Reifferscheid Florian, Seewald Stephan, Eimer Christine, Otto Matthias, Rudolph Marcus, Richter Anja, Hoffmann Florian, Viergutz Tim, Terboven Tom
Campus Kiel, Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland.
DRF Stiftung Luftrettung gemeinnützige AG, Filderstadt, Deutschland.
Anaesthesist. 2021 Nov;70(11):928-936. doi: 10.1007/s00101-021-00966-z. Epub 2021 Apr 23.
The preclinical treatment of a traumatic or spontaneous tension pneumothorax remains a particular challenge in pediatric patients. Currently recommended interventions for decompression are either finger thoracostomy or needle decompression. Due to the tiny intercostal spaces, finger thoracostomy may not be feasible in small children and surgical preparation may be necessary. In needle decompression, the risk of injuring underlying vital structures is increased because of the smaller anatomic structures. As most emergency physicians do not regularly work in pediatric trauma care, decompression of tension pneumothorax is associated with significant uncertainty; however, in this rare emergency situation, consistent and goal-oriented action is mandatory and lifesaving. An assessment of pre-existing experience and commonly used techniques therefore seems necessary to deduce the need for future education and training.
In this study an online survey was created to evaluate the experience and the favored prehospital treatment of tension pneumothorax in children among German emergency physicians.
An online survey was conducted with 43 questions on previous experience with tension pneumothorax in children, favored decompression technique and anatomical structures in different age groups. Surveyed were the emergency physicians of the ground-based emergency medical service of the University Medical Center Mannheim, the German Air Rescue Service (DRF) and the pediatric emergency medical service of the City of Munich.
More than half of all respondents stated that there was uncertainty about the procedure of choice. Needle decompression was favored in smaller children and mini-thoracostomy in older children. In comparison with the literature, the thickness of the chest wall was mostly estimated correctly by the emergency medical physicians. The depth of the vital structures was underestimated at most of the possible insertion sites in all age groups. At the lateral insertion sites on the left hemithorax, however, the distance to the left ventricle was overestimated. The caliber of the needle selected for decompression tended to be too large, especially in younger children.
Even though having interviewed an experienced group of prehospital emergency physicians, the experience in decompression of tension pneumothorax in children is relatively scant. Knowledge of chest wall thickness and depth to vital structures is sufficient, the choice of needle calibers tends to be too large but still reasonable. For many providers a large amount of uncertainty about the right choice of technique and equipment arises from the challenge of decompressing a tension pneumothorax in children and therefore further theoretical education and regular training are required for safe performance of the procedure.
创伤性或自发性张力性气胸的临床前治疗在儿科患者中仍然是一项特殊挑战。目前推荐的减压干预措施是手指胸腔造口术或针式减压。由于肋间间隙微小，手指胸腔造口术在幼儿中可能不可行，可能需要进行手术准备。在针式减压中，由于解剖结构较小，损伤潜在重要结构的风险增加。由于大多数急诊医生不经常从事儿科创伤护理工作，张力性气胸的减压存在很大不确定性；然而，在这种罕见的紧急情况下，一致且目标明确的行动是必需的且能挽救生命。因此，评估既往经验和常用技术似乎有必要，以推断未来教育和培训的需求。
在本研究中，创建了一项在线调查，以评估德国急诊医生对儿童张力性气胸的经验和首选的院前治疗方法。
进行了一项在线调查，包含43个关于儿童张力性气胸既往经验、首选减压技术以及不同年龄组解剖结构的问题。接受调查的是曼海姆大学医学中心地面紧急医疗服务、德国空中救援服务（DRF）以及慕尼黑市儿科紧急医疗服务的急诊医生。
超过一半的受访者表示对选择的操作存在不确定性。针式减压在较小儿童中更受青睐，而迷你胸腔造口术在较大儿童中更受青睐。与文献相比，急诊医生大多能正确估计胸壁厚度。在所有年龄组的大多数可能穿刺部位，重要结构的深度被低估。然而，在左半胸的外侧穿刺部位，到左心室的距离被高估。用于减压的所选针的口径往往过大，尤其是在较小儿童中。
尽管采访了一组经验丰富的院前急诊医生，但儿童张力性气胸减压的经验相对较少。对胸壁厚度和到重要结构深度的了解足够，针口径的选择往往过大但仍属合理。对于许多医疗人员来说，在儿童张力性气胸减压的挑战中，对于正确选择技术和设备存在大量不确定性，因此需要进一步的理论教育和定期培训以安全地进行该操作。
