RAISED COMPARTMENTAL PRESSURE IN CHILDREN - A BASIS FOR MANAGEMENT

In children, raised intracompartmental pressure which may lead to a co mpartment syndrome is relatively common and follows a wide variety of insults. Cell viability is compromised at much lower compartmental pre ssures than in adults, and clinical awareness must be heightened espec ially in the hypotensive child. Suspicion follows an awareness of clin ical situations associated with the risk of raised compartmental press ure. Clinical confirmation may be difficult in the context of the unco operative child. Diagnosis is established by invasive pressure monitor ing. Intervention becomes mandatory when the compartmental pressure ha s risen to within 30 mmHg of the mean arterial pressure, which varies with the age and clinical status of the child. Management is by fascio tomy which should be wide and open and decompress all affected compart ments. Thirty children with raised intracompartmental pressure are rep orted: 21 children were managed non-operatively and nine underwent fas ciotomy. Two children with absolute intracompartmental pressures of 28 mm Hg and 35 mmHg required fasciotomy whereas five children with intr acompartmental pressures between 30 mmHg and 44 mmHg were managed non- operatively In this latter group this policy resulted in no demonstrab le morbidity. (C) 1998 Elsevier Science Ltd. All rights reserved.