The diagnosis of acute lower limb compartment syndrome: Applications of near infrared spectroscopy

Abstract

Acute compartment syndrome of the lower limb is a significant problem in surgical practice, the successful management of which depends upon swift diagnosis and intervention. Conventionally, diagnosis has been based upon clinical assessment; however, this can be unreliable and the potential for missed compartment syndrome remains. The supplementary use of compartment pressure monitoring has addressed some of these issues, but it remains an invasive technique, the exact role of which is still debated in the literature. Near infrared spectroscopy (NIRS) is an emerging technique in medical practice which provides a non-invasive, continuous and real time measure of local tissue oxygenation. Early experimental work and subsequent clinical studies have demonstrated that NIRS provides an accurate means of detecting compartment syndrome, and that its sensitivity in some circumstances may exceed that of monitoring compartment pressures. Despite this promise, limitations of the technique, such as difficultly monitoring the deep posterior compartment of leg using current systems, and the relative expense of the equipment, have hindered broader adoption.

Diagnosis Accuracy for Compartment Syndrome: A Systematic Review and Meta-Analysis

“…16,34 Near-infrared spectrometry to measure tissue oxygenation is not used clinically because of several diagnostic trial failures. [35][36][37] ICP measurement offers a universal and reliable adjunct when the physical examination or history is inaccurate. The study by Triffitt et al 26 assessed the ICP as an absolute value rather than perfusion pressure.…”

The Reliability of a Pre-Loaded Treadmill Time-Trial in Moderate Normobaric Hypoxia

“…However, variability increased during moderate intensity exercise (CV: 10.9 %, ICC: 0.88) and TT (CV: 28.8 %, ICC: − 0.18), suggesting decreasing reliability at faster running speeds. Considerable muscle deformation during high-intensity running likely changed the path length of NIR light through the muscle, leading to motion artefacts which may have been misinterpreted as alterations in the relevant chromophore (i. e., oxyhaemoglobin and deoxyhaemoglobin) concentrations [5]. Anecdotally, there was also regular loss of signal during high-intensity running probably due to separation of the NIRS probe and skin, which may have introduced further variability into the NIRS signal.…”

An evaluation of the normal range of StO2measurements at rest and following a mixed exercise protocol

“…NIRS has several applications relevant to military clinical practice: the diagnosis of acute or chronic exertional compartment syndrome,1 2 assessment of tissue viability and early recognition of free/regional reconstructive flap failure3–5 and guiding resuscitation in trauma or sepsis management 6–8…”