title: Anterior versus lateral needle decompression of tension pneumothorax: comparison by computed tomography chest wall measurement.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  A retrospective study was conducted of emergency department (ED) patients who underwent computed tomography (CT) of the chest as part of their evaluation for blunt trauma. A convenience sample of 159 patients was formed by reviewing consecutive scans of eligible patients. Six measurements from the skin surface to the pleural surface were made for each patient: anterior second intercostal space, lateral fourth intercostal space, and lateral fifth intercostal space on the left and right sides.
  
  
  RESULTS
  The distance from skin to pleura at the anterior second intercostal space averaged 46.3 mm on the right and 45.2 mm on the left. The distance at the midaxillary line in the fourth intercostal space was 63.7 mm on the right and 62.1 mm on the left. In the fifth intercostal space the distance was 53.8 mm on the right and 52.9 mm on the left. The distance of the anterior approach was statistically less when compared to both intercostal spaces (p < 0.01).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. lsanche1@bidmc.harvard.edu
authors.forename: Leon D
authors.initials: LD
authors.lastname: Sanchez
authors.forename: Shannon
authors.initials: S
authors.lastname: Straszewski
authors.forename: Amina
authors.initials: A
authors.lastname: Saghir
authors.forename: Atif
authors.initials: A
authors.lastname: Khan
authors.forename: Erin
authors.initials: E
authors.lastname: Horn
authors.forename: Christopher
authors.initials: C
authors.lastname: Fischer
authors.forename: Faisal
authors.initials: F
authors.lastname: Khosa
authors.forename: Marc A
authors.initials: MA
authors.lastname: Camacho
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000295:instrumentation*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000601:surgery*; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000000981:diagnostic imaging* / Q000601:surgery*; D035441:Thoracic Wall / Q000000981:diagnostic imaging* / Q000601:surgery*; D013907:Thoracostomy / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery*