were to measure the chest wall thicknesses (CWTs) at second intercostal space (ICS) mid-clavicular line (MCL) and fifth ICS MAL directly, and compare the actual success rates of needle thoracostomies (NTs) by inserting a 5-cm-long syringe needle. Predictive values of weight, body mass index (BMI) and CWT were also analyzed.<br />Materials and Methods: This study included 199 measurements of 50 adult fresh cadavers from both hemithoraces. Five-centimeter-long syringe needles were inserted and secured. Penetration into the pleural cavity was assessed, and CWTs at 4 locations were measured. Achieved power of this study for the primary aim of CWT comparison from 2 <superscript>nd</superscript> and 5 <superscript>th</superscript> ICSs was .94.<br />Results: Overall mean CWTs at 2 <superscript>nd</superscript> ICS MCL and 5 <superscript>th</superscript> ICS MAL were measured as 2.46 ± 0.78 and 2.89 ± 1.09, respectively, and 5 <superscript>th</superscript> ICS MAL was found to be statistically thicker (P = .002). The success rate of NT at 2 <superscript>nd</superscript> ICS MCL was 87% (95% CI, 80-94), and that at 5 <superscript>th</superscript> ICS MAL was 78% (95% CI, 70-86; P = .3570). Only 6 (17.1%) of 35 failed NTs had a CWT greater than 5-cm. Needle thoracostomy has failed in 29 (14.9%) of 194 locations, despite a CWT less than 5-cm. Below a weight of 72 kg, BMI of 23 kg/m <superscript>2</superscript> , or CWT of 2.4 cm, all NTs were successful.<br />Discussion and Conclusions: In this report, we present the largest cadaver-based cohort to date to the best of our knowledge, and we observed a statistically nonsignificant 9% more NT success rate at 2 <superscript>nd</superscript> ICS at a power of 88% and statistically significant more success rate in males at 5 <superscript>th</superscript> ICS was (47.7%). We also observed thinner CWTs and higher success rates than previous imaging-based studies. A BMI of 23 kg/m <superscript>2</superscript> or less and weight of 72 kg or less seem to accurately rule-out NT failure in cadavers, and they seem to be better predictors at the bedside.<br /> (Copyright © 2016 Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1532-8171
Volume :
34
Issue :
12
Database :
MEDLINE
Journal :
The American journal of emergency medicine
Publication Type :
Academic Journal
Accession number :
27609120
Full Text :
https://doi.org/10.1016/j.ajem.2016.08.038