흉부 외상 환자에서 늑막 천자를 위해 바늘 도관의 길이에 대한 연구

Study of the Length of Needle Thoracostomy Catheter Needed for Patients with Chest Trauma

  • 강성원 (경북대학교 의과대학 응급의학교실) ;
  • 류현욱 (경북대학교 의과대학 응급의학교실) ;
  • 박정배 (경북대학교 의과대학 응급의학교실) ;
  • 서강석 (경북대학교 의과대학 응급의학교실) ;
  • 정제명 (경북대학교 의과대학 응급의학교실)
  • Kang, Sung Won (Department of Emergency Medicine, College of Medicine, Kyungpook National University) ;
  • Ryoo, Hyun Wook (Department of Emergency Medicine, College of Medicine, Kyungpook National University) ;
  • Park, Jung Bae (Department of Emergency Medicine, College of Medicine, Kyungpook National University) ;
  • Seo, Kang Suk (Department of Emergency Medicine, College of Medicine, Kyungpook National University) ;
  • Chung, Jae Myung (Department of Emergency Medicine, College of Medicine, Kyungpook National University)
  • 투고 : 2008.11.19
  • 심사 : 2009.06.07
  • 발행 : 2009.06.30

초록

Purpose: This study was conducted to evaluate the length of the catheter used in a needle thoracostomy for emergency decompression of a tension pneumothorax by measuring the chest wall thickness (CWT) in patients with chest trauma Methods: A retrospective review of 201 patients with chest trauma who had been transported the emergency department in a tertiary university hospital in a metropolitan area between 1 January and 31 February 2007 was performed. The average CWT at the second intercostal space (ICS) in the midclavicular line (MCL) was measured by using a chest computed tomography scan. Results: As the left and the right mean CWTs were $3.4{\pm}1.0cm$ and $3.4{\pm}1.0cm$, respectively, there was no significant statistical difference between them. The mean CWT of female patients was significantly higher than that of male patients (p=0.001). The mean CWT of patients under the age of 65 years was significantly thicker than that of the patients over the age of 65 years (p<0.001). Of the studied patients, 12 (6.0%) a CWT > 5 cm. Conclusion: A 5 cm-length catheter in a needle thoracostomy may be insufficient for emergency decompression of a tension pneumothorax, so a catheter longer than 5 cm in length is needed.

키워드

참고문헌

  1. Cullinane DC, Morris JA, Bass JG, Rutherford EJ. Needle thoracostomy may not be indicated in the trauma patient. Injury 2001;32:749-52 https://doi.org/10.1016/S0020-1383(01)00082-1
  2. Britten S, Palmer SH. Chest wall thickness may limit adequate drainage of tension pneumothorax by needle thoracocentesis. J Accid Emerg Med 1996;13:426-7 https://doi.org/10.1136/emj.13.6.426
  3. Jones R, Hollingsworth J. Tension pneumothoraces not responding to needle thoracocentesis. Emerg Med J 2002;19:176-7 https://doi.org/10.1136/emj.19.2.176
  4. Roberts JR, Hedges J. Clinical procedures in emergency medicine, 3rd ed. philadelphia, PA: W.B.Sanders Co;1998. p132-6
  5. Cummins RO. Advanced cardiac life support. Dallas, TX: American Heart Association; 1997. 14-4-14-6
  6. Sanders MJ. thoracic trauma in paramedic text book, 2nd ed. St. Louis, MO: Mosby, Inc; 2001. p692-5
  7. American college of surgeons. Advanced trauma life support program for doctors, 7th ed. Chicago, IL: American college of surgeons; p127
  8. Givens ML, Ayotte K, Manifold C. Needle thoracostomy: implications of computed tomography chest wall thickness. Acad Emerg Med 2004;11:211-3
  9. Britten S, Palmer SH, Snow TM. Needle thoracocentesis in tension pneumothorax: insufficient cannula length and potential failure. Injury 1996;27:321-2 https://doi.org/10.1016/0020-1383(96)00007-1
  10. Harcke HT, Pearse LA, Levy AD, Getz JM, Robinson SR. Chest wall thickness in military personnel : implications for needle thoracentesis in tension pneumothorax. Mil Med 2007;172:1260-3
  11. Leigh-smith S, Harris T. Tension pneumothorax-time for a re-think? Emerg Med J 2005;22:8-16 https://doi.org/10.1136/emj.2003.010421
  12. Fitzgerald M, Mackenzie C, Marasco S, Hoyle R, Kossmann T. Pleural decompression and drainage during trauma reception and resuscitation. Injury 2008:39;9-20 https://doi.org/10.1016/j.injury.2007.07.021
  13. Marinaro JL, Kenny CV, Smith SR, Valdez SD, Crandall CS, Schermer CR. Needle thoracostomy in trauma patients: what catheter length is adequate? Acad Emerg Med 2003:10;495 https://doi.org/10.1197/aemj.10.5.495