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Original Research |

Tension Pneumothorax Decompression with Needle Thoracostomy Colorimetric Capnography

Nimesh D. Naik, MD; Matthew C. Hernandez, MD; Jeff R. Anderson, Ph.D; Erika K. Ross, Ph.D; Martin D. Zielinski, MD; Johnathon M. Aho, MD
Author and Funding Information

Conflicts of Interest and Source ofFunding: Mayo Foundation has a financial interest in technologies developed by some authors. Dr. Aho reports patent disclosures for multiple technologies which he does not receive royalty.

National Heart, Lung, and Blood Institute T32 HL105355 (Aho).

Mayo Clinic - Department of Surgery Innovation Accelerator

Mayo Clinic – Office of Translation to Practice

This work has not previously or concurrently been submitted for publication.

1Department of Surgery, Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN

2Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN

3Office of Translation to Practice, Mayo Clinic, Rochester, MN

4Department of Surgery, Mayo Clinic, Rochester, MN

Corresponding Author: Johnathon M. Aho MD, Division of Trauma Critical Care and General Surgery, Department of Surgery, Physiology and Biomedical Engineering Mayo Clinic, 200 First Street SW, Rochester, MN 55905.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.04.179
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Abstract

Background  The success of needle decompression for tension pneumothorax is variable, and there are no objective measures assessing effective decompression. Colorimetric capnography, which detects carbon dioxide present within the pleural space, may serve as a simple test to assess effective needle decompression.

Methods  Three swine underwent traumatically induced tension pneumothorax, (n=15 standard of care, n=15 with needle capnography). Standard of care needle thoracostomy (n=15) using an 8 cm angiocatheter was performed. Similarly, decompression was performed with the addition of colorimetric capnography. Subjective operator assessment of decompression was recorded and compared to true decompression using thoracoscopic visualization for both techniques. Area under receiver operating curves was calculated and pairwise comparison was used to assess statistical significance (p<0.05).

Results  Needle colorimetric capnography’s detection of decompression was found to be 100% accurate (15/15 attempts), when compared to that of thoracoscopic assessment (true decompression). Furthermore, it accurately detected the lack of tension pneumothorax, no presence of pathologic/space occupying lesion, in 100% (10/10 attempts) of cases. Standard of care needle decompression was detected by operators 9/15 attempts (60%) and detected when tension pneumothorax not present 3/10 attempts (30%). True decompression occurred using colorimetry 15/15 (100%) times and using standard of care treatment 12/15 (80%) times. Area under receiver operating curves were 0.65 for standard of care and 1.0 for needle capnography (p=0.002)

Conclusion  Needle decompression with colorimetric capnography provides a rapid, effective, and highly accurate method for eliminating operator bias for tension pneumothorax decompression. This may have utility for treatment of this life threatening condition.


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