Raised compartmental pressure in children: a basis for management.

Abstract

In children, raised intracompartmental pressure which may lead to a compartment syndrome is relatively common and follows a wide variety of insults. Cell viability is compromised at much lower compartmental pressures than in adults, and clinical awareness must be heightened, especially in the hypotensive child. Suspicion follows an awareness of clinical situations associated with the risk of raised compartmental pressure. Clinical confirmation may be difficult in the context of the uncooperative child. Diagnosis is established by invasive pressure monitoring. Intervention becomes mandatory when the compartmental pressure has risen to within 30 mmHg of the mean arterial pressure, which varies with the age and clinical status of the child. Management is by fasciotomy which should be wide and open and decompress all affected compartments. Thirty children with raised intracompartmental pressure are reported: 21 children were managed non-operatively and nine underwent fasciotomy. Two children with absolute intracompartmental pressures of 28 mmHg and 35 mmHg required fasciotomy, whereas five children with intra-compartmental pressures between 30 mmHg and 44 mmHg were managed non-operatively. In this latter group this policy resulted in no demonstrable morbidity.