Articles: thoracostomy-instrumentation.
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Scand J Trauma Resus · Jan 2012
Randomized Controlled Trial Comparative StudyEvaluation of performance of two different chest tubes with either a sharp or a blunt tip for thoracostomy in 100 human cadavers.
Emergent placement of a chest tube is a potentially life-saving procedure, but rate of misplacement and organ injury is up to 30%. In principle, chest tube insertion can be performed by using Trocar or Non-trocar techniques. If using trocar technique, two different chest tubes (equipped with sharp or blunt tip) are currently commercially available. This study was performed to detect any difference with respect to time until tube insertion, to success and to misplacement rate. ⋯ Data suggest that chest drain insertion with trocars is associated with a 6-14% operator-related complication rate. No difference in average time could be found. However, misplacements and organ injuries occurred more frequently using sharp tips. Consequently, if using a trocar technique, the use of blunt tipped kits is recommended.
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Comparative Study Clinical Trial
Needle decompression for tension pneumothorax in Tactical Combat Casualty Care: do catheters placed in the midaxillary line kink more often than those in the midclavicular line?
Tactical Combat Casualty Care (TCCC) is a system of prehospital trauma care designed for the combat environment. Needle decompression (ND) is a critical TCCC intervention, because previous data suggest that up to 33% of all preventable deaths on the battlefield result from tension pneumothoraces. There has recently been increased interest in performing ND at the fifth intercostal space in the midaxillary line to prevent complications associated with landmarking second intercostal space in the midclavicular line site. We developed a model to assess whether catheters placed in the midaxillary line for decompressing tension pneumothoraces are more prone to kinking than those placed in the midclavicular line because of adducted arms during military transport. ⋯ This study suggests that the 14-gauge, 1.5-inch angiocatheter used for ND in the midaxillary line may partially and temporarily occlude in patients who will be transported on military stretchers. The pressure of 12.8 mm Hg has been documented in animal models as the pressure at which hemodynamic instability develops. This may contribute to the reaccumulation of tension pneumothoraces and ultimate patient deterioration in military transport.
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Needle thoracostomy is an emergent procedure designed to relieve tension pneumothorax. High failure rates because of the needle not penetrating into the thoracic cavity have been reported. Advanced Trauma Life Support guidelines recommend placement in the second intercostal space, midclavicular line using a 5-cm needle. The purpose of this study was to evaluate placement in the fifth intercostal space, midaxillary line, where tube thoracostomy is routinely performed. We hypothesized that this would result in a higher successful placement rate. ⋯ In a cadaveric model, needle thoracostomy was successfully placed in 100% of attempts at the fifth intercostal space but in only 58% at the traditional second intercostal position. On average, the chest wall was 1 cm thinner at this position and may improve successful needle placement. Live patient validation of these results is warranted.
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Comparative Study
Anterior versus lateral needle decompression of tension pneumothorax: comparison by computed tomography chest wall measurement.
Recent research describes failed needle decompression in the anterior position. It has been hypothesized that a lateral approach may be more successful. The aim of this study was to identify the optimal site for needle decompression. ⋯ With commonly available angiocatheters, the lateral approach is less likely to be successful than the anterior approach. The anterior approach may fail in many patients as well. Longer angiocatheters may increase the chances of decompression, but would also carry a higher risk of damage to surrounding vital structures.
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Early-onset scoliosis with co-existing thoracic deformity is particularly difficult to treat, with early surgery usually being the only rational solution. Operative correction of the deformed spine and rib cage employs techniques enabling further growth of the structures, an example of which is the Vertical Expandable Prosthetic Titanium Rib (VEPTR), designed to provide dynamic stabilization of the spinal column and the thoracic cage. Our study aimed to present difficulties and complications related to VEPTR-based operative reduction of the spinal and thoracic deformities in the youngest child. ⋯ The specific character of the method makes it liable to a variety of difficulties and complications that may sometimes affect the outcome. Both the authors' experience and published data prove the clinical effectiveness of VEPTR. Nevertheless, it is only a temporary means that cannot disturb the strategic anatomical elements of the spine which are to be involved in subsequent conventional operative procedures. An awareness of the limitations and possible difficulties connected with VEPTR allows for some modifications with which the technique continues to be the most effective sequential treatment of thoracic and spinal deformities in the youngest child.