Assessment of elevated compartment pressures by pressure-related ultrasound: a cadaveric model

Sellei, Richard Martin; Hingmann, Simon; Weber, Christian David; Jeromin, Sabine; Zimmermann, Felix; Turner, James; Hildebrand, Frank; Pape, Hans-Christian

doi:10.1007/s00068-014-0449-9

Cited by 20 publications

(13 citation statements)

References 25 publications

(26 reference statements)

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“… Furthermore, 15 animal models and 2 cadaveric studies were included in this review (Table 2). This study includes 852 human participants and 319 animals, out of which there were 27 dogs (specifically beagles), 53 pigs, 118 rabbits, and 121 rats. Thirty articles included a control group or control contralateral extremity.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Modalities for Acute Compartment Syndrome of the Extremities

et al. 2019

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IMPORTANCE Acute compartment syndrome (ACS) can cause catastrophic tissue damage leading to permanent muscle and nerve loss. Acute compartment syndrome is a clinical diagnosis, with intracompartmental pressure (ICP) used in equivocal cases. There are no reliable diagnostic methods. The clinical evaluation is impossible to standardize, and the threshold for ICP has been known to be unreliable; thus, guidelines for diagnosis can result in overtreatment or delayed diagnosis.OBJECTIVE To present and review the advantages and disadvantages of each diagnostic modality and identify gaps that need to be addressed in the future and to review the most used and appropriate animal and human ACS models. EVIDENCE REVIEWWe included clinical studies and animal models investigating diagnostic modalities for ACS of the extremities. A MEDLINE and Web of Science search was performed. The protocol for the study was registered on PROSPERO (CRD42017079266). We assessed the quality of the clinical studies with Newcastle-Ottawa scale and reported level of evidence for each article.FINDINGS Fifty-one articles were included in this study, reporting on 38 noninvasive and 35 invasive modalities. Near-infrared spectroscopy and direct ICP measurement using a Stryker device were the most common, respectively. Cadaveric studies used saline infusions to create an ACS model. Most studies with human participants included injured patients with acquired ACS or at risk of developing ACS. In healthy human participants, tourniquets formed the most commonly used ACS model. Application of tourniquets and infusion of saline or albumin were the most used ACS models among animal studies. CONCLUSIONS AND RELEVANCEThis article reports on the most common as well as many new and modified diagnostic modalities, which can serve as inspiration for future investigations to develop more effective and efficient diagnostic techniques for ACS. Future studies on diagnostic modalities should include the development of tools for continuous assessment of ICP to better identify the earliest alterations suggestive of impending ACS. With the advent of such technologies, it may be possible to develop far less aggressive and more effective approaches for early detection of ACS.

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Section: Resultsmentioning

confidence: 99%

Diagnostic Modalities for Acute Compartment Syndrome of the Extremities

et al. 2019

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“…Compression sonography presents a novel non-invasive method for assessing compartment pressure. Whereas different studies could proof the feasibility of the method in models, human cadavers [12] or living animals [5] , very little data are available about standard values in healthy human subjects. To our knowledge, the presented study is the first to report these standard values in an adequate sample of healthy volunteers.…”

Section: Discussionmentioning

confidence: 99%

“…The applied pressure can be monitored using a pressure manometer mounted on the ultrasound head. Feasibility of this method has been shown in vitro models [13] , human cadavers [12] and living animals [5] . A correlation between rising intracompartmental pressure and decreasing compartment compressibility (defined as decreasing change of diameter due to application of a specified extrinsic pressure) has been shown [5] .…”

Section: Introductionmentioning

confidence: 99%

Tibial anterior compartment compressibility in healthy subject, measured using compression sonography

Anwander

Büchel

Krause

et al. 2022

Injury

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Introduction: Compression sonography has been introduced for non-invasive measurement of compartment compressibility and possible diagnostic tool for acute or chronic compartment syndrome in studies using human cadavers and animal models.To date, standard values in healthy subjects are not yet defined. The aim was to define standard compartment compressibility values in healthy human subjects and to assess the reliability of this measurement method. Methods: In 60 healthy volunteers, using ultrasound, the diameter of the tibial anterior compartment was measured while applying no pressure, 10mbar and 80mbar of external pressure. A pressure manometer on the ultrasound head was used to monitor the externally applied pressure. Compartment compressibility ratio (R 0-80 , respectively R 10-80 ) was calculated as following: The delta of the compartment diameter with high and low external pressure, divided through the diameter with low external pressure. In 10 volunteers, two examinators conducted each two measurements to assess the reliability. Results: Mean compartment compressibility ratio R 10-80 was 15.9% ±3.6 (range: 7.2 -22.2). Mean compartment compressibility ratio R 0-80 was 18.2% ±5.0 (3.0 -32.1). There was no significant correlation with lower leg circumference, height, weight, BMI, gender, hours of sport per week and type of sport (e.g. weightlifting/ cardio).For R 10-80 , intraobserver ICC 2.1 was 0.89 for an experienced observer and 0.79 for a non-experienced observer. Interobserver ICC 2.1 was 0.78. For R 0-80 , intraobserver ICC 2.1 was 0.71 for the experienced and 0.56 for the unexperienced observer. Interobserver ICC 2.1 was 0.59. Discussion: In healthy volunteers between 18 and 50 years of age, mean compartment compressibility ratio R 10-80 was 15.9% ±3.6, independent of demographic factors and sport activity. Application of 10mbar instead of 0mbar increased image quality. Subsequently, R 10-80 showed lower standard deviation and both higher intraobserver and interobserver reliability than R 0-80 . Using R 10-80 , this measurement method is reliable with very high intra-and interobserver correlation.

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“… Sellei R. et al (2015) used this method in several studies. In the pilot study, they used an ECS model (a container filled with water) and in the second study, they focused on human cadaver limbs ( Sellei R. M. et al, 2015 ). These studies compared the depth of the compartment with no probe pressure with the depth at a probe pressure of 100 mm Hg.…”

Section: Non-invasive Diagnostic Methodsmentioning

confidence: 99%

Extremity compartment syndrome: A review with a focus on non-invasive methods of diagnosis

Novák

Penhaker

Raška

et al. 2022

Front. Bioeng. Biotechnol.

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The article deals with an overview of acute extremity compartment syndrome with a focus on the option of non-invasive detection of the syndrome. Acute extremity compartment syndrome (ECS) is an urgent complication that occurs most often in fractures or high-energy injuries. There is still no reliable method for detecting ECS. The only objective measurement method used in clinical practice is an invasive measurement of intramuscular pressure (IMP). The purpose of this paper is to summarize the current state of research into non-invasive measurement methods that could allow simple and reliable continuous monitoring of patients at risk of developing ECS. Clinical trials are currently underway to verify the suitability of the most studied method, near-infrared spectroscopy (NIRS), which is a method for measuring the local oxygenation of muscle compartments. Less explored methods include the use of ultrasound, ultrasound elastography, bioimpedance measurements, and quantitative tissue hardness measurements. Finding a suitable method for continuous non-invasive monitoring of the syndrome would greatly improve the quality of care for patients at risk. ECS must be diagnosed quickly and accurately to prevent irreversible tissue damage that can occur within hours of syndrome onset and may even warrant amputation if neglected.

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Assessment of elevated compartment pressures by pressure-related ultrasound: a cadaveric model

Cited by 20 publications

References 25 publications

Diagnostic Modalities for Acute Compartment Syndrome of the Extremities

Diagnostic Modalities for Acute Compartment Syndrome of the Extremities

Tibial anterior compartment compressibility in healthy subject, measured using compression sonography

Extremity compartment syndrome: A review with a focus on non-invasive methods of diagnosis

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