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Devices Used in the Treatment of Tension Pneumothorax

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Abstract

Purpose of Review

This review will describe pathophysiology, current emergency department (ED) treatment strategies, and novel devices used in the management of acute tension pneumothorax.

Recent Findings

Traditional decompression success rates for the treatment of acute tension pneumothorax utilizing a standard 5-cm angiocatheter are inadequate in many cases. Novel devices and anatomical approaches have recently been developed to improve upon the rate of successful decompression and treatment.

Summary

Recent studies have shown greater success in emergent decompression of acute tension pneumothorax at the 4th or 5th intercostal space along the anterior axillary line, when compared to the traditional decompression site at the 2nd or 3rd intercostal space at the mid clavicular line. The standard 5-cm catheter used for decompression may not be long enough in many patients to reach the intrapleural space at the 2nd intercostal space along the mid clavicular line. The use of an 8-cm angiocatheter may be required at the 4th or 5th intercostal insertion site at the anterior axillary line. Novel decompression devices have been studied in animal models with improved success rates and quicker time to restoration of normal physiology. Devices described in this review include the modified Veress needle and the Reactor™ device. Human clinical trials are needed to confirm the safety and efficacy of these devices for clinical use.

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References

Papers of particular interest, recently published, have been highlighted as: • Of importance •• Of major importance

  1. Le T, Bhushan V, Sochat M, et al. First aid for the USMLE step 1 2021: a student to student guide. McGraw Hill Education, New York, NY. 2021.

  2. Walker SP, Bibby AC, Halford P, et al. Recurrence rates in primary spontaneous pneumothorax: a systematic review and meta-analysis. Eur Respir J. 2018;52(3):1800864. https://doi.org/10.1183/13993003.00864-2018. (PMID: 30002105).

    Article  PubMed  Google Scholar 

  3. Bense L, Eklund G, Wiman LG. Smoking and the increased risk of contracting spontaneous pneumothorax. Chest. 1987;92(6):1009–12. https://doi.org/10.1378/chest.92.6.1009. (PMID: 3677805).

    Article  CAS  PubMed  Google Scholar 

  4. Melton LJ 3rd, Hepper NG, Offord KP. Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974. Am Rev Resp Dis. 1979;120(6):1379–82. https://doi.org/10.1164/arrd.1979.120.6.1379.

    Article  PubMed  Google Scholar 

  5. Baumann MH, Strange C, Heffner JE, et al. Management of spontaneous pneumothorax. Chest. 2001;119:590–602.

    Article  CAS  PubMed  Google Scholar 

  6. Noppen M, De Keukeleire T. Pneumothorax Respiration. 2008;76:121–7.

    Article  PubMed  Google Scholar 

  7. Hoechter DJ, Speck E, Siegl D, et al. Tension pneumothorax during one-lung ventilation - an underestimated complication? J Cardiothorac Vasc Anesth. 2018;32(3):1398–402. https://doi.org/10.1053/j.jvca.2017.07.022. (Epub 2017 Jul 21 PMID: 29361455).

    Article  PubMed  Google Scholar 

  8. • Laan DV, Vu TD, Thiels CA, et al. Chest wall thickness and decompression failure: a systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. Injury. 2016;47:797–804. This review presents strong evidence for altering needle decompression position from the 2nd/3rd MCL to the 4th/5th AAL.

  9. Kaserer A, Stein P, Simmen H-P, et al. Failure rate of prehospital chest decompression after severe thoracic trauma. Am J Emerg Med. 2017;35:469–74.

    Article  PubMed  Google Scholar 

  10. Baumann MH, Noppen M. Pneumothorax. Respirology. 204;9:157–164.

  11. Roberts DJ, Leigh-Smith S, Faris PD, et al. Clinical manifestations of tension pneumothorax: protocol for a systematic review and meta-analysis. Syst Rev. 2014;4(3):3. https://doi.org/10.1186/2046-4053-3-3. (PMID:24387082), (PMCID:PMC3880980).

    Article  Google Scholar 

  12. Ghisalberti M, Guerrera F, De Vico A, et al. Age and clinical presentation for primary spontaneous pneumothorax. Heart Lung Circ. 2020;29:1648–55.

    Article  PubMed  Google Scholar 

  13. Sadikot RT, Greene T, Meadows K, Arnold AG. Recurrence of primary spontaneous pneumothorax. Thorax. 199;52:805–809.

  14. Mendogni P, Vannucci J, Ghisalberti M, Anile M, Aramini B, Congedo MT, Nosotti M, Bertolaccini L. Collaborators of the Pneumothorax Working Group, on behalf of the Italian Society for Thoracic Surgery (endorsed by the Italian Ministry of Health) Collaborators of the Pneumothorax Working Group; D'Ambrosio AE, De Vico A, Guerrera F, Imbriglio G, Pardolesi A, Schiavon M, Russo E. Epidemiology and management of primary spontaneous pneumothorax: a systematic review. Interact Cardiovasc Thorac Surg. 2020;30(3):337–345. https://doi.org/10.1093/icvts/ivz290. (PMID: 31858124).

  15. Tran J, Haussner W, Shah K. Traumatic pneumothorax: a review of current diagnostic practices and evolving management. J Emerg Med. 2021;61:517–28.

    Article  PubMed  Google Scholar 

  16. Liman ST, Kuzucu A, Tastepe AI, Ulasan GN, Topcu S. Chest injury due to blunt trauma. Europ J Cardiothor Surg. 2003;23:374–8.

    Article  Google Scholar 

  17. Imran JB, Eastman AL. Pneumothorax JAMA. 2017;318(10):974. https://doi.org/10.1001/jama.2017.10476. (PMID: 28898380).

    Article  PubMed  Google Scholar 

  18. Roberts DJ, Leigh-Smith S, Faris PD, et al. Clinical presentation of patients with tension pneumothorax: a systematic review. Ann Surg. 2015;261(6):1068–78. https://doi.org/10.1097/SLA.0000000000001073. (PMID: 25563887).

    Article  PubMed  Google Scholar 

  19. The ATLS Subcommittee. American College of Surgeons’ Committee on Trauma, and the International ATLS working group. Advanced trauma life support (ATLS®): The ninth edition. J Trauma Acute Care Surg. 2013;74(5):1363–1366.

  20. O’Connor AR, Morgan WE. Radiological review of pneumothorax. Br Med J. 2015;330:1493–7.

    Article  Google Scholar 

  21. Collins J, Stern EJ. Chest radiology: the essentials, 2nd ed. Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia, PA. 2008.

  22. Kirkpatrick AW, Sirois M, Laupland KB, et al. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the extended focused assessment with sonography for trauma (EFAST). J Trauma. 2004;57:288–95.

    Article  CAS  PubMed  Google Scholar 

  23. Husain LF, Hagopian L, Wayman D, Baker WE, Carmody KA. Sonographic diagnosis of pneumothorax. J Emerg Trauma Shock. 2012;5(1):76–81. https://doi.org/10.4103/0974-2700.93116.PMID:22416161;PMCID:PMC3299161.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ball CG, Ranson K, Dente CJ, et al. Clinical predictors of occult pneumothoraces in severely injured blunt polytrauma patients: a prospective observational study. Injury. 2009;40(1):44–7. https://doi.org/10.1016/j.injury.2008.07.015. (Epub 2009 Jan 8 PMID: 19131061).

    Article  PubMed  Google Scholar 

  25. Wernecke K, Galanski M, Peters PE, Hansen J. Pneumothorax: evaluation by ultrasound–preliminary results. J Thorac Imaging. 1987;2(2):76–8 (PMID: 3298684).

    Article  CAS  PubMed  Google Scholar 

  26. • Dahmarde H, Parooie F, Salarzaei M. Accuracy of ultrasound in diagnosis of pneumothorax: a comparison between neonates and adults: a systematic review and meta-analysis. Can Respir J. 2019;2019:5271982. doi: https://doi.org/10.1155/2019/5271982. (PMID: 31933707), (PMCID: PMC6942780). Discusses the elevated sensitivity of ultrasound in the diagnosis of pneumothorax over chest x-ray.

  27. • Chan KK, Joo DA, McRae AD, et al. Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department. Cochrane Database Syst Rev. 2020;7(7):CD013031. https://doi.org/10.1002/14651858.CD013031.pub2. (PMID:32702777), (PMCID: PMC7390330). Observes greater sensitivity of pneumothorax in traumatic etiology with ultrasound over chest x-ray.

  28. Trupka A, Waydhas C, Hallfeldt KK, et al. Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study. J Trauma. 1997;43(3):405–11; discussion 411–2. https://doi.org/10.1097/00005373-199709000-00003. (PMID: 9314300).

  29. Omert L, Yeaney WW, Protetch J. Efficacy of thoracic computerized tomography in blunt chest trauma. Amer Surg. 2001;7:660–4.

    Article  Google Scholar 

  30. Cai W, Tabbara M, Takata N, et al. MDCT for automated detection and measurement of pneumothoraces in trauma patients. AJR Am J Roentgenol. 2009;192(3):830–6. https://doi.org/10.2214/AJR.08.1339. (PMID: 19234283).

    Article  PubMed  Google Scholar 

  31. Li X, Thrall JH, Digumarthy SR, et al. Deep learning-enabled system for rapid pneumothorax screening on chest CT. Eur J Radiol. 2019;120:108692. https://doi.org/10.1016/j.ejrad.2019.108692. Epub 2019 Sep 26. (PMID: 31585302).

  32. Wayne MA, McSwain NE Jr. Clinical evaluation of a new device for the treatment of tension pneumothorax. Ann Surg. 1980 Jun;191(6):760–2. PMID: 7387238; PMCID: PMC1344792.

  33. Chang SJ, Ross SW, Kiefer DJ, et al. Evaluation of 8.0-cm needle at the fourth anterior axillary line for needle chest decompression of tension pneumothorax. J Trauma Acute Care Surg. 2014;76(4):1029–34. https://doi.org/10.1097/TA.0000000000000158. (PMID: 24662868).

  34. Inaba K, Ives C, McClure K, et al. Radiologic evaluation of alternative sites for needle decompression of tension pneumothorax. Arch Surg. 2012;147(9):813–8. https://doi.org/10.1001/archsurg.2012.751. (PMID: 22987168).

    Article  PubMed  Google Scholar 

  35. Kulvatunyou N, Erickson L, Vijayasekaran A, et al. Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax. Br J Surg. 2014;101(2):17–22. https://doi.org/10.1002/bjs.9377. (PMID: 24375295).

    Article  CAS  PubMed  Google Scholar 

  36. Terada T, Nishimura T, Uchida K, et al. How emergency physicians choose chest tube size for traumatic pneumothorax or hemothorax: a comparison between 28Fr and smaller tube. Nagoya J Med Sci. 2020;82(1):59–68. https://doi.org/10.18999/nagjms.82.1.59.PMID:32273633;PMCID:PMC7103871.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Chang SH, Kang YN, Chiu HY, Chiu YH. A systematic review and meta-analysis comparing pigtail catheter and chest tube as the initial treatment for pneumothorax. Chest. 2018;153(5):1201–12. https://doi.org/10.1016/j.chest.2018.01.048. (Epub 2018 Feb 13 PMID: 29452099).

    Article  PubMed  Google Scholar 

  38. • Bauman ZM, Kulvatunyou N, Joseph B, et al. Randomized clinical trial of 14-French (14F) pigtail catheters versus 28–32F chest tubes in the management of patients with traumatic hemothorax and hemopneumothorax. World J Surg. 2021;45(3):880–886. https://doi.org/10.1007/s00268-020-05852-0. Epub 2021 Jan 7. (PMID: 33415448), (PMCID:PMC7790482). This randomized clinical trial found that failure rates and tube duration between smaller pigtail and larger chest tubes were similar, but that patients reported significantly less pain with the use of the pigtail catheter.

  39. •• Lubin D, Tang AL, Friese RS, et al. Modified Veress needle decompression of tension pneumothorax: a randomized crossover animal study. J Trauma Acute Care Surg. 2013;75(6):1071–5. https://doi.org/10.1097/TA.0b013e318299563d. (PMID: 24256683). This novel device showed greater success and quicker return to non-tension physiology in swine models over large bore IV angiocatheter

  40. •• Sheldon RR, Do WS, Forte DM, et al. An evaluation of a novel medical device versus standard interventions in the treatment of tension pneumothorax in a swine model (sus scrofa). Mil Med. 2019;185:125–130. Physiological decompression and return to normal physiology with the Reactor™ device in swine models with induced tension pneumothorax was significantly more successful compared to needle decompression

  41. •• Kuckelman J, Derickson M, Phillips C, et al. Evaluation of a novel thoracic entry device versus needle decompression in a tension pneumothorax swine model. Am J Surg. 2018;215(5):832–835. https://doi.org/10.1016/j.amjsurg.2017.12.014. Epub 2018. (PMID:29317045). Novel use of the blunt tipped bladed trocar showed greater tension pneumothorax treatment than traditional use of needle decompression

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  1. Wayne State University School of Medicine, Detroit, MI, USA

    Andrew J. Kirmse

  2. Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA

    James H. Paxton

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Kirmse, A., Paxton, J.H. Devices Used in the Treatment of Tension Pneumothorax. Curr Emerg Hosp Med Rep 11, 151–157 (2023). https://doi.org/10.1007/s40138-023-00272-5

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