Study of efficacy and safety of needle thoracostomy at the second intercostal space in the midclavicular line and ?fth intercostal space in the anterior axillary line by using computed tomography scans in Japanese patients

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  • 日本人におけるCT画像を用いた第2肋間鎖骨中線，第5肋間前腋窩線での胸腔穿刺の有用性と安全性の検討

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Background: Needle thoracostomy is an effective and prompt treatment of tension pneumothorax. However, needle thoracostomy performed at the second intercostal space (ICS) in the midclavicular line (MCL) has often been associated with high failure rates. In recent years, the usefulness of fifth ICS in the anterior axillary line (AAL) has been studied. The purpose of this study is to confirm the efficacy and safety of needle thoracostomy at the second ICS in the MCL and fifth ICS in the AAL in Japanese patients.<br>Methods: We performed a retrospective review of chest computed tomography scans of 153 trauma patients over 18 years old who were admitted to the emergency department of Hakodate Municipal Hospital. Through the Picture Archive and Communication System (PACS), patients’ chest wall thickness (thickness of fat and thickness of muscle) and distances to both the liver and heart from the chest wall were measured at the second ICS in the MCL and fifth ICS in the AAL.<br>Results: Among the 153 patients, 52.9% were male. The mean age was 61.6 years. Height and body weight between male and female patients were significantly different (p<0.0001) but body mass index (BMI) was not significantly different (p>0.05). In every site, approximately 10% of chest wall thickness (CWT) values were less than 50mm. In 26 cases (17.0%), the distance of the liver from the right fifth ICS in the AAL was less than 50mm. Needle thoracostomy failure risk rate increased in cases in which BMI exceeded 25. Failure rates when BMI was higher than 30 ranged from 50 to 88%. Complication risks were higher in instances in which BMI was under 30.<br>Conclusions: In the present study, needle thoracostomy’s success rate from the second ICS in the MCL and fifth ICS in the AAL was as high as nearly 90%. However from the fifth ICS it was also associated with possible risks to the liver and heart. Failure of needle thoracostomy could be linked to obesity in Japanese patients.

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