Continuous Monitoring of Ischemic Biomarkers Augments Diagnosis of Peripheral Compartment Syndrome in a Porcine Model
Jenna R. Lambert*, Jaeyoung Lee, Katharine P. Playter, Aviv Liani, Daniah ALNafisee, Hiroshi Fujimaki, Giorgio Giatsidis
Division of Plastic Surgery, UMass Chan Medical School, Worcester, MA
The incidence of peripheral compartment syndrome (PCS) arising from lower limb fractures can be up to 9%. Current detection of PCS uses single timepoint intracompartmental pressure (ICP) readings and clinical judgement, which have up to a 35% false positive rate and a positive predictive value of 70%, respectively. In vivo models of limb hypoperfusion, but not of PCS, have demonstrated that changes in tissue biomarkers correlate with tissue ischemia. Supplementing ICP with continuous monitoring of these ischemic biomarkers could increase PCS diagnostic accuracy. We hypothesize that continuously monitored biomarkers of tissue injury will correlate with increases in ICP in a porcine PCS model.
Yorkshire swine (Male, ~60 kg, n=6) were used to model tourniquet-induced PCS to the peroneus tertius muscle (PTM) of the anterior thigh bilaterally. PCS was maintained for ~6 hours. ICP and superficial tissue oxygenation (SrO2) were measured continuously every 30 minutes and interstitial fluid (ISF) from the compartment was collected hourly for analysis of pH, glucose, and lactate levels.
ICP increased immediately after inflation and continued to do so (pre-inflation: 18.3±4.4 mmHg; end of experiment: 81.9±34.5 mmHg; p<0.0001). SrO2 decreased immediately upon inflation and continued decreasing (pre-inflation: 74.1±6.4%; end of experiment: 22.6±15.7%; p<0.0001). Mean pH decreased by 1.25 (pre-inflation: 7.67±0.31; end of experiment: 6.4±1.3; p=0.0073). Glucose concentration decreased by 5.6 mg/dL (pre-inflation: 7.5±9.6 mg/dL; end of experiment: 1.9±5.4 mg/dL; p=0.10). Lactate concentration increased by 6.9 mg/dL (pre-inflation: 4.6±4.3 mg/dL; end of experiment: 11.5±6.5 mg/dL; p=0.0059).
Predictable changes in continuously monitored biomarkers may assist in the accurate diagnosis of PCS in addition to standard ICP measurements.
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