Powers William F, Clancy Thomas V, Adams Ashley, West Tonnya C, Kotwall Cyrus A, Hope William W
Department of Surgery, South East Area Health Education Center, Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC, United States.
Injury. 2014 Jan;45(1):107-11. doi: 10.1016/j.injury.2013.08.026. Epub 2013 Sep 7.
Obesity increases the incidence of mortality in trauma patients. Current Advanced Trauma Life Support guidelines recommend using a 5-cm catheter at the second intercostal (ICS) space in the mid-clavicular line to treat tension pneumothoraces. Our study purpose was to determine whether body mass index (BMI) predicted the catheter length needed for needle thoracostomy.
We retrospectively reviewed trauma patients undergoing chest computed tomography scans January 2004 through September 2006. A BMI was calculated for each patient, and the chest wall thickness (CWT) at the second ICS in the mid-clavicular line was measured bilaterally. Patients were grouped by BMI as underweight (≤ 18.5 kg/m2), normal weight (18.6-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)), or obese (≥ 30 kg/m(2)).
Three hundred twenty-six patients were included in the study; 70% were male. Ninety-four percent of patients experienced blunt trauma. Sixty-three percent of patients were involved in a motor vehicle collision. The average BMI was 29 [SD 7.8]. The average CWT was 6.2 [SD 1.9]cm on the right and 6.3 [SD 1.9]cm on the left. As BMI increased, a statistically significant (p<0.0001) CWT increase was observed in all BMI groups. There were no significant differences in ISS, ventilator days, ICU length of stay, or overall length of stay among the groups.
As BMI increases, there is a direct correlation to increasing CWT. This information could be used to quickly select an appropriate needle length for needle thoracostomy. The average patient in our study would require a catheter length of 6-6.5 cm to successfully decompress a tension pneumothorax. There are not enough regionally available data to define the needle lengths needed for needle thoracostomy. Further study is required to assess the feasibility and safety of using varying catheter lengths.
肥胖会增加创伤患者的死亡率。当前的《高级创伤生命支持指南》建议在锁骨中线第二肋间（ICS）间隙使用5厘米长的导管来治疗张力性气胸。我们的研究目的是确定体重指数（BMI）是否能预测胸腔穿刺造口术所需的导管长度。
我们回顾性分析了2004年1月至2006年9月期间接受胸部计算机断层扫描的创伤患者。计算每位患者的BMI，并双侧测量锁骨中线第二肋间的胸壁厚度（CWT）。患者按BMI分为体重过轻（≤18.5千克/平方米）、正常体重（18.6 - 24.9千克/平方米）、超重（25 - 29.9千克/平方米）或肥胖（≥30千克/平方米）。
326名患者纳入研究；70%为男性。94%的患者经历钝性创伤。63%的患者涉及机动车碰撞。平均BMI为29[标准差7.8]。右侧平均CWT为6.2[标准差1.9]厘米，左侧为6.3[标准差1.9]厘米。随着BMI增加，所有BMI组的CWT均有统计学显著增加（p<0.0001）。各组间在损伤严重度评分（ISS）、呼吸机使用天数、重症监护病房住院时间或总住院时间方面无显著差异。
随着BMI增加，与CWT增加直接相关。该信息可用于快速选择胸腔穿刺造口术合适的针长度。我们研究中的普通患者成功解除张力性气胸需要6 - 6.5厘米长的导管。没有足够的区域可用数据来确定胸腔穿刺造口术所需的针长度。需要进一步研究以评估使用不同导管长度的可行性和安全性。
