Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Scand J Trauma Resusc Emerg Med. 2019 Oct 11;27(1):90. doi: 10.1186/s13049-019-0671-x.
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.
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.
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%).
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.
对于需要减压张力性气胸的新生儿和儿童，缺乏针对针类型和大小选择的具体建议。本回顾性研究的目的是确定儿科患者张力性气胸减压的最佳针长和直径。
利用计算机断层扫描（CT）确定能够成功减压且同时最大限度降低损伤胸内结构、肋间血管和神经风险的最佳针长和直径。对 0 岁、5 岁和 10 岁儿童的现有 CT 胸部扫描进行回顾性分析。在腋前线（AAL）第 4 肋间测量两侧胸壁厚度和肋间空间宽度。在每个年龄组中，评估了三种不同孔径和长度的针，以确定其足够的减压长度和损伤胸内器官、肋间血管和神经的风险。
共回顾了 197 次 CT 扫描，其中 58 次被排除，最终纳入了 139 名儿童和 278 次测量的研究人群。第 4 肋间空间宽度较小（0 岁：0.44±0.13cm；5 岁：0.78±0.22cm；10 岁：1.12±0.36cm）。在第 4 肋间 AAL，减压失败与损伤风险的比例，以 22G/2.5cm 导管在婴儿中最有利（右侧：2%，左侧：4%；损伤风险：右侧：14%，左侧：24%），22G/2.5cm 或 20G/3.2cm 导管在 5 岁儿童中（20G/3.2cm：右侧：2.1%，左侧：0%；损伤风险：右侧：2.1%，左侧：17%）和 18G/4.5cm 针在 10 岁儿童中（右侧：9.5%，左侧：9.5%；损伤风险：右侧：7.1%，左侧：11.9%）。
对于出现张力性气胸的 0 岁、5 岁和 10 岁儿童，我们分别推荐使用 22G/2.5cm、20G/3.2cm 和 18G/4.5cm 针进行急性减压。
