Near-infrared spectroscopy versus compartment pressure for the diagnosis of lower extremity compartmental syndrome using electromyography-determined measurements of neuromuscular function

Larry M. Gentilello, Anthony Sanzone, Leilei Wang, Ping Yu Liu, Larry Robinson

Research output: Contribution to journalArticle

70 Scopus citations

Abstract

Background: Compartmental syndrome (CS) is difficult to diagnose in intensive care unit patients. Compartment perfusion pressure (CPP) is an invasive, indirect measure of ischemia. Near-infrared spectroscopy is noninvasive, and directly measures ischemia by transmitting light through tissues at wavelengths that react with hemoglobin to provide percent tissue oxygen saturation (StO2). Animal studies demonstrate that StO2 is superior to CPP for detecting CS. However, there are no studies in humans comparing StO2 with CPP. We hypothesized that StO2 can reliably detect CS, and is superior to CPP. Methods: CS was induced in 15 human volunteers using a standard calf compression model. At 30-minute intervals, compression was increased to reduce StO2 from baseline (86% ± 4%) to 60%, 40%, 20%, and < 10%, with simultaneous recording of CPP. Outcome variables included deep peroneal nerve conduction assessed by electromyography, cutaneous peroneal nerve sensitivity using Semmes-Weinstein monofilanients, and pain (visual analog scale). Results: Both StO2 and CPP significantly correlated with all ischemia outcome variables (p < 0.001). Receiver operating characteristic curves of deep peroneal nerve conduction demonstrated that StO2 had higher sensitivity than CPP for detecting > 50% block. For example, when specificity was 83% for StO2 and 84% for CPP, sensitivity was 85% versus 56%, respectively (p = 0.02). When specificity for both was 72%, sensitivity was 94% for StO2 versus 76% for CPP (p = 0.04). Conclusion: In intensive care unit patients who cannot alert physicians to symptoms, near-infrared spectroscopy may help clinicians to avoid delayed or unnecessary prophylactic fasciotomy, and provides the benefits of a continuous, non-invasive monitoring technique.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume51
Issue number1
StatePublished - Jul 1 2001

Keywords

  • Compartmental syndrome
  • Fractures
  • Ischemia
  • Musculoskeletal physiology
  • Near-infrared spectroscopy
  • Orthopedic equipment
  • Orthopedics
  • Oximetry

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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