Ultrasound determination of chest wall thickness: implications for needle thoracostomy
| Autor: | Michael E. Richards, Jonathan Marinaro, A. Robb McLean, Cameron Crandall |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Adult
Male medicine.medical_specialty Supine position National Health and Nutrition Examination Survey Population Axillary lines Thoracostomy Body Mass Index Young Adult Sex Factors Reference Values Statistical significance Confidence Intervals Humans Medicine Thoracic Wall education Ultrasonography education.field_of_study business.industry Body Weight Ultrasound Pneumothorax General Medicine Middle Aged Body Height Confidence interval Surgery Cross-Sectional Studies Linear Models Emergency Medicine Female business Nuclear medicine Body mass index |
| Zdroj: | The American Journal of Emergency Medicine. 29:1173-1177 |
| ISSN: | 0735-6757 |
| Popis: | Objective: Computed tomography measurements of chest wall thickness (CWT) suggest that standardlength angiocatheters (4.5 cm) may fail to decompress tension pneumothoraces. We used an alternative modality, ultrasound, to measure CWT. We correlated CWT with body mass index (BMI) and used national data to estimate the percentage of patients with CWT greater than 4.5 cm. Methods: This was an observational, cross-sectional study of a convenience sample. We recorded standing height, weight, and sex. We measured CWT with ultrasound at the second intercostal space, midclavicular line and at the fourth intercostal space, midaxillary line on supine subjects. We correlated BMI (weight [in kilograms]/height 2 [in square meters]) with CWT using linear regression. 95% Confidence intervals (CIs) assessed statistical significance. National Health and Nutrition Examination Survey results for 2007-2008 were combined to estimate national BMI adult measurements. Results: Of 51 subjects, 33 (65%) were male and 18 (35%) were female. Mean anterior CWT (male, 2.1 cm; CI, 1.9-2.3; female, 2.3 cm; CI, 1.7-2.7), lateral CWT (male, 2.4 cm; CI, 2.1-2.6; female, 2.5 cm; CI 2.0-2.9), and BMI (male, 27.7; CI, 26.1-29.3; female, 30.0; CI, 25.8-34.2) did not differ by sex. Lateral CWT was greater than anterior CWT (0.2 cm; CI, 0.1-0.4; P b .01). Only one subject with a BMI of 48.2 had a CWT that exceeded 4.5 cm. Using national BMI estimates, less than 1% of the US population would be expected to have CWT greater than 4.5 cm. Conclusions: Ultrasound measurements suggest that most patients will have CWT less than 4.5 cm and that CWT may not be the source of the high failure rate of needle decompression in tension pneumothorax. © 2010 Published by Elsevier Inc. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect