The Relationship Between the Distance Between the Skin and the Pleura at the Level of the Second Intercostal Space and Age, Sex, and Body Mass Index
DOI:
https://doi.org/10.66288/actamedi.2026.75Keywords:
Tension pneumothorax, needle decompression, distance between the skin and the pleura, computed tomography, ultrasonographyAbstract
Objective: The efficacy of standard cannula lengths (50 mm) in the management of tension pneumothorax (TP) remains a subject of debate. The objective of this study is to ascertain the skin-pleural distance (SPD) at the level of the midclavicular line in the second intercostal space (ICS) and to determine the relationship between this distance and age, gender, and Body Mass Index (BMI).
Materials and MethodsThis retrospective observational study encompassed 150 patients who underwent chest computed tomography (CT) scans. Consequently, CPM measurements were performed using both CT and ultrasound (USG) in two distinct arm positions (arms at the sides and above the head). The data were then subjected to a series of analyses that included categorizations based on age (i.e., young and old), gender, and VKE categories.
Findings: The sample included 58% male and 42% female participants, with an average age of 56.23 years. According to CT measurements, CPM was found to be significantly higher in women than in men (p0.001). While the CPM exceeded 50 mm in approximately 32–33% of female patients, this rate was only 2.3% in male patients. It was observed that the risk of procedural failure (CPM > 50 mm) increased as VKE increased. All ultrasound measurement methods demonstrated a positive and significant correlation with CT measurements. While a propensity for higher CPM was evident among the younger age group, no statistically significant disparities were observed between age demographics.
Conclusion: The utilization of standard-length cannulas is associated with an elevated risk of unsuccessful needle decompression, a phenomenon that is particularly salient in women, young patients, and individuals with high VKE. In women, the presence of breast tissue, which increases the distance, is a critical factor. In the domain of emergency medicine, the selection of material tailored to the specific needs of each patient is of paramount importance during TP interventions.
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