Treatments for Compartment Syndrome

Compartment syndrome (CS) is a complex condition in which increased pressure in a compartment limits blood supply, resulting in reduced or absent tissue perfusion. Two theories exist as to its pathophysiology: The arteriovenous (AV) pressure gradient theory proposes that increased tissue pressure results in increased pressure of veins in the compartment, decreasing the AV pressure gradient and resulting in decreased oxygen delivery. The ischemia-reperfusion theory states that as the compartmental pressure increases, interstitial fluid pressure rises above the capillary pressure, resulting in perfusion impairment. The subsequent ischemia and reperfusion can cause edema and cellular damage.

Skeletal muscle CS, or extremity compartment syndrome (ECS), is the most widely recognized CS. Surgical decompression, usually by fasciotomy, is the definitive treatment. In abdominal compartment syndrome (ACS), increased intraabdominal pressure can result in progressive intraabdominal organ dysfunction and detrimental effects on cardiovascular, respiratory, and central nervous systems. When ACS is suspected or confirmed and medical management is unsuccessful, surgical decompression should be considered. Treatment for thoracic compartment syndrome (TCS), the dysfunction of intrathoracic organs and tissues secondary to increased intrathoracic pressure, entails decompression and is achieved via thoracotomy; delayed sternal closure following decompression is advocated. Risk factors can include anything causing significant chest trauma. All forms of CS are associated with significant morbidity and mortality.

CommentaryThis article offered several take-away points. (1) CS is a possible sequela to any injury or disease process, including common ones (eg, fractures, gastric dilatation-volvulus, ascites); (2) measurement of intraabdominal pressure is achievable with material readily available; (3) pain management is the cornerstone of therapy; (4) some simple therapies, including gastric decompression and changing body position, can reduce compartment pressure; (5) fervent fluid therapy should be avoided; (6) awareness can lead to avoidance of CS—or at least further progression—reducing morbidity and mortality.—Franciszek von Esse, VMD, DABVP

SourceCompartment syndrome: Pathophysiology, clinical presentations, treatment, and prevention in human and veterinary medicine. Nielsen LK, Whelan M. JVECC 22:291-302, 2012.