Determining optimal needle size for decompression of tension pneumothorax in children - a CT-based study.
Children
Decompression
Needle size
Tension pneumothorax
Journal
Scandinavian journal of trauma, resuscitation and emergency medicine
ISSN: 1757-7241
Titre abrégé: Scand J Trauma Resusc Emerg Med
Pays: England
ID NLM: 101477511
Informations de publication
Date de publication:
11 Oct 2019
11 Oct 2019
Historique:
received:
12
05
2019
accepted:
25
09
2019
entrez:
13
10
2019
pubmed:
13
10
2019
medline:
30
1
2020
Statut:
epublish
Résumé
For neonates and children requiring decompression of tension pneumothorax, specific recommendations for the choice of needle type and size are missing. The aim of this retrospective study was to determine optimal length and diameter of needles for decompression of tension pneumothorax in paediatric patients. Utilizing computed tomography, we determined optimal length and diameter of needles to enable successful decompression and at the same time minimize risk of injury to intrathoracic structures and the intercostal vessels and nerve. Preexisting computed tomography scans of the chest were reviewed in children aged 0, 5 and 10 years. Chest wall thickness and width of the intercostal space were measured at the 4th intercostal space at the anterior axillary line (AAL) on both sides of the thorax. In each age group, three needles different in bore and length were evaluated regarding sufficient length for decompression and risk of injury to intrathoracic organs and the intercostal vessels and nerve. 197 CT-scans were reviewed, of which 58 were excluded, resulting in a study population of 139 children and 278 measurements. Width of the intercostal space was small at 4th ICS AAL (0 years: 0.44 ± 0.13 cm; 5 years: 0.78 ± 0.22 cm; 10 years: 1.12 ± 0.36 cm). The ratio of decompression failure to risk of injury at 4th ICS AAL was most favourable for a 22G/2.5 cm catheter in infants (Decompression failure: right: 2%, left: 4%, Risk of injury: right: 14%, left: 24%), a 22G/2.5 cm or a 20G/3.2 cm catheter in 5-year-old children (20G/3.2 cm: Decompression failure: right: 2.1%, left: 0%, Risk of injury: right: 2.1%, left: 17%) and a 18G/4.5 cm needle in 10-year-old children (Decompression failure: right: 9.5%, left: 9.5%, Risk of injury: right: 7.1%, left: 11.9%). In children aged 0, 5 and 10 years presenting with a tension pneumothorax, we recommend 22G/2.5 cm, 20G/3.2 cm and 18G/4.5 cm needles, respectively, for acute decompression.
Sections du résumé
BACKGROUND
BACKGROUND
For neonates and children requiring decompression of tension pneumothorax, specific recommendations for the choice of needle type and size are missing. The aim of this retrospective study was to determine optimal length and diameter of needles for decompression of tension pneumothorax in paediatric patients.
METHODS
METHODS
Utilizing computed tomography, we determined optimal length and diameter of needles to enable successful decompression and at the same time minimize risk of injury to intrathoracic structures and the intercostal vessels and nerve. Preexisting computed tomography scans of the chest were reviewed in children aged 0, 5 and 10 years. Chest wall thickness and width of the intercostal space were measured at the 4th intercostal space at the anterior axillary line (AAL) on both sides of the thorax. In each age group, three needles different in bore and length were evaluated regarding sufficient length for decompression and risk of injury to intrathoracic organs and the intercostal vessels and nerve.
RESULTS
RESULTS
197 CT-scans were reviewed, of which 58 were excluded, resulting in a study population of 139 children and 278 measurements. Width of the intercostal space was small at 4th ICS AAL (0 years: 0.44 ± 0.13 cm; 5 years: 0.78 ± 0.22 cm; 10 years: 1.12 ± 0.36 cm). The ratio of decompression failure to risk of injury at 4th ICS AAL was most favourable for a 22G/2.5 cm catheter in infants (Decompression failure: right: 2%, left: 4%, Risk of injury: right: 14%, left: 24%), a 22G/2.5 cm or a 20G/3.2 cm catheter in 5-year-old children (20G/3.2 cm: Decompression failure: right: 2.1%, left: 0%, Risk of injury: right: 2.1%, left: 17%) and a 18G/4.5 cm needle in 10-year-old children (Decompression failure: right: 9.5%, left: 9.5%, Risk of injury: right: 7.1%, left: 11.9%).
CONCLUSIONS
CONCLUSIONS
In children aged 0, 5 and 10 years presenting with a tension pneumothorax, we recommend 22G/2.5 cm, 20G/3.2 cm and 18G/4.5 cm needles, respectively, for acute decompression.
Identifiants
pubmed: 31604472
doi: 10.1186/s13049-019-0671-x
pii: 10.1186/s13049-019-0671-x
pmc: PMC6788035
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
90Subventions
Organisme : Deutsche Forschungsgemeinschaft
ID : IN-1150438
Références
Ann Emerg Med. 2013 Mar;61(3):263-70
pubmed: 22841174
J Trauma Acute Care Surg. 2016 Jan;80(1):119-24
pubmed: 26683398
Emerg Med Australas. 2016 Feb;28(1):78-83
pubmed: 26644368
Korean J Thorac Cardiovasc Surg. 2011 Dec;44(6):418-22
pubmed: 22324027
Prehosp Disaster Med. 2008 Nov-Dec;23(6):553-7
pubmed: 19557973
J Trauma Acute Care Surg. 2015 Dec;79(6):983-9; discussion 989-90
pubmed: 26680137
Prehosp Emerg Care. 2019 Sep-Oct;23(5):663-671
pubmed: 30624127
Respir Care. 2010 Nov;55(11):1495-8
pubmed: 20979678
Emerg Med J. 2005 Nov;22(11):788-9
pubmed: 16244336
J Trauma Acute Care Surg. 2014 Apr;76(4):1029-34
pubmed: 24662868
Emerg Med J. 2018 Nov;35(11):669-674
pubmed: 30154141
Injury. 2016 Apr;47(4):797-804
pubmed: 26724173
Prehosp Disaster Med. 2015 Jun;30(3):249-53
pubmed: 25857267
J Trauma Acute Care Surg. 2015 Dec;79(6):1044-8
pubmed: 26488319
Scand J Trauma Resusc Emerg Med. 2019 Apr 16;27(1):45
pubmed: 30992028
Chest. 1998 Oct;114(4):1116-21
pubmed: 9792586
Ann R Coll Surg Engl. 2008 Jan;90(1):54-7
pubmed: 18201502