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Capstone

Thoracic Compartment Syndrome

1 August 2004

Abstract

Background: Thoracic compartment syndrome is not well recognized as a complication of thoracic trauma in medical literature but does exist in trauma centers. Compartment syndromes are increasing pressures in a confined space causing compression of vital organs and tissues leading to failure of function, ischemia, and inspiration. Thoracic compartment syndrome compromises the heart and lung function for the already severely compromised patient. This study will define thoracic compartment syndrome using physiologic parameters and establish the standard of care for treatment. This retrospective study will also identify the survival rates of patients with thoracic compartment syndrome treated at a level 1 trauma center in Oregon. With this data, we will attempt to develop a prognosis for these patients.

Research Design: Data were selected of patients who have suffered thoracic trauma and the complication of thoracic compartment syndrome. Mechanism of injury, physiologic data, physical examination results, diagnostic imaging, and therapeutic interventions were recorded on a spreadsheet. Patient survival probability was derived using the TRISS method.

Results: Six patients' data were collected. TCS was caused by PTX, HTX, and hydrothorax secondary to thoracic trauma and resuscitative efforts. Patients were tachycardic, hypotensive, acidotic, anemic, and had a mean GCS of 6.5. The data from imaging performed was not used in the diagnosis of TCS. TCS was eventually released with sternotomy or thoracostomy tubes. Survival probability averaged on 63.5%, with the actual survival rate of 83.3%.

Conclusions: With widespread knowledge of such a syndrome, trauma surgeons will add it to their thoracic trauma differential and be on the alert for patients with increasing PEEP requirements with difficult ventilation, worsening metabolic acidosis, and worsening hypotension despite fluid replacement and vasopressor agents. Identifying these patients early in resuscitation may lead to faster treatment with sternotomy if there is limited or no response to thoracostomy; for those patients who do not respond to thorax decompressions, BMCO may offer another option.


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