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ONUR, ÖZGE ECMEL

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ÖZGE ECMEL

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2013 - 20162
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End date: 2019 × Subject: DECOMPRESSION ×

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    Determination of the chest wall thicknesses and needle thoracostomy success rates at second and fifth intercostal spaces: a cadaver-based study
    (W B SAUNDERS CO-ELSEVIER INC, 2016) DENİZBAŞI ALTINOK, ARZU; Ozen, Can; Akoglu, Haldun; Ozdemirel, Rifat Ozgur; Omeroglu, Elif; Ozpolat, Cigdem Ulubay; Onur, Ozge; Buyuk, Yalcin; Denizbasi, Arzu
    Introduction: The purposes of this study were to measure the chest wall thicknesses (CWTs) at second intercostal space (ICS) mid-clavicular line (MCL) and fifth ICS MAL directly, and compare the actual success rates of needle thoracostomies (NTs) by inserting a 5-cm-long syringe needle. Predictive values of weight, body mass index (BMI) and CWT were also analyzed. Materials and Methods: This study included 199 measurements of 50 adult fresh cadavers from both hemithoraces. Five-centimeter-long syringe needles were inserted and secured. Penetration into the pleural cavity was assessed, and CWTs at 4 locations were measured. Achieved power of this study for the primary aim of CWT comparison from 2nd and 5th ICSs was .94. Results: Overall mean CWTs at 2nd ICS MCL and 5th ICS MAL were measured as 2.46 +/- 0.78 and 2.89 +/- 1.09, respectively, and 5th ICSMAL was found to be statistically thicker (P - .002). The success rate of NT at 2nd ICS MCL was 87% (95% CI, 80-94), and that at 5th ICSMAL was 78% (95% CI, 70-86; P = .3570). Only 6 (17.1%) of 35 failed NTs had a CWT greater than 5-cm. Needle thoracostomy has failed in 29 (14.9%) of 194 locations, despite a CWT less than 5-cm. Below a weight of 72 kg, BMI of 23 kg/m(2), or CWT of 2.4 cm, all NTs were successful. Discussion and Conclusions: In this report, we present the largest cadaver-based cohort to date to the best of our knowledge, and we observed a statistically nonsignificant 9% more NT success rate at 2nd ICS at a power of 88% and statistically significant more success rate in males at 5th ICS was (47.7%). We also observed thinner CWTs and higher success rates than previous imaging-based studies. A BMI of 23 kg/m(2) or less and weight of 72 kg or less seem to accurately rule-out NT failure in cadavers, and they seem to be better predictors at the bedside. (C) 2016 Elsevier Inc. All rights reserved.
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    Determination of the appropriate catheter length and place for needle thoracostomy by using computed tomography scans of pneumothorax patients
    (ELSEVIER SCI LTD, 2013) DENİZBAŞI ALTINOK, ARZU; Akoglu, Haldun; Akoglu, Ebru Unal; Evman, Serdar; Akoglu, Tayfun; Denizbasi Altinok, Arzu; Guneysel, Ozlem; Onur, Ozge Ecmel; Eroglu, Serkan Emre
    Introduction: The primary goal of this study was to compare the chest wall thicknesses (CWT) at the 2nd intercostal space (ICS) at the mid-clavicular line (MCL) and 5th ICS at the mid-axillary line (MAL) in a population of patients with a CT confirmed pneumothorax (PTX). This result will help physicians to determine the optimum needle thoracostomy (NT) puncture site in patients with a PTX. Materials and methods: All trauma patients who presented consecutively to A&E over a 12-month period were included. Among all the trauma patients with a chest CT (4204 patients), 160 were included in the final analysis. CWTs were measured at both sides and were compared in all subgroup of patients. Results: The average CWT for men on the 2nd ICS-MCL was 38 mm and for women was 52 mm; on the other hand, on the 5th ICS-MAL was 33 mm for men and 38 mm for women. On the 2nd ICS-MCL 17% of men and 48% of women; on the 5th ICS-MAL 13% of men and 33% of women would be inaccessible with a routine 5-cm catheter. Patients with trauma, subcutaneous emphysema and multiple rib fractures would have thicker CWT on the 2nd ICS-MCL. Patients with trauma, lung contusion, sternum fracture, subcutaneous emphysema and multiple rib fractures would have thicker CWT on the 5th ICS-MAL. Conclusions: This study confirms that a 5.0-cm catheter would be unlikely to access the pleural space in at least 1/3 of female and 1/10 of male Turkish trauma patients, regardless of the puncture site. If NT is needed, the 5th ICS-MAL is a better option for a puncture site with thinner CWT. (C) 2012 Elsevier Ltd. All rights reserved.