title: Measure of chest wall thickness in French soldiers: which technique to use for needle decompression of tension pneumothorax at the front?
abstract: OBJECTIVE
  Needle decompression of tension pneumothorax in soldiers of the French infantry has a risk for failure when the standard procedure that involves the insertion of a 14-gauge, 5-cm catheter into the 2nd intercostal space (ICS) is used. This study measured the chest wall thickness (CWT) to assess whether this approach is appropriate.
  
  
  METHODS
  CWT was measured by ultrasound in 122 French soldiers at the 2nd and 4th ICSs on both the right and left sides.
  
  
  RESULTS
  CWT was measured at 4.19 cm (± 0.96 cm) at the 2nd ICS and 3.00 cm (± 0.91 cm) at the 4th ICS (p < 0.001). CWT was greater than 5 cm in 24.2% of cases at the 2nd ICS and 4.9% of cases at the 4th ICS (p < 0.001).
  
  
  CONCLUSIONS
  This study suggests a high risk of failure when using the technique currently taught in the French army. A lateral approach into the 4th ICS could decrease this risk. The results of this study must be validated in patients presenting tension pneumothorax.
authors.affiliation: Département d'anesthésie-réanimation-urgences, Hôpital d'Instruction des Armées Desgenettes, 108 Boulevard Pinel, 69003 Lyon, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Lamblin
authors.affiliation: Département d'anesthésie-réanimation-urgences, Hôpital d'Instruction des Armées Desgenettes, 108 Boulevard Pinel, 69003 Lyon, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Turc
authors.affiliation: Service de Pneumologie, Hôpital d'Instruction des Armées Desgenettes, 108 Boulevard Pinel, 69003 Lyon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Bylicki
authors.affiliation: Département d'anesthésie-réanimation-urgences, Hôpital d'Instruction des Armées Desgenettes, 108 Boulevard Pinel, 69003 Lyon, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Lohéas
authors.affiliation: Département d'anesthésie-réanimation-urgences, Hôpital d'Instruction des Armées Desgenettes, 108 Boulevard Pinel, 69003 Lyon, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Martinez
authors.affiliation: Département d'anesthésie-réanimation-urgences, Hôpital d'Instruction des Armées Desgenettes, 108 Boulevard Pinel, 69003 Lyon, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Derkenne
authors.affiliation: Département d'anesthésie-réanimation-urgences, Hôpital d'Instruction des Armées Desgenettes, 108 Boulevard Pinel, 69003 Lyon, France.
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Wey
authors.affiliation: Département d'anesthésie-réanimation-urgences, Hôpital d'Instruction des Armées Desgenettes, 108 Boulevard Pinel, 69003 Lyon, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Précloux
mesh_terms: D000328:Adult; D015992:Body Mass Index; D019299:Decompression, Surgical / Q000295:instrumentation*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008889:Military Personnel; D009339:Needles; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D035441:Thoracic Wall / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography