Phonomyography as a non-invasive continuous monitoring technique for muscle ischemia in an experimental model of acute compartment syndrome

Diagnosis of acute compartment syndrome (ACS) of the extremities is based on clinical signs with or without complementary measurement of muscle compartmental pressure. However, in cases of imminent compartment syndrome, unconscious patients or children the appropriate diagnose remains challenging. Despite all efforts to improve technical devices to objectify the signs by measurements of numerous parameters, needle compartment pressure measurement is to date accepted as the gold standard to facilitate decision making. But its invasiveness, the controversy about pressure thresholds and its potentially limited validity due to a single measurement support the need for further developments to diagnose ACS. Numerous technical improvements have been published and revealed promising new applications for non-invasive diagnostics. Since the pathology of an ACS is well characterized two approaches of measurements are described: to detect either increasing compartmental pressure or decreasing perfusion pressure. In the following, currently known investigations are reviewed and related to their pathophysiological principals, modes of clinical application, value and reliability.

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Non-invasive measurement of muscle compartment elasticity in lower limbs to determine acute compartment syndrome: Clinical results with pressure related ultrasound

Injury ◽

10.1016/j.injury.2019.11.027 ◽

2020 ◽

Vol 51 (2) ◽

pp. 301-306

Author(s):

R.M. Sellei ◽

J. Wollnitz ◽

N. Reinhardt ◽

M. de la Fuente ◽

K. Radermacher ◽

...

Keyword(s):

Compartment Syndrome ◽

Clinical Results ◽

Acute Compartment Syndrome ◽

Lower Limbs ◽

Non Invasive ◽

Muscle Compartment ◽

Invasive Measurement

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Continual near-infrared spectroscopy monitoring in the injured lower limb and acute compartment syndrome

The Bone & Joint Journal ◽

10.1302/0301-620x.100b6.bjj-2017-0736.r3 ◽

2018 ◽

Vol 100-B (6) ◽

pp. 787-797 ◽

Cited By ~ 6

Author(s):

M. S. Shuler ◽

M. Roskosky ◽

T. Kinsey ◽

D. Glaser ◽

W. Reisman ◽

...

Keyword(s):

Infrared Spectroscopy ◽

Compartment Syndrome ◽

Near Infrared Spectroscopy ◽

Lower Limb ◽

Near Infrared ◽

Multilevel Modelling ◽

Acute Compartment Syndrome ◽

Graphical Methods ◽

Non Invasive ◽

Control Compartment

Aims The aim of this study was to evaluate near-infrared spectroscopy (NIRS) as a continuous, non-invasive monitor for acute compartment syndrome (ACS). Patients and Methods NIRS sensors were placed on 86 patients with, and 23 without (controls), severe leg injury. NIRS values were recorded for up to 48 hours. Longitudinal data were analyzed using summary and graphical methods, bivariate comparisons, and multivariable multilevel modelling. Results Mean NIRS values in the anterior, lateral, superficial posterior, and deep posterior compartments were between 72% and 78% in injured legs, between 69% and 72% in uninjured legs, and between 71% and 73% in bilaterally uninjured legs. In patients without ACS, the values were typically > 3% higher in injured compartments. All seven limbs with ACS had at least one compartment where NIRS values were 3% or more below a reference uninjured control compartment. Missing data were encountered in many instances. Conclusion NIRS oximetry might be used to aid the assessment and management of patients with ACS. Sustained hyperaemia is consistent with the absence of ACS in injured legs. Loss of the hyperaemic differential warrants heightened surveillance. NIRS values in at least one injured compartment(s) were > 3% below the uninjured contralateral compartment(s) in all seven patients with ACS. Additional interventional studies are required to validate the use of NIRS for ACS monitoring. Cite this article: Bone Joint J 2018;100-B:787–97.

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Acute Compartment Syndrome of the Thigh in Combat Casualties

Journal of Surgical Orthopaedic Advances ◽

10.3113/jsoa.2013.0042 ◽

2013 ◽

Vol 22 (01) ◽

pp. 42-49 ◽

Cited By ~ 10

Author(s):

Brendan D. Masini ◽

Adam W. Racusin ◽

Joseph C. Wenke ◽

Tad L. Gerlinger ◽

Joseph R. Hsu

Keyword(s):

Compartment Syndrome ◽

Acute Compartment Syndrome ◽

Combat Casualties

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Faculty Opinions recommendation of The estimated sensitivity and specificity of compartment pressure monitoring for acute compartment syndrome.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718001450.793475575 ◽

2013 ◽

Author(s):

Edilson Forlin

Keyword(s):

Compartment Syndrome ◽

Sensitivity And Specificity ◽

Acute Compartment Syndrome ◽

Compartment Pressure ◽

Pressure Monitoring

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Does the shoe-lace technique aid direct closure of fasciotomy wounds after acute compartment syndrome of the lower leg? a retrospective case-control study

Scandinavian Journal of Surgery ◽

10.1177/14574969211019639 ◽

2021 ◽

pp. 145749692110196

Author(s):

P. Suomalainen ◽

T.-K. Pakarinen ◽

I. Pajamäki ◽

M. K. Laitinen ◽

H.-J. Laine ◽

...

Keyword(s):

Compartment Syndrome ◽

Outcome Measurement ◽

Controlled Trial ◽

Lower Leg ◽

Conventional Technique ◽

Tibia Fracture ◽

Acute Compartment Syndrome ◽

Retrospective Case ◽

Direct Closure ◽

Patient Database

Background & aim: Tibia fractures are relatively common injuries that are accompanied with acute compartment syndrome in approximately 2% to 20% of cases. Although the shoe-lace technique, where vessel loops are threaded in a crisscross fashion and tightened daily, has been widely used, no studies have compared the shoe-lace technique with the conventional one. The aim of this study was to compare the shoe-lace technique with the conventional technique. Materials and Methods: We identified 359 consecutive patients with intramedullary nailed tibia fracture and complete medical records including outpatient data between April 2007 and April 2015 from electronic patient database of our institute. The use of the shoe-lace technique was compared to conventional one (in which wounds were first left open with moist dressings). Main outcome measurement is direct closure of fasciotomy wounds. Results: From 359 consecutive patients with intramedullary nailed tibia fracture, fasciotomy was performed on 68 (19%) patients. Of these, the shoe-lace technique was used in 47 (69%) patients while in 21 (31%) patients, the shoe-lace technique was not applied. Side-to-side approximation was successful in 36 patients (77%) in the shoe-lace+ group and 7 patients (33%) in the shoe-lace– group (p = 0.002). Conclusion: The main finding of our comparative study was that the shoe-lace technique seems to ease direct closure of lower leg fasciotomy wounds, and thus reduces the frequency of free skin grafts. Our finding needs to be confirmed in a high-quality randomized controlled trial.

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Evaluating the Possibility of Translating Technological Advances in Non-Invasive Continuous Lactate Monitoring into Critical Care

Sensors ◽

10.3390/s21030879 ◽

2021 ◽

Vol 21 (3) ◽

pp. 879

Author(s):

Robert D. Crapnell ◽

Ascanio Tridente ◽

Craig E. Banks ◽

Nina C. Dempsey-Hibbert

Keyword(s):

Critical Care ◽

Continuous Monitoring ◽

Performance Monitoring ◽

Plasma Concentrations ◽

Lactate Production ◽

Anaerobic Exercise ◽

Response To Treatment ◽

Diverse Range ◽

Non Invasive ◽

Technological Advances

Lactate is widely measured in critically ill patients as a robust indicator of patient deterioration and response to treatment. Plasma concentrations represent a balance between lactate production and clearance. Analysis has typically been performed with the aim of detecting tissue hypoxia. However, there is a diverse range of processes unrelated to increased anaerobic metabolism that result in the accumulation of lactate, complicating clinical interpretation. Further, lactate levels can change rapidly over short spaces of time, and even subtle changes can reflect a profound change in the patient’s condition. Hence, there is a significant need for frequent lactate monitoring in critical care. Lactate monitoring is commonplace in sports performance monitoring, given the elevation of lactate during anaerobic exercise. The desire to continuously monitor lactate in athletes has led to the development of various technological approaches for non-invasive, continuous lactate measurements. This review aims firstly to reflect on the potential benefits of non-invasive continuous monitoring technology within the critical care setting. Secondly, we review the current devices used to measure lactate non-invasively outside of this setting and consider the challenges that must be overcome to allow for the translation of this technology into intensive care medicine. This review will be of interest to those developing continuous monitoring sensors, opening up a new field of research.

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