Terboven Tom, Betka Ivette, Weiss Christel, Rudolph Marcus, Viergutz Tim, Leonhard Georg, Schöler Michael
Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Department of Medical Statistics, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Ultrasound J. 2021 May 10;13(1):25. doi: 10.1186/s13089-021-00226-6.
Emergent needle decompression in children is a rare event for emergency medicine and critical care providers. Hereby, risk of injury of intrathoracic structures is high and knowledge of age-specific values of chest wall thickness and width of the intercostal space (ICS) is crucial to avoid injuries. Investigation of the correlation of chest wall thickness and width of the intercostal space with age and body dimension like weight and height could provide guidance on depth of insertion and choice of the needle.
We performed a prospective observational clinical trial in a pediatric surgery operating room that included a convenient sample of children aged 0-10 years undergoing elective surgery. Chest wall thickness and width of the intercostal space were measured with ultrasound at 2nd ICS midclavicular line (MCL) and 4th ICS anterior axillary line (AAL). Correlation of these measures with age, height, weight, BMI and Broselow color was calculated. Furthermore, intra-class correlation coefficient was calculated as a measure of reproducibility and the presence of vital structures (e.g., heart, thymus gland, large pulmonary vessels) at the possible insertion sites for needle decompression was investigated.
Of 410 potentially eligible patients, 300 were included in the study. Correlation of chest wall thickness was moderate with weight (2nd ICS MCL: r = 0.57; 4th ICS MCL: r = 0.64) and BMI (r = 0.44 and r = 0.6) and was lower with age (r = 0.38 for both intercostal spaces), height (r = 0.42 and r = 0.40) and Broselow color (r = 0.42 and r = 0.38). Correlation of width of the ICS with anthropometric data was generally stronger, with height showing the strongest, albeit not really strong, correlation (r = 0.71 and r = 0.62). Intra-class correlation was excellent with an ICC of 0.93. Vital structures were significantly more often present at 2nd ICS MCL then at 4th ICS AAL (14 vs. 2 patients; p = 0.0042).
Correlation of chest wall thickness and width of the intercostal space with anthropometric data is at most moderate. Insertion depth and width of the intercostal space can therefore not be predicted accurately from anthropometric data. Ultrasound assessment of the thoracic wall appears to be a reliable technique and could therefore assist in reducing the risk of injury and increasing decompression success. Trial registration German clinical trials register, DRKS00014973, Registered February 11th 2019, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014973.
对于急诊医学和重症监护人员而言，儿童紧急针吸减压是一种罕见情况。因此，胸内结构损伤风险很高，了解胸壁厚度和肋间间隙（ICS）宽度的年龄特异性值对于避免损伤至关重要。研究胸壁厚度和肋间间隙宽度与年龄以及体重和身高之类的身体尺寸之间的相关性，可为进针深度和针具选择提供指导。
我们在一家儿科手术室进行了一项前瞻性观察性临床试验，纳入了0至10岁接受择期手术的便利样本儿童。在锁骨中线（MCL）第2肋间和腋前线（AAL）第4肋间用超声测量胸壁厚度和肋间间隙宽度。计算这些测量值与年龄、身高、体重、BMI和布罗泽洛颜色之间的相关性。此外，计算组内相关系数作为可重复性的度量，并研究针吸减压可能进针部位重要结构（如心脏、胸腺、大的肺血管）的存在情况。
在410名可能符合条件的患者中，300名被纳入研究。胸壁厚度与体重（第2肋间MCL：r = 0.57；第4肋间MCL：r = 0.64）和BMI（r = 0.44和r = 0.6）的相关性为中等，与年龄（两个肋间间隙r均为0.38）、身高（r = 0.42和r = 0.40）和布罗泽洛颜色（r = 0.42和r = 0.38）的相关性较低。ICS宽度与人体测量数据的相关性总体上更强，身高显示出最强的相关性，尽管并非非常强（r = 0.71和r = 0.62）。组内相关性极佳，ICC为0.93。重要结构在第2肋间MCL处出现的频率明显高于第4肋间AAL处（14例对2例；p = 0.0042）。
胸壁厚度和肋间间隙宽度与人体测量数据的相关性至多为中等。因此，无法根据人体测量数据准确预测进针深度和肋间间隙宽度。胸壁的超声评估似乎是一种可靠的技术，因此有助于降低损伤风险并提高减压成功率。试验注册 德国临床试验注册中心，DRKS00014973，2019年2月11日注册，https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014973 。
