Abstract
Background
Acute compartment syndrome (ACS) is the result of increased intracompartmental pressure
(ICP), and to avoid a delay in diagnosis requires ICP measurement. This study was
designed to compare 2 available methods with Bland-Altman analysis for measuring ICP
in experimental animal models, healthy volunteers, and patients with suspected ACS
to evaluate their agreement and interchangeability.
Methods
In 20 New Zealand White rabbits, we inflated a tourniquet to stop arterial blood flow
to establish ACS rabbit models, of which ICP was measured and recorded by the Whitesides
apparatus and the invasive arterial blood pressure monitor system (IABPMS) before
and after modeling. The same 2 measurements were applied to the tibialis anterior
compartment's ICP of 30 healthy volunteers. The experimental data were analyzed using
the Bland-Altman method. Once it was considered to be a substitute for the Whitesides
apparatus based on statistical analysis, we used IABPMS to measure the ICP of the
patients suspected of having ACS to estimate its clinical prospect.
Results
The rabbit models' ICP estimated by the Whitesides apparatus and IABPMS were 9.60 ± 2.74 and 9.55 ± 2.33 mm Hg, with an increase to 30.20 ± 4.44 and 30.05 ± 4.58 mm Hg after modeling, respectively. The limits of agreement for the ICP were
−2.01/2.11 and −2.41/2.71 mm Hg before and after model establishment. The healthy volunteers' ICP
were 10.92 ± 6.06 and 10.85 ± 5.87 mm Hg; the limits of agreement for the ICP were −2.53/2.66 mm Hg. With IABPMS to continuously monitor the ICP increasing (40.45 ± 10.42 vs 13.82 ± 4.94 mm Hg) and ΔP (34.54 ± 11.77 mm Hg) to guide the diagnosis of ACS, 5 of 11 patients underwent the emergency
fasciotomy for decompression.
Conclusion
The invasive pressure monitoring via IABPMS can be used as an alternative to the Whitesides
method, thanks to the sufficient agreement between the 2 methods in ICP measurement,
and also for its advantages recommended as a novel diagnostic approach to ACS in experimental
and clinical applications.
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Article Info
Publication History
Published online: June 07, 2016
Accepted:
June 1,
2016
Received:
April 29,
2016
Footnotes
☆Source of Funding: This study was supported by the Health and Family Planning Commission of Shanghai Pudong New District ( PW2013B-13 ).
☆☆Compliance with ethical requirements: This study was approved by the institutional ethics committee, and written informed consent was obtained from all volunteers and patients.
★Conflict of interest: All authors declare that they have no conflict of interest related to the current study.
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© 2016 Elsevier Inc. All rights reserved.
