Ahmad Suhaib J S, Degiannis Jason R, Head Marion, Ahmed Ahmed R, Gelber Edgar, Hakky Sherif, Kieser Armin, Müller Martin, Darling John, Jakob Dominik A, Kyriazidis Ioannis Panagiotis, Degiannis Konstantinos, Dorn Patrick, Lala Anil, Bowman Christopher, Wilkinson Danielle, Whiteley Graham, Hassan Umair, Mohamed Younis, Loo Kai Hui, Davies Ynyr Dewi, Egan Richard, Pouwels Sjaak, Coulthard Amber, Churchill Lowri, Bhavra Kiran, Bailey Christopher, Johnson Ian, Rees Ifan, Williams Dafydd, Hajibandeh Shahab, Yang Wah, Subbe Christian Peter, Owen Amy, Rawaf David, Khamise Ameer, Khalid Ali Waleed, Parmar Chetan, Soler J Agustin, Khalil Miriam, Mohajer-Bastami Ata, Moin Sarah, Archid Rami, Abdulmajed Mohamed, Jones Rosalind, Balasubaramaniam Vignesh, Al-Salihi Rawa, Shoker Arran, Hwang Mei-Ju, Griffiths Olga, Pandey Sushil, Lee-Smith Lucy, Exadaktylos Aristomenis K
Department of General Surgery, Betsi Cadwaladr University Health Board, Bangor, Wales, UK.
Department of Emergency Medicine, Inselspital University Hospital of Bern, Bern, Switzerland.
World J Emerg Surg. 2025 May 19;20(1):39. doi: 10.1186/s13017-025-00613-7.
Tension pneumothorax (TP) is a life-threatening condition. The immediate recommended management is needle decompression (ND), followed by the insertion of an intercostal chest drain. The European Trauma Course (ETC) and the Advanced Trauma Life Support (ATLS) guidelines differ on needle size and decompression site, creating clinical uncertainty. This meta-analysis aims to explore the optimal approach for emergency needle decompression in TP.
This meta-analysis followed the PRISMA 2020 guidelines. It included English-language RCTs, cohort, case-control, cross-sectional studies, and case series with more than six patients. Studies on adults undergoing needle decompression therapy for TP or with chest wall thickness measurements were included. Ovid MEDLINE, Embase, and Web of Science databases were searched until May 31, 2024. Data were extracted, assessed for quality using OCEBM and GRADE, and analyzed using SPSS and OpenMeta with random-effects models.
needle decompression failure rate.
patient demographics, cannula size, and chest wall thickness comparisons.
This review analyzed 51 studies on needle decompression for TP, with a weighted mean patient age of 36.67 years. Radiological data from 24 studies (n = 8046) indicated a 32.84% failure rate for needle penetration into the pleural cavity (I: 99.72%). Increased needle length reduced failure rates by 7.76% per cm. No significant differences in chest wall thickness between genders were observed (T-test, p = 0.77), but thickness at the 5th anterior axillary line (5AAL) and 5th midaxillary line (5MAL) was less than at the 2nd midclavicular line (2MCL). Injury rates were higher at 5AAL than 5MAL, with strong positive correlations between needle length and injury at these sites (0.88, 0.91).
Based on our meta-analysis, a 7 cm needle may be appropriate for decompression of right-sided tension pneumothorax at either the 5th intercostal space along the midaxillary line or the 2nd intercostal space along the midclavicular line. For left-sided cases, given the potential risk of cardiac injury, the 2nd midclavicular line is a safer option. However, these recommendations should be interpreted with caution due to considerable heterogeneity among the included studies, potential risk of bias, and variability in measurement techniques. Clinical decisions should always be individualized, taking into account patient-specific factors.
张力性气胸（TP）是一种危及生命的疾病。目前推荐的紧急处理方法是针式减压（ND），随后插入肋间胸腔引流管。欧洲创伤课程（ETC）和高级创伤生命支持（ATLS）指南在针的尺寸和减压部位上存在差异，这导致了临床实践中的不确定性。本荟萃分析旨在探讨TP紧急针式减压的最佳方法。
本荟萃分析遵循PRISMA 2020指南。纳入了英文的随机对照试验（RCT）、队列研究、病例对照研究、横断面研究以及患者超过6例的病例系列。纳入了对接受TP针式减压治疗或有胸壁厚度测量的成年人的研究。检索了Ovid MEDLINE、Embase和Web of Science数据库，检索截至2024年5月31日。提取数据，使用牛津循证医学中心（OCEBM）和推荐分级的评估、制定与评价（GRADE）方法评估质量，并使用SPSS和OpenMeta软件采用随机效应模型进行分析。
针式减压失败率。
患者人口统计学特征、套管尺寸和胸壁厚度比较。
本综述分析了51项关于TP针式减压的研究，加权平均患者年龄为36.67岁。来自24项研究（n = 8046）的放射学数据表明，针穿入胸膜腔的失败率为32.84%（I²：99.72%）。针的长度每增加1厘米，失败率降低7.76%。未观察到不同性别之间胸壁厚度有显著差异（t检验，p = 0.77），但腋前线第5肋间（5AAL）和腋中线第5肋间（5MAL）的厚度小于锁骨中线第2肋间（2MCL）。5AAL的损伤率高于5MAL，在这些部位针的长度与损伤之间存在强正相关（0.88，0.91）。
基于我们的荟萃分析，对于右侧张力性气胸，7厘米长的针在腋中线第5肋间或锁骨中线第2肋间进行减压可能是合适的。对于左侧病例，考虑到心脏损伤的潜在风险，锁骨中线第2肋间是更安全的选择。然而，由于纳入研究之间存在相当大的异质性、潜在的偏倚风险以及测量技术的变异性，这些建议应谨慎解读。临床决策应始终个体化，考虑患者的具体因素。
