INTRODUCTION: The primary goal of this study was to compare the chest wall thicknesses (CWT) at the 2nd intercostal space (ICS) at the mid-clavicular line (MCL) and 5th ICS at the mid-axillary line (MAL) in a population of patients with a CT confirmed pneumothorax (PTX). This result will help physicians to determine the optimum needle thoracostomy (NT) puncture site in patients with a PTX. MATERIALS AND METHODS: All trauma patients who presented consecutively to A&E over a 12-month period were included. Among all the trauma patients with a chest CT (4204 patients), 160 were included in the final analysis. CWTs were measured at both sides and were compared in all subgroup of patients. RESULTS: The average CWT for men on the 2nd ICS-MCL was 38mm and for women was 52mm; on the other hand, on the 5th ICS-MAL was 33mm for men and 38mm for women. On the 2nd ICS-MCL 17% of men and 48% of women; on the 5th ICS-MAL 13% of men and 33% of women would be inaccessible with a routine 5-cm catheter. Patients with trauma, subcutaneous emphysema and multiple rib fractures would have thicker CWT on the 2nd ICS-MCL. Patients with trauma, lung contusion, sternum fracture, subcutaneous emphysema and multiple rib fractures would have thicker CWT on the 5th ICS-MAL. CONCLUSIONS: This study confirms that a 5.0-cm catheter would be unlikely to access the pleural space in at least 1/3 of female and 1/10 of male Turkish trauma patients, regardless of the puncture site. If NT is needed, the 5th ICS-MAL is a better option for a puncture site with thinner CWT.
INTRODUCTION: The primary goal of this study was to compare the chest wall thicknesses (CWT) at the 2nd intercostal space (ICS) at the mid-clavicular line (MCL) and 5th ICS at the mid-axillary line (MAL) in a population of patients with a CT confirmed pneumothorax (PTX). This result will help physicians to determine the optimum needle thoracostomy (NT) puncture site in patients with a PTX. MATERIALS AND METHODS: All traumapatients who presented consecutively to A&E over a 12-month period were included. Among all the traumapatients with a chest CT (4204 patients), 160 were included in the final analysis. CWTs were measured at both sides and were compared in all subgroup of patients. RESULTS: The average CWT for men on the 2nd ICS-MCL was 38mm and for women was 52mm; on the other hand, on the 5th ICS-MAL was 33mm for men and 38mm for women. On the 2nd ICS-MCL 17% of men and 48% of women; on the 5th ICS-MAL 13% of men and 33% of women would be inaccessible with a routine 5-cm catheter. Patients with trauma, subcutaneous emphysema and multiple rib fractures would have thicker CWT on the 2nd ICS-MCL. Patients with trauma, lung contusion, sternum fracture, subcutaneous emphysema and multiple rib fractures would have thicker CWT on the 5th ICS-MAL. CONCLUSIONS: This study confirms that a 5.0-cm catheter would be unlikely to access the pleural space in at least 1/3 of female and 1/10 of male Turkish traumapatients, regardless of the puncture site. If NT is needed, the 5th ICS-MAL is a better option for a puncture site with thinner CWT.
Authors: Danuel V Laan; Trang Diem N Vu; Cornelius A Thiels; T K Pandian; Henry J Schiller; M Hassan Murad; Johnathon M Aho Journal: Injury Date: 2015-12-13 Impact factor: 2.586
Authors: Johnathon M Aho; Raaj K Ruparel; Phillip G Rowse; Rushin D Brahmbhatt; Donald Jenkins; Mariela Rivera Journal: World J Surg Date: 2015-11 Impact factor: 3.352
Authors: Nimesh D Naik; Matthew C Hernandez; Jeff R Anderson; Erika K Ross; Martin D Zielinski; Johnathon M Aho Journal: Chest Date: 2017-05-10 Impact factor: 9.410
Authors: Johnathon M Aho; Cornelius A Thiels; Moustafa M El Khatib; Daniel S Ubl; Danuel V Laan; Kathleen S Berns; Elizabeth B Habermann; Scott P Zietlow; Martin D Zielinski Journal: J Trauma Acute Care Surg Date: 2016-02 Impact factor: 3.313
Authors: Brian Wernick; Heidi H Hon; Ronnie N Mubang; Anthony Cipriano; Ronson Hughes; Demicha D Rankin; David C Evans; William R Burfeind; Brian A Hoey; James Cipolla; Sagar C Galwankar; Thomas J Papadimos; Stanislaw P Stawicki; Michael S Firstenberg Journal: Int J Crit Illn Inj Sci Date: 2015 Jul-Sep