Expertos Invitados





SINDROME COMPARTIMENTAL

(especial para SIIC © Derechos reservados)
El síndrome compartimental requiere un alto índice de sospecha, un conocimiento adecuado de sus síntomas y signos clínicos y su confirmación mediante la medición de la presión intracompartimental.
constantinou9.jpg Autor:
c Constantinou
Columnista Experto de SIIC
Artículos publicados por c Constantinou
Coautor
George Velmahos, M.D., Ph.D.* 
University of Sothern California Keck School of Medicine*
Recepción del artículo
4 de Febrero, 2004 		Primera edición
15 de Junio, 2004 		Segunda edición, ampliada y corregida
7 de Junio, 2021

SINDROME COMPARTIMENTAL

Resumen
Las lesiones vasculares producen isquemia y su reparación produce la reperfusión. La isquemia y la reperfusión producen síndrome compartimental. Aunque es un evento local, este síndrome no arriesga sólo la extremidad afectada, sino también la vida del paciente. Su manejo se mejora mediante un alto índice de sospecha junto con un conocimiento adecuado de los síntomas clínicos sutiles (confirmados mediante la medición de la presión intracompartimental). Aunque los valores de CPK mayores a 5 000 U incrementan el riesgo de insuficiencia renal, la experiencia de casi 2 000 pacientes con valores anormales de CPK ingresados a la Unidad de Cuidados Intensivos de nuestra institución mostraron que el tratamiento con manitol/bicarbonato no reduce este riesgo, como tampoco previene la necesidad de diálisis o reduce la mortalidad, aunque existen algunas indicaciones de que puede ser beneficioso en pacientes con valores de CPK mayores a 30 000 U.

Palabras clave
Compartimental, lesiones vasculares, insuficiencia renal


Artículo completo
(castellano)
Extensión:  +/-9.69 páginas impresas en papel A4
Exclusivo para suscriptores/assinantes

COMPARTMENT SYNDROME

Abstract
Vascular injuries produce ischemia, and their repair produces reperfusion. Ischemia and reperfusion produce compartment syndrome. Although a local event, a compartment syndrome risks not only the affected extremity, but also the life of the patient. A high index of suspicion coupled with adequate knowledge of subtle clinical symptoms (and confirmed by intracompartmental pressure measurement), improve management of compartment syndrome. Although CPK values greater than 5 000 U increase the risk of renal failure, experience from almost 2 000 patients with abnormal CPK values that were admitted in the ICU in our center showed that treatment with mannitol/bicarbonate does not reduce that risk, neither does it prevent the need for dialysis nor does it reduce mortality. There are some indications though, that it may be beneficial in patients with CPK values greater than 30 000 U.

Key words
Compartment, vascular injuries, renal failure


Full text
(english)
 para suscriptores/ assinantes
Clasificación en siicsalud
Artículos originales > Expertos del Mundo >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Ortopedia y Traumatología
Relacionadas: Medicina Interna, Nefrología y Medio Interno



Comprar este artículo
Extensión: 9.69 páginas impresas en papel A4

file05.gif (1491 bytes) Artículos seleccionados para su compra



Bibliografía del artículo
  1. Matsen FA III. Compartmental syndromes. New York, Grune and Stratton, 1980;pp 1-162.
  2. Mubarak SJ, Hargens AR. Compartment syndromes and Volkmann's contracture. Philadelphia, WB Saunders, 1981, pp 1-232.
  3. Harris K, Walker PM, Mickle DAG, et al. Metabolic response of skeletal muscle to ischemia. Am J Physiol 1986;250:213-20.
  4. Moore RE, III, Friedman RJ. Current concepts in pathophysiology and diagnosis of compartment syndrome. J Emerg Med 1989;7:657-62.
  5. Davies MG, Hagen PO. The vascular endothelium. A new horizon. Ann Surg 1993;218:593-609.
  6. Allen DM, Chen L, Seaber AV, et al. Pathophysiology and related studies of the no reflow phenomenon in skeletal muscle. Clin Orthop 1995;314:122-33.
  7. Ames A, Wright RL, Kowada M, et al. Cerebral ishemia – the no reflow phenomenon. Am J Pathol 1968;52:437-53.
  8. Granger DN. Role of xanthine oxidase and granulocytes in ischemia-reperfusion injury. Am J Physiol 1988;1363-6135:H1269-H1275.
  9. Grishame MB, Jefferson MM, Thomas EL. Role of monochloramine in the oxidation of erythrocyte hemoglobin by stimulated neutrhophils. J Biol Chem 1984;259:6757-65.
  10. Petrone WF, English DK, Wong K, et al. Free radicals and inflammation: Superoxide-dependent activation of a neutrophil chemotactic factor in plasma. Proc Natl Acad Sci 1979;77:1159-63.
  11. Hofmeister EP, Shin AY. The role of prophylactic fasciotomy and medical treatment in limb ishemia and revascularization. Hand Clin N Am 1998;14:457-65.
  12. Yassin MM, Harkin DW, Barros D'Sa AA, et al. Lower limb ischemia-reperfusion injury triggers a systemic inflammatory response and multiple organ dysfunction. World J Surg. 2002;1:115-21.
  13. Cywes S, Louw JG. Phlegmasia cerulea dolens: successful treatment by relieving fasciotomy. Surgery 1962;51:169-72.
  14. Dennis C. Disaster following femoral vein ligation for thrombophlebitis: relief by fasciotomy. Surgery 1945;17:264-9.
  15. Gulli B, Templeman D. Compartment syndrome of the lower extremity. Orthop Clin N Am 1994;25:677-84.
  16. Hill SL, Bianchi J. The gluteal compartment syndrome. Am Surg 1997;9:823-6.
  17. Doyle J. Anatomy of the upper extremity muscle compartments. Hand Clin N Am 1998;14:343-64.
  18. Velmahos GC, Vassiliu P. Extremity compartment syndrome. In: Trauma Management. D Demetriades, JA Asensio (eds). Landes Bioscience 2000, pp 405-12.
  19. Hargens AR, Akeson WH, Mubarak SJ, et al. Interstitial fluid pressure in muscle and compartment syndrome in man. Microvasc Res 1977;14:1-10.
  20. Matsen FA, III, Mayo KA, Sheridan GW, Krugmire RB, Jr. Monitoring of intramuscular pressure. Surgery 1976;79:702-9.
  21. Rorabek CH, Clarke KM. The pathophysiology of the anterior tibial compartment syndrome: an experimental investigation. J Trauma 1978;18:299-304.
  22. Sheridan GW, Matsen FA, III, Krugmire RB, Jr. Further investigation on the pathophysiology of the compartmental syndrome. Clin Orthop Relat Res 1977;123:266-70.
  23. Hargens AR, Mubarak SJ. Current concepts in the pathophysiology, evaluation, and diagnosis of compartment syndrome. Hand Clin N Am 1998;14:371-83.
  24. White TO, Howell GE, Will EM, et al. Elevated intramuscular compartment pressures do not influence outcome after tibial fracture. J Trauma. 2003;55:1133-8.
  25. Robbs JV, Baker LW. Late revascularization of the lower limb following acute arterial occlusion. Br J Surg 1979;78:490-3.
  26. Oda J, Tanaka H, Yoshioka T, et al. Analysis of 372 patients with crush syndrome caused by the Hanshin-Awaji earthquake. J Trauma 1997;42:470-6.
  27. Vanholder R, Sever MS, Erek E, et al. Rhabdomyolysis. J Am Soc Nephrol. 2000;11:1553-61
  28. Lappalainen H, Tiula E, Uotila L, et al. Elimination kinetics of myoglobin and creatine kinase in rhabdomyolysis: implications for follow-up. Crit Care Med. 2002;30:2212-5.
  29. Ward MM. Factors predictive of acute renal failure in rhabdomyolysis. Arch Inten Med 1988;148:15537.
  30. Knottenbelt JD. Traumatic rhabdomyolysis from severe beating-Experience of volume diuresis in 200 patients. J Trauma 1994;37:214-9.
  31. Nimmo GR, Lambie AT, Cumming AD. Rhabdomyolysis and acute renal failure. Intens Care Med 1989;15:486-7.
  32. Mars M, Hadley GP. Failure of pulse oximetry in the assessment of raised limb intracompartmental pressure. Injury 1994;25:379-81.
  33. Giannoti G, Cohn SM, Brown M, et al. Utility of near-infrared spectroscopy in the diagnosis of lower extremity compartment syndrome. J Trauma 2000;48:396-401.
  34. Garr JL, Gentilello LM, Cole PA, et al. Monitoring for compartmental syndrome using near-I spectroscopy: A noninvasive, continuous, transcutaneous monitoring technique. J Trauma 1999;46:613-8.
  35. Gentilello LM, Sanzone A, Wang L, et al. Near-infrared spectroscopy versus compartment pressure for the diagnosis of lower extremity compartmental syndrome using electromyography-determined measurements of neuromuscular function. J Trauma. 2001;51:1-8.
  36. Shah PM, Wapnir I, Babu S, et al . Compartment syndrome in combined arterial and venous injury of the lower extremity. Am J Surg 1989;158:136-41.
  37. McGee DL, Dalsey WC. The mangled extremity. Compartment syndrome and amputations. Emerg Clin N Am 1992;10:783-800.
  38. Perry MO. Compartment syndromes and reperfusion injury. Surg Clin N Am 1988;68:853-68.
  39. Velmahos GC, Theodorou D, Demetriades D, et al. Complications and nonclosure rates of fasciotomy for trauma and related risk factors. World J Surg 1997;21:247-53.
  40. Matsen FA, Krugmire RB. Compartment syndromes. Surg Gynecol Obstet 1978;147:943-9.
  41. Hallock GG. An endoscopic technique for decompressive fasciotomy. Ann Plast Surg 1999;43:668-7
  42. Herbert KJ, Hickey MJ, Lepore DA, et al. Effects of the endothelin receptor antagonist Bosentan on ischaemia/reperfusion injury in rat skeletal muscle. Eur J Pharmacol. 2001 Jul 13;424:59-67.
  43. Ron D, Taitelman U, Michaelson M, et al. Prevention of acute renal failure in traumatic rhabdomyolysis. Arch Intern Med. 1984 Feb;144:277-80.
  44. Homsi E, Barreiro MF, Orlando JM, et al. Prophylaxis of acute renal failure in patients with rhabdomyolysis. Ren Fail. 1997 Mar;19:283-8.
  45. Brown CV, Rhee P, Chan L, et al. Preventing renal failure in patients with rhabdomyolysis: Do bicarbonate and mannitol make a difference J Trauma (in press).
  46. Lagerstorm CF, Reed LR, Rowlands BJ, et al. Early fasciotomy for acutre clinically evident post-traumatic compartment syndrome. Am J Surg 1989;158:36-40.
  47. Filed CK, Senkowsky J, Hollier LH, et al. Fasciotomy for vascular trauma: is it too much, too often Am Surg 1994;60:409-13.
  48. Fitzgerald AM, Gaston P, Wilson Y, et al. Long-term sequelae of fasciotomy wounds. Br J Plast Surg 2000;53:690-3.
  49. Harris I. Gradual closure of fasciotomy wounds using a vessel loop shoelace. Injury 1993;24:565-7.
  50. Almekinders LC. Gradual closure of fasciotomy wounds. Orthop Rev 1991;20:82-4.
  51. Hirvensalo E, Tuominen H, Lapinsuo M, et al. Compartment syndrome of the lower limb caused by a tourniquet: A report of two cases. J Orthop Trauma 1992;4:469-72.
Título español
Resumen
 Palabras clave
 Bibliografía
 Artículo completo
(exclusivo a suscriptores)
 Autoevaluación
  Tema principal en SIIC Data Bases
 Especialidades

 English title
 Abstract
 Key words
Full text
(exclusivo a suscriptores)

Autor 
Artículos
Correspondencia

Patrocinio y reconocimiento
Imprimir esta página
 
 
 
 
 
 
 
 
 
 
 
 
Está expresamente prohibida la redistribución y la redifusión de todo o parte de los contenidos de la Sociedad Iberoamericana de Información Científica (SIIC) S.A. sin previo y expreso consentimiento de SIIC.
ua31618
Inicio/Home

Copyright siicsalud © 1997-2024 ISSN siicsalud: 1667-9008