Determining optimal needle size for decompression of tension pneumothorax in children – a CT-based study
Abstract 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 pneumot...
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| Format: | Article |
| Language: | English |
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BMC
2019-10-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
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| Online Access: | http://link.springer.com/article/10.1186/s13049-019-0671-x |
| _version_ | 1819226950331269120 |
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| author | Georg Leonhard Daniel Overhoff Lucas Wessel Tim Viergutz Marcus Rudolph Michael Schöler Holger Haubenreisser Tom Terboven |
| author_facet | Georg Leonhard Daniel Overhoff Lucas Wessel Tim Viergutz Marcus Rudolph Michael Schöler Holger Haubenreisser Tom Terboven |
| author_sort | Georg Leonhard |
| collection | DOAJ |
| description | Abstract 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 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 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 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. |
| first_indexed | 2024-12-23T10:33:38Z |
| format | Article |
| id | doaj.art-e84b38c8730c4a2fad7ec8545739e8d5 |
| institution | Directory Open Access Journal |
| issn | 1757-7241 |
| language | English |
| last_indexed | 2024-12-23T10:33:38Z |
| publishDate | 2019-10-01 |
| publisher | BMC |
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| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj.art-e84b38c8730c4a2fad7ec8545739e8d52022-12-21T17:50:22ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412019-10-012711710.1186/s13049-019-0671-xDetermining optimal needle size for decompression of tension pneumothorax in children – a CT-based studyGeorg Leonhard0Daniel Overhoff1Lucas Wessel2Tim Viergutz3Marcus Rudolph4Michael Schöler5Holger Haubenreisser6Tom Terboven7Department of Anaesthesiology and Intensive Care Medicine, University Medical Center MannheimInstitute of Clinical Radiology and Nuclear Medicine, University Medical Center MannheimDepartment of Paediatric Surgery, University Medical Center MannheimDepartment of Anaesthesiology and Intensive Care Medicine, University Medical Center MannheimDepartment of Anaesthesiology and Intensive Care Medicine, University Medical Center MannheimDepartment of Anaesthesiology and Intensive Care Medicine, University Medical Center MannheimInstitute of Clinical Radiology and Nuclear Medicine, University Medical Center MannheimDepartment of Anaesthesiology and Intensive Care Medicine, University Medical Center MannheimAbstract 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 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 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 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.http://link.springer.com/article/10.1186/s13049-019-0671-xTension pneumothoraxChildrenDecompressionNeedle size |
| spellingShingle | Georg Leonhard Daniel Overhoff Lucas Wessel Tim Viergutz Marcus Rudolph Michael Schöler Holger Haubenreisser Tom Terboven Determining optimal needle size for decompression of tension pneumothorax in children – a CT-based study Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Tension pneumothorax Children Decompression Needle size |
| title | Determining optimal needle size for decompression of tension pneumothorax in children – a CT-based study |
| title_full | Determining optimal needle size for decompression of tension pneumothorax in children – a CT-based study |
| title_fullStr | Determining optimal needle size for decompression of tension pneumothorax in children – a CT-based study |
| title_full_unstemmed | Determining optimal needle size for decompression of tension pneumothorax in children – a CT-based study |
| title_short | Determining optimal needle size for decompression of tension pneumothorax in children – a CT-based study |
| title_sort | determining optimal needle size for decompression of tension pneumothorax in children a ct based study |
| topic | Tension pneumothorax Children Decompression Needle size |
| url | http://link.springer.com/article/10.1186/s13049-019-0671-x |
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