Measure of Chest Wall Thickness in French Soldiers: Which Technique to Use for Needle Decompression of Tension Pneumothorax at the Front?

ABSTRACT Objectives: 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.