Comparison of NIRS, serum biomarkers and muscle damage in a porcine balloon compression model of acute compartment syndrome.

Background: Near Infrared Spectroscopy (NIRS) has been shown to aid in the diagnosis of Extremity acute compartment syndrome (ACS) offering continuous real time capability to monitor perfusion in extremities. Porcine models of ACS have been developed to attempt to aid in the understanding of the development of ACS and provide better methods of diagnosing ACS. The objective of the present study was to assess and correlate NIRS, tibial intra-compartmental pressure (TICP), tibial intra-compartmental perfusion pressure (TIPP), serum markers of inflammation and muscle injury in a balloon compression model of ACS. Methods: Six swine were used. Balloon catheters were inflated below the cranial tibialis (CT) muscle. Systolic, diastolic, and mean arterial pressures, compartmental pressures, and oximetry were measured prior to, during and after balloon inflation/deflaton. CT muscle was collected for muscle damage scoring. Serum creatine kinases (CK), myoglobin, TNF-[alpha], IL-1[beta], IL-6 were measured. Data analysis included comparing differences in TICP, NIRS and TIPP measurements as well as to CK, myoglobin, TNF-[alpha], IL-1[beta], and IL-6 levels between time points. Pearson's correlations were calculated for muscle degeneration and edema and NIRS. Results: Increases in TICP and decreases in TIPP were found. NIRS detected significant changes in tissue oxygenation at all the same time points. Myoglobin significantly increased from 45.7 +/- 13.0 ng/mL (baseline) to 219.5 +/- 57.3 ng/mL (balloon deflation) and continued to increase over the duration of the study. CK significantly increase 2 hours post balloon deflation. CT muscle degeneration, necrosis and edema scores were higher in the test than the control legs. Conclusions: NIRS of the compartment provided a reliable, sensitive measure of both an increase and decrease in TICP and TIPP in this porcine balloon model of ACS. CK and myoglobin significantly increased following balloon removal. Significant correlations between muscle degeneration, edema, hemorrhage and NIRS were found. (C) 2016 Lippincott Williams & Wilkins, Inc.

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