Pilot Study of Role of Continuous Tissue pH Measurement in the Diagnosis of Acute Compartment Syndrome
Abstract
Objectives and Rationale: Acute compartment syndrome (ACS) is a serious condition that occurs when pressure builds up within a muscle compartment in an injured extremity. The increased pressure is caused by swelling of the muscles in the area surrounding the injury, which is most commonly a broken bone. If the pressure gets too high, the blood supply to the injured extremity is reduced, and if severe, results in damage to the muscle and nerves contained in muscle compartment. If not treated in a timely manner, it results in death of the affected muscle cells that in turn results in permanent loss of function and contracture of the affected muscle(s). ACS is very difficult to diagnose because there are no tests that reliably determine when ACS is occurring. However, since the ultimate damage done by ACS is a metabolic injury caused by lack of oxygen delivery, different chemicals (biomarkers) that are indicative of the extent of injury can build up in the muscle tissue. The tissue also becomes progressively acidotic due to the build of lactic acid. This can be measured by inserting pH probes into the affected muscle. This application proposes an observational study to validate the use of continuous intramuscular pH monitoring (cIMpH) in diagnosing ACS. This method would be useful in both civilian and military settings, including situations where wounded service members are in the austere environment of prolonged field care. Patients enrolled in this proposed study will be a subset of 40 patients enrolled in a larger parent study (Award W81XWH-20-2-0050/Evaluation of the Diagnostic and Therapeutic Value of Tissue Ultrafiltration in Patients at Risk of Acute Compartment Syndrome), the goals of which are to integrate classic clinical signs and symptoms of ACS with the latest advances in monitoring and treatment of ACS, including detailed serial assessment of continuous measurement of intramuscular pressure (cIMP) and randomization of patients to receive continuous tissue ultrafiltration (TUF) upon enrollment vs standard of care (no TUF). The parent study also evaluates a novel approach of incorporating interstitial fluid biomarkers obtained using TUF (total creatinine kinase, lactate, potassium, ammonium measured in interstitial fluid) into diagnosis and treatment decisions. The specific goal of the proposed study is to assess the value of cIMpH in diagnosing ACS. Ultimate Applicability and Clinical Impact: This application directly addresses FY21 PRORP CTA Focus Area 3: Compartment Syndrome. Novel treatment strategies to improve current diagnoses for compartment syndrome. Alternatives to intracompartmental pressure measurements are encouraged. Secondly, since more accurate diagnosis of ACS may lead to the ability to maintain an injured Warfighter in their operational environment, this project also aligns with Focus Area 1a: Retention Strategies: Battlefield Care: Strategies that can be utilized at or near the point of injury to allow an injured Service Member to remain on the battlefield or on mission without the need for evacuation. This proposal is targeted towards the validation of methods to diagnose and manage ACS that are ideally suited to any patient with an extremity injury, both civilians and military. In both civilian and military scenarios, ACS is notoriously difficult to diagnose. Further, the only available treatment is immediate fasciotomy. In some military scenarios, significant resources are devoted to immediate medevac of combat casualties. In the scenario of PFC, wherein such treatment is more difficult, a reliable means of diagnosing impending or early ACS is needed. The addition of continuous pH to a subset of patients in the parent study will supply pilot data regarding the efficacy of cIMpH as a potentially valuable and simple biomarker that can be readily measured in the field by a medic. Such a low-tech approach that makes the diagnosis of impending ACS more precise would r
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210831
Entities
People
- Andrew Schmidt
Organizations
- Hennepin Healthcare Research Institute
- United States Army