Kenji Inaba, Crystal Ives, Kelsey McClure, Bernardino C Branco, Marc Eckstein, David Shatz, Matthew J Martin, Sravanthi Reddy, Demetrios Demetriades
{"title":"张力性气胸针减压替代部位的放射学评价。","authors":"Kenji Inaba, Crystal Ives, Kelsey McClure, Bernardino C Branco, Marc Eckstein, David Shatz, Matthew J Martin, Sravanthi Reddy, Demetrios Demetriades","doi":"10.1001/archsurg.2012.751","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To compare the distance to be traversed during needle thoracostomy decompression performed at the second intercostal space (ICS) in the midclavicular line (MCL) with the fifth ICS in the anterior axillary line (AAL).</p><p><strong>Design: </strong>Patients were separated into body mass index (BMI) quartiles, with BMI calculated as weight in kilograms divided by height in meters squared. From each BMI quartile, 30 patients were randomly chosen for inclusion in the study on the basis of a priori power analysis (n = 120). Chest wall thickness on computed tomography at the second ICS in the MCL was compared with the fifth ICS in the AAL on both the right and left sides through all BMI quartiles.</p><p><strong>Setting: </strong>Level I trauma center.</p><p><strong>Patients: </strong>Injured patients aged 16 years or older evaluated from January 1, 2009, to January 1, 2010, undergoing computed tomography of the chest.</p><p><strong>Results: </strong>A total of 680 patients met the study inclusion criteria (81.5% were male and mean age was 41 years [range, 16-97 years]). Of the injuries sustained, 13.2% were penetrating, mean (SD) Injury Severity Score was 15.5 (10.3), and mean BMI was 27.9 (5.9) (range, 15.4-60.7). The mean difference in chest wall thickness between the second ICS at the MCL and the fifth ICS at the AAL was 12.9 mm (95% CI, 11.0-14.8; P < .001) on the right and 13.4 mm (95% CI, 11.4-15.3; P < .001) on the left. There was a stepwise increase in chest wall thickness across all BMI quartiles at each location of measurement. There was a significant difference in chest wall thickness between the second ICS at the MCL and the fifth ICS at the AAL in all quartiles on both the right and the left. The percentage of patients with chest wall thickness greater than the standard 5-cm decompression needle was 42.5% at the second ICS in the MCL and only 16.7% at the fifth ICS in the AAL.</p><p><strong>Conclusions: </strong>In this computed tomography-based analysis of chest wall thickness, needle thoracostomy decompression would be expected to fail in 42.5% of cases at the second ICS in the MCL compared with 16.7% at the fifth ICS in the AAL. The chest wall thickness at the fifth ICS AAL was 1.3 cm thinner on average and may be a preferred location for needle thoracostomy decompression.</p>","PeriodicalId":8298,"journal":{"name":"Archives of Surgery","volume":"147 9","pages":"813-8"},"PeriodicalIF":0.0000,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/archsurg.2012.751","citationCount":"69","resultStr":"{\"title\":\"Radiologic evaluation of alternative sites for needle decompression of tension pneumothorax.\",\"authors\":\"Kenji Inaba, Crystal Ives, Kelsey McClure, Bernardino C Branco, Marc Eckstein, David Shatz, Matthew J Martin, Sravanthi Reddy, Demetrios Demetriades\",\"doi\":\"10.1001/archsurg.2012.751\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To compare the distance to be traversed during needle thoracostomy decompression performed at the second intercostal space (ICS) in the midclavicular line (MCL) with the fifth ICS in the anterior axillary line (AAL).</p><p><strong>Design: </strong>Patients were separated into body mass index (BMI) quartiles, with BMI calculated as weight in kilograms divided by height in meters squared. From each BMI quartile, 30 patients were randomly chosen for inclusion in the study on the basis of a priori power analysis (n = 120). Chest wall thickness on computed tomography at the second ICS in the MCL was compared with the fifth ICS in the AAL on both the right and left sides through all BMI quartiles.</p><p><strong>Setting: </strong>Level I trauma center.</p><p><strong>Patients: </strong>Injured patients aged 16 years or older evaluated from January 1, 2009, to January 1, 2010, undergoing computed tomography of the chest.</p><p><strong>Results: </strong>A total of 680 patients met the study inclusion criteria (81.5% were male and mean age was 41 years [range, 16-97 years]). Of the injuries sustained, 13.2% were penetrating, mean (SD) Injury Severity Score was 15.5 (10.3), and mean BMI was 27.9 (5.9) (range, 15.4-60.7). The mean difference in chest wall thickness between the second ICS at the MCL and the fifth ICS at the AAL was 12.9 mm (95% CI, 11.0-14.8; P < .001) on the right and 13.4 mm (95% CI, 11.4-15.3; P < .001) on the left. There was a stepwise increase in chest wall thickness across all BMI quartiles at each location of measurement. There was a significant difference in chest wall thickness between the second ICS at the MCL and the fifth ICS at the AAL in all quartiles on both the right and the left. The percentage of patients with chest wall thickness greater than the standard 5-cm decompression needle was 42.5% at the second ICS in the MCL and only 16.7% at the fifth ICS in the AAL.</p><p><strong>Conclusions: </strong>In this computed tomography-based analysis of chest wall thickness, needle thoracostomy decompression would be expected to fail in 42.5% of cases at the second ICS in the MCL compared with 16.7% at the fifth ICS in the AAL. 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引用次数: 69
摘要
目的:比较锁骨中线(MCL)第二肋间隙(ICS)与腋前线(AAL)第五肋间隙(ICS)的开胸针减压所需要穿越的距离。设计:将患者分为身体质量指数(BMI)四分位数，BMI计算为体重(公斤)除以身高(米)的平方。根据先验功率分析，从每个BMI四分位数中随机选择30例患者纳入研究(n = 120)。通过所有BMI四分位数，比较MCL第2个ICS与AAL第5个ICS在左右两侧的计算机断层胸壁厚度。地点:一级创伤中心。患者:2009年1月1日至2010年1月1日接受胸部计算机断层扫描的16岁及以上的受伤患者。结果:共有680例患者符合研究纳入标准，其中81.5%为男性，平均年龄41岁[范围，16-97岁]。其中穿透性损伤占13.2%，平均(SD)损伤严重程度评分为15.5(10.3)，平均BMI为27.9(5.9)(范围15.4-60.7)。第二组胸壁厚度与第五组胸壁厚度的平均差值为12.9 mm (95% CI, 11.0-14.8;P < 0.001)，右侧为13.4 mm (95% CI, 11.4-15.3;P < 0.001)。在每个测量位置，所有BMI四分位数的胸壁厚度都逐步增加。在右、左各四分位数上，位于MCL的第2次ICS与位于AAL的第5次ICS的胸壁厚度均有显著差异。在MCL的第二次ICS中胸壁厚度大于标准5cm减压针的患者比例为42.5%，而在AAL的第五次ICS中仅为16.7%。结论:在这项基于胸壁厚度的计算机断层扫描分析中，在MCL的第二次ICS中，有42.5%的病例预计针状开胸减压失败，而在AAL的第五次ICS中，这一比例为16.7%。第5个ICS AAL胸壁厚度平均薄1.3 cm，可能是穿刺胸廓减压的首选位置。
Radiologic evaluation of alternative sites for needle decompression of tension pneumothorax.
Objective: To compare the distance to be traversed during needle thoracostomy decompression performed at the second intercostal space (ICS) in the midclavicular line (MCL) with the fifth ICS in the anterior axillary line (AAL).
Design: Patients were separated into body mass index (BMI) quartiles, with BMI calculated as weight in kilograms divided by height in meters squared. From each BMI quartile, 30 patients were randomly chosen for inclusion in the study on the basis of a priori power analysis (n = 120). Chest wall thickness on computed tomography at the second ICS in the MCL was compared with the fifth ICS in the AAL on both the right and left sides through all BMI quartiles.
Setting: Level I trauma center.
Patients: Injured patients aged 16 years or older evaluated from January 1, 2009, to January 1, 2010, undergoing computed tomography of the chest.
Results: A total of 680 patients met the study inclusion criteria (81.5% were male and mean age was 41 years [range, 16-97 years]). Of the injuries sustained, 13.2% were penetrating, mean (SD) Injury Severity Score was 15.5 (10.3), and mean BMI was 27.9 (5.9) (range, 15.4-60.7). The mean difference in chest wall thickness between the second ICS at the MCL and the fifth ICS at the AAL was 12.9 mm (95% CI, 11.0-14.8; P < .001) on the right and 13.4 mm (95% CI, 11.4-15.3; P < .001) on the left. There was a stepwise increase in chest wall thickness across all BMI quartiles at each location of measurement. There was a significant difference in chest wall thickness between the second ICS at the MCL and the fifth ICS at the AAL in all quartiles on both the right and the left. The percentage of patients with chest wall thickness greater than the standard 5-cm decompression needle was 42.5% at the second ICS in the MCL and only 16.7% at the fifth ICS in the AAL.
Conclusions: In this computed tomography-based analysis of chest wall thickness, needle thoracostomy decompression would be expected to fail in 42.5% of cases at the second ICS in the MCL compared with 16.7% at the fifth ICS in the AAL. The chest wall thickness at the fifth ICS AAL was 1.3 cm thinner on average and may be a preferred location for needle thoracostomy decompression.
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