Haemodilution is always considerable during cardiopulmonary bypass (CPB). If this extra fluid sits in the muscle compartments then a corresponding rise in the compartment pressure (CP) is to be expected. The aim of this study was to measure pressure changes in a body compartment with new equipment, the MTC® (Microtransducer). Changes in plasma colloid osmotic pressure (COP) were also measured during and after CPB to find a connection, if any, between CP and plasma COP.
Ten elective consecutive CPB patients were studied. A 3-French (3-F) catheter-size electronic MTC® was inserted in an anterior tibial compartment before CPB. The CP was monitored for 48 h. Plasma COP was also measured before, during and after CPB.
CP increased significantly during and after CPB in all patients (p=0.01). COP decreased significantly in all patients (p=0.005), but no correlation was found between changes in COP and CP values in this study. Most of the patients reached their highest CP just after weaning off bypass. The CP remained elevated for 48 h, even though it then tended to decrease again. None of the patients reached the starting value within 48 h. COP decreased rapidly after going on bypass, but returned towards its starting value approximately 6 h after bypass.
It is concluded that CP increases considerably during and after CPB and stays increased for at least 2 days after CPB. COP decreases during CPB, but reaches normal values 6 h after the CPB. No correlation was found between changes in CP and COP. The MTC® is a safe and easy way to measure intracompartment pressure.
Get full access to this article
View all access options for this article.
References
1.
Despopoulos A , Silbernagl S.Heart and circulation. In: Color atlas of physiology. New York: Thieme , 1986: 158-161.
2.
Prior FGR.Plasma colloid osmotic pressure in the critically ill . Care Crit Ill1999; 15: 167-172 .
3.
Cooper JR , Slogoff S.Hemodilution and priming solution for cardiopulmonary bypass. In: Gravlee CP , Davis RF eds. Cardiopulmonary bypass. Baltimore, MD: Williams & Wilkins , 1993: 134-134.
4.
Davies LK.Hypothermia: physiology and clinical use. In: Gravlee CP , Davis RF eds. Cardiopulmonary bypass. Baltimore, MD: Williams & Wilkins , 1993: 148-148.
5.
Vinten-Johansen J , Hammon JW.Myocardial protection during cardiac surgery. In: Gravlee CP , Davis RF eds. Cardiopulmonary bypass. Baltimore, MD: Williams & Wilkins , 1993: 165-181.
6.
Kirklin JK , George JF , Holman W.The inflammatory response to cardiopulmonary bypass. In: Gravlee CP , Davis RF eds. Cardiopulmonary bypass. Baltimore, MD: Williams & Wilkins , 1993: 237-238.
7.
Sladen RN , Berkowitz DE.Cardiopulmonary bypass and the lung. In: Gravlee CP , Davis RF eds. Cardiopulmonary bypass. Baltimore, MD: Williams & Wilkins , 1993: 469-469.
8.
Utley JR.Renal function and fluid balance with cardiopulmonary bypass. In: Gravlee CP , Davis RF eds. Cardiopulmonary bypass. Baltimore, MD: Williams & Wilkins , 1993: 500-500.
9.
Kouchoukos NT , Abboud N , Klausing WR.Perfusion for thoracic aortic surgery. In: Gravlee CP , Davis RF eds. Cardiopulmonary bypass. Baltimore, MD: Williams & Wilkins , 1993: 642-642.
10.
Cilley RE , Bartlett RH.Extracorporeal life support for respiratory failure. In: Gravlee CP , Davis RF eds. Cardiopulmonary bypass. Baltimore, MD: Williams & Wilkins , 1993: 662-662.
11.
Hemmings HC , Thomas SJ.Termination of cardiopulmonary bypass. In: Gravlee CP , Davis RF eds. Cardiopulmonary bypass. Baltimore, MD: Williams & Wilkins , 1993: 772-772.
12.
Abbott MA , McLaren AD , Algie T.Intra-ocular pressure during cardiopulmonary bypass: a comparison of crystalloid and colloid priming solutions . Anaesthesia1994; 49: 343-346 .
13.
Shin’oka T , Shum-Tim D , Laussen PCet al.Effects of oncotic pressure and hematocrit on outcome after hypothermic circulatory arrest . Ann Thorac Surg1998; 65: 155-164 .
14.
DeFouw DO , Meyenhofer MF , Rizzo VJ , Henry CBS.Ultrastructural aspects of capillary barrier functions after injury. In: Zikria BA , Oz MO , Carlson W eds. Reperfusion injuries and clinical capillary leak syndrome. New York: Futura , 1994: 3-23.
15.
Pinsky D , Stern D.Hypoxia-induced modulation of endothelial cell function. In: Zikria BA , Oz MO , Carlson W eds. Reperfusion injuries and clinical capillary leak syndrome. New York: Futura , 1994: 31-51.
16.
Taylor AE , Moore T , Khimenko P.Microcirculatory exchange of fluid and protein and development of the third space. In: Zikria BA , Oz MO , Carlson W eds. Reperfusion injuries and clinical capillary leak syndrome. New York: Futura , 1994: 59-137.
17.
Lucchesi BR.Cardiac reperfusion injury. In: Zikria BA , Oz MO , Carlson W eds. Reperfusion injuries and clinical capillary leak syndrome. New York: Futura , 1994: 171-194.
18.
Zikria BA , Bascom JU.Mechanisms of multiple system organ failure. In: Zikria BA , Oz MO , Carlson W eds. Reperfusion injuries and clinical capillary leak syndrome. New York: Futura , 1994: 443-480.
19.
Zikria BA.A biophysical approach: ‘sealing’ of capillary leak by intravenous biodegradable macromolecules. In: Zikria BA , Oz MO , Carlson W eds. Reperfusion injuries and clinical capillary leak syndrome. New York: Futura , 1994: 547-593.
20.
Castaneda AR , Jonas RA , Mayer JE , Hanley FL.Cardiac surgery of the neonate and infant. Philadelphia, PA: WB Saunders , 1994: 25-25, 83-85, 481-496.
21.
Yeh T , Parmar JM , Rebeyka IMet al.Limiting edema in neonatal cardiopulmonary bypass with narrow-range molecular weight hydroxyethyl starch . J Thorac Cardiovasc Surg1992; 104: 659-665 .
22.
Zabala MS , Leombruni E , Di Stefano S.The effects of colloidal and crystalloidal fluids on acidosis and lactacidemia in cardiopulmonary bypass . Ann Ital Chir1993; 64: 387-391 .
23.
Quinn RH , Ruby ST.Compartment syndrome after elective revascularization for chronic ischemia: case report and review of the literature . Arch Surg1992; 127: 865-866 .
24.
Myerson MS.Management of compartment syndromes of the foot . Clin Orthop1991; 271: 239-248 .
25.
Heckman MM , Whitesides TE , Grewe SR , Rooks MD.Compartment pressure in association with closed tibial fractures . J Bone Joint Surg1994; 78-A: 1285-1292 .
26.
Skjeldal S , Hvaal K , Strømsøe K , Nordsletten L.Losjetrykk etter margnagling av leggbrud . Tidsskr Nor Lægeforen1995; 115: 1932-1933 .
27.
Matava MJ , Whitesides TE , Seiler JG , Hewan-Lowe K , Hutton WC.Determination of the compartment pressure threshold of muscle ischemia in a canine model . J Trauma1994; 37: 50-58 .
Hartsock LA , O’Farell D , Seaber AV , Urbaniak JR.Effect of increased compartment pressure on the microcirculation of skeletal muscle . Microsurgery1998; 18: 67-71 .
30.
Seekamp A , van Griensven M , Blankenburg H , Regel G.Intramuscular partial oxygen tension monitoring in compartment syndrome: an experimental study . Eur J Emerg Med1997; 4: 185-192 .
31.
Allen RC , Schneider J , Longenecker L , Kosinski AS , Smith RB , Lumsden AB.Lower extremity ischemia after cardiac surgery . Am J Surg1993; 165: 124-129 .
Yamamoto T , Makuuchi H , Naruse Y , Kobayashi T , Goto M , Nonaka K.Postoperative compartment syndrome in patient with acute aortic dissection . Jpn J Thorac Cardiovasc Surg1998; 46: 1162-1167 .
34.
Turnipseed WD , Hurschler C , Vanderby R Jr.The effects of elevated compartment pressure on tibial arteriovenous flow and relationship of mechanical and biochemical characteristics of fascia to genesis of chronic anterior compartment syndrome . J Vasc Surg1995; 21: 810-816 .
35.
Hanlon M , Barnes M , Lamb G , Nicol R.Central compartment pressure monitoring following clubfoot release . J Pediatr Orthop1995; 16: 63-66 .
36.
McQueen MM , Christie J , Court-Brown CM.Acute compartment syndrome in tibial diaphyseal fractures . J Bone Joint Surg1996; 78-B: 95-98 .
37.
Williams PR , Russell ID , Mintowt-Czyz MJ.Compartment pressure monitoring: current UK orthopaedic practice . Int J Care Injured1998; 29: 229-232 .
38.
Moehring HD , Voigtlander JP.Compartment pressure monitoring during intramedullary fixation of tibial fractures . Orthopedics1995, 18: 631-635 .
39.
Bernot M , Gupta R , Dobraz J , Chance B , Heppenstall RB , Sapega A.The effect of antecedent ischemia on the tolerance of skeletal muscle to increased interstitial pressure . J Orthop Trauma1996; 10: 555-559 .
40.
Gonzales J , Morrissey T , Byrne T , Rizzo R , Wilmore D.Bioelectric impedance detects fluid retention in patients undergoing cardiopulmonary bypass . J Thorac Cardiovasc Surg1995; 110: 111-118 .
41.
Olthof CG , Jansen PGM , de Vries JPet al.Inerstitial fluid volume during cardiac surgery measured by means of non-invasive conductivity technique . Acta Anaesthesiol Scand1995; 39: 508-512 .
42.
Aita DJ , Kvamme P , Rice JC , Kerstein MD.Venous insufficiency: a late sequelae of four-compartment fasciotomy in the lower extremity ? Am Surg1993; 59: 574-577 .
43.
Mars M , Hadley GP.Failure of pulse oximetry in the assessment of raised limb intracompartmental pressure . Injury1994; 25: 378-381 .
44.
Haaverstad R , Johnsen H , Sather OD , Myhre HO.Lymph drainage and the development of post-reconstructive leg oedema is not influenced by the type of inguinal incision: prospective randomised study in patients undergoing femoropopliteal bypass surgery . Eur J Vasc Endovasc Surg1995; 10: 316-322 .
45.
Haaverstad R , Nilsen G , Myhre HO , Sæther OD , Rinck PA.The use of MRI in the investigation of leg oedema . Eur J Vasc Surg1992; 6: 124-129 .
46.
Steinberg BD , Gelberman RH.Evaluation of limb compartments with suspected increased interstitial pressure: noninvasive method for determining quantitative hardness . Clin Orthop1994; 300: 248-253 .
47.
Gilbart MK , Oglive-Harris DJ , Broadhurst C , Clarfield M.Anterior tibial compartment pressure during intermittent sequential pneumatic compression therapy . Am J Sports Med1995; 23: 769-772 .
48.
Crenshaw AG , Wiger P , Styf J.Evaluation of techniques for measuring negative intramuscular pressure in humans . Eur J Appl Physiol1998; 77: 44-49 .
49.
Wiger P , Styf JR.Effects of limb elevation on abnormally increased intramuscular pressure, blood perfusion pressure, and foot sensation: experimental study in humans . J Orthop Trauma1998; 12: 343-347 .
