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Continual near-infrared spectroscopy monitoring in the injured lower limb and acute compartment syndrome.

Abstract Aims The aim of this study was to evaluate near-infrared spectroscopy (NIRS) as a continuous, non-invasive monitor for acute compartment syndrome (ACS). Patients and Methods NIRS sensors were placed on 86 patients with, and 23 without (controls), severe leg injury. NIRS values were recorded for up to 48 hours. Longitudinal data were analyzed using summary and graphical methods, bivariate comparisons, and multivariable multilevel modelling. Results Mean NIRS values in the anterior, lateral, superficial posterior, and deep posterior compartments were between 72% and 78% in injured legs, between 69% and 72% in uninjured legs, and between 71% and 73% in bilaterally uninjured legs. In patients without ACS, the values were typically > 3% higher in injured compartments. All seven limbs with ACS had at least one compartment where NIRS values were 3% or more below a reference uninjured control compartment. Missing data were encountered in many instances. Conclusion NIRS oximetry might be used to aid the assessment and management of patients with ACS. Sustained hyperaemia is consistent with the absence of ACS in injured legs. Loss of the hyperaemic differential warrants heightened surveillance. NIRS values in at least one injured compartment(s) were > 3% below the uninjured contralateral compartment(s) in all seven patients with ACS. Additional interventional studies are required to validate the use of NIRS for ACS monitoring. Cite this article: Bone Joint J 2018;100-B:787-97.
PMID
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Authors

Mayor MeshTerms
Keywords

Acute compartment syndrome

Clinical guidelines

Combat

Military

Near-infrared spectroscopy

Oximetry

Journal Title the bone & joint journal
Publication Year Start




PMID- 29855235
OWN - NLM
STAT- MEDLINE
DCOM- 20180612
LR  - 20180612
IS  - 2049-4408 (Electronic)
IS  - 2049-4394 (Linking)
VI  - 100-B
IP  - 6
DP  - 2018 Jun 1
TI  - Continual near-infrared spectroscopy monitoring in the injured lower limb and
      acute compartment syndrome.
PG  - 787-797
LID - 10.1302/0301-620X.100B6.BJJ-2017-0736.R3 [doi]
AB  - Aims The aim of this study was to evaluate near-infrared spectroscopy (NIRS) as a
      continuous, non-invasive monitor for acute compartment syndrome (ACS). Patients
      and Methods NIRS sensors were placed on 86 patients with, and 23 without
      (controls), severe leg injury. NIRS values were recorded for up to 48 hours.
      Longitudinal data were analyzed using summary and graphical methods, bivariate
      comparisons, and multivariable multilevel modelling. Results Mean NIRS values in 
      the anterior, lateral, superficial posterior, and deep posterior compartments
      were between 72% and 78% in injured legs, between 69% and 72% in uninjured legs, 
      and between 71% and 73% in bilaterally uninjured legs. In patients without ACS,
      the values were typically > 3% higher in injured compartments. All seven limbs
      with ACS had at least one compartment where NIRS values were 3% or more below a
      reference uninjured control compartment. Missing data were encountered in many
      instances. Conclusion NIRS oximetry might be used to aid the assessment and
      management of patients with ACS. Sustained hyperaemia is consistent with the
      absence of ACS in injured legs. Loss of the hyperaemic differential warrants
      heightened surveillance. NIRS values in at least one injured compartment(s) were 
      > 3% below the uninjured contralateral compartment(s) in all seven patients with 
      ACS. Additional interventional studies are required to validate the use of NIRS
      for ACS monitoring. Cite this article: Bone Joint J 2018;100-B:787-97.
FAU - Shuler, M S
AU  - Shuler MS
AD  - Athens Orthopedic Clinic, Athens, Georgia, USA.
FAU - Roskosky, M
AU  - Roskosky M
AD  - Johns Hopkins University, Baltimore, Maryland, USA and The Geneva Foundation,
      Tacoma, Washington, USA.
FAU - Kinsey, T
AU  - Kinsey T
AD  - Athens Orthopedic Clinic, Athens, Georgia, USA.
FAU - Glaser, D
AU  - Glaser D
AD  - Glaser Consulting, San Diego, California, USA.
FAU - Reisman, W
AU  - Reisman W
AD  - Grady Memorial Hospital; Emory University School of Medicine, Athens, Georgia,
      USA.
FAU - Ogburn, C
AU  - Ogburn C
AD  - Athens Orthopedic Clinic, Athens, Georgia, USA.
FAU - Yeoman, C
AU  - Yeoman C
AD  - The Geneva Foundation, Tacoma, Washington, USA.
FAU - Wanderman, N R
AU  - Wanderman NR
AD  - Mayo Clinic, Rochester, Minnesota, USA.
FAU - Freedman, B
AU  - Freedman B
AD  - Mayo Clinic, Rochester, Minnesota, USA.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
PL  - England
TA  - Bone Joint J
JT  - The bone & joint journal
JID - 101599229
SB  - AIM
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Compartment Syndromes/*diagnostic imaging
MH  - Feasibility Studies
MH  - Female
MH  - Humans
MH  - Leg Injuries/*diagnostic imaging
MH  - Lower Extremity
MH  - Male
MH  - Middle Aged
MH  - Monitoring, Physiologic/methods
MH  - Muscle, Skeletal/*physiopathology
MH  - Prospective Studies
MH  - Spectroscopy, Near-Infrared/*methods
MH  - United States
MH  - Young Adult
OTO - NOTNLM
OT  - Acute compartment syndrome
OT  - Clinical guidelines
OT  - Combat
OT  - Military
OT  - Near-infrared spectroscopy
OT  - Oximetry
EDAT- 2018/06/02 06:00
MHDA- 2018/06/13 06:00
CRDT- 2018/06/02 06:00
PHST- 2018/06/02 06:00 [entrez]
PHST- 2018/06/02 06:00 [pubmed]
PHST- 2018/06/13 06:00 [medline]
AID - 10.1302/0301-620X.100B6.BJJ-2017-0736.R3 [doi]
PST - ppublish
SO  - Bone Joint J. 2018 Jun 1;100-B(6):787-797. doi:
      10.1302/0301-620X.100B6.BJJ-2017-0736.R3.