Document Detail


Does needle thoracostomy provide adequate and effective decompression of tension pneumothorax?
MedLine Citation:
PMID:  22902737     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Tension pneumothorax (tPTX) is a common and potentially fatal event after thoracic trauma. Needle decompression is the currently accepted first-line intervention but has not been well validated. The purpose of this study was to evaluate the effectiveness of a properly placed and patent needle thoracostomy (NT) compared with standard tube thoracostomy (TT) in a swine model of tPTX.
METHODS: Six adult swine underwent instrumentation and creation of tPTX using thoracic CO2 insufflation via a balloon trocar. A continued 1 L/min insufflation was maintained to simulate an ongoing air leak. The efficacy and failure rate of NT (14 gauge) compared with TT (34F) was assessed in two separate arms: (1) tPTX with hemodynamic compromise and (2) tPTX until pulseless electrical activity (PEA) obtained. Hemodynamics was assessed at 1 and 5 minutes after each intervention.
RESULTS: A reliable and highly reproducible tPTX was created in all animals with a mean insufflation volume of 2441 mL. tPTX resulted in the systolic blood pressure declining 54% from baseline (128-58 mm Hg), cardiac output declining by 77% (7-1.6 L/min), and equalization of central venous pressure and wedge pressures. In the first arm, there were 19 tPTX events treated with NT placement. All NTs were patent on initial placement, but 5 (26%) demonstrated mechanical failure (due to kinking, obstruction, or dislodgment) within 5 minutes of placement, all associated with hemodynamic decline. Among the 14 NTs that remained patent at 5 minutes, 6 (43%) failed to relieve tension physiology for an overall failure rate of 58%. Decompression with TT was successful in relieving tPTX in 100%. In the second arm, there were 21 tPTX with PEA events treated initially with either NT (n = 14) or TT (n = 7). The NT failed to restore perfusion in nine events (64%), whereas TT was successful in 100% of events as a primary intervention and restored perfusion as a rescue intervention in eight of the nine NT failures (88%).
CONCLUSION: Thoracic insufflation produced a reliable and easily controlled model of tPTX. NT was associated with high failure rates for relief of tension physiology and for treatment of tPTX-induced PEA and was due to both mechanical failure and inadequate tPTX evacuation. This performance data should be considered in future NT guideline development and equipment design.
Authors:
Matthew Martin; Steven Satterly; Kenji Inaba; Kelly Blair
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  73     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-28     Completed Date:  2013-08-22     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1412-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Madigan Army Medical Center, Tacoma, Washington, USA. matthew.martin1@amedd.army.mil
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MeSH Terms
Descriptor/Qualifier:
Animals
Decompression, Surgical / methods*
Disease Models, Animal
Needles
Pneumothorax / etiology,  physiopathology,  surgery*
Swine
Thoracic Injuries / complications,  surgery
Thoracostomy / methods*
Treatment Outcome
Comments/Corrections
Comment In:
J Trauma Acute Care Surg. 2013 Mar;74(3):949   [PMID:  23425767 ]
J Trauma Acute Care Surg. 2013 Mar;74(3):949   [PMID:  23425768 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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