The following is a summary of “Using Ultrasound to Determine Optimal Location for Needle Decompression of Tension Pneumothorax: A Pilot Study” published in the October 2022 issue of Emergency Medicine by Nelson et al.

Life-threatening sequelae from chest injuries include tension pneumothorax, which rapidly deteriorates without decompression. Decompression is typically taught to occur at the second intercostal space (ICS) in the midclavicular line. However, high treatment failure rates have cast doubt on this. Recent research suggests that the skin-to-pleura distance is shortest at the mid-axillary line (MAL) 5th ICS. Researchers wanted to see how the thickness of the chest wall varied across the 2 facilities, so they used point-of-care ultrasound (POCUS). The primary goal was to measure the distance from the skin surface to the pleural lining at the 2nd intercostal space (ICS) along the MAL and the 5th ICS along the MCL. 

Investigators also wanted to see how well the 2 tests agreed with one another, or how reliable the raters were. This preliminary investigation involved only 1 location. A linear transducer was used to carry out the POCUS procedure. The distance from the skin to the pleural line was measured at the right 2nd and 5th intercostal spaces (ICS). A 2nd ultrasonographer, this one without the patient’s knowledge, then repeated the measurements. To evaluate the consistency between observers, intraclass correlation coefficients (ICCs) were computed. By the 5th ICS-MAL, 93% of participants had reduced chest wall distance. 

The median distance at the 2nd and 6th ICS was 2.28 cm and 1.80 cm. Very strong reliability was seen between the 2nd and 5th ICS, with an ICC of 0.90 (95% CI 0.81-0.95) and 0.75 (95% CI 0.54-0.87), respectively. In contrast, the findings show that by the 5th ICS, the gap between the chest walls has decreased for these individuals. Study group agree that the 5th ICS is the best place to execute needle decompression and that POCUS can help pinpoint the precise spot where it’s needed.