Noninvasive Measurements of Intramuscular Pressure Using Pulsed Phase-locked Loop Ultrasound for Detecting Compartment Syndromes: A Preliminary Report

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Abstract

Objectives

To develop a human model for compartment tamponade and test the efficacy of ultrasonic pulsed phase-locked loop (PPLL) fascial displacement waveform analysis for noninvasive measurement of intramuscular pressure (IMP).

Design

Human subject experiment.

Setting

University Level 1 trauma center.

Participants

Nine male and 1 female volunteers (age 20 to 59),3 male acute compartment syndrome (ACS) patients (age 31 to 38).

Intervention

Thigh tourniquet was inflated in a stepwise fashion from 40 to 100 mm Hg to increase IMP transiently in volunteers.

Main Outcome Measurements

Invasive IMP by slit catheter and PPLL fascial displacement waveform in volunteers with model ACS and patients with ACS.

Results

In the model compartment tamponade group, thigh cuff occlusion increased IMP in the anterior compartment from a mean of 12.1 mm Hg (SE=1.5) to a mean of 27.4 mm Hg (SE=2.4, N=8, P<0.0001). By fast Fourier transform, the ratio of the amplitude of the fundamental frequency to the amplitude of the second harmonic frequency of the fascial displacement waveform as measured by PPLL increased from a resting mean of 1.12 (SE=0.07) to a mean of 1.85 (SE=0.18) under the same protocol (N=6, P=0.001). Combined data with compartment syndrome patients revealed linear correlation between IMP and PPLL with an R2 value of 0.8887.

Conclusions

Subarterial thigh cuff pressure causes a significant and transient increase in IMP, serving as a model for anterior compartment tamponade. PPLL is able to detect fascial displacement waveforms corresponding to arterial pulsation and furthermore distinguishes between normal and elevated IMP. There is a linear correlation between PPLL measurements and invasive IMP. The PPLL shows potential utility as a device for noninvasive measurement of IMP for detecting compartment syndromes.

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