CRITICAL CARE - ADULTS / REVIEW ARTICLE
Exploring Pandora’s box: a review of thoracic compartment syndrome
1
Department of Intensive Care, Fundación Clínica Shaio, Bogota D.C., Colombia
2
Facultad de Medicina, Doctorado en Ciencias Clínicas, Universidad de La Sabana, Chía, Cundinamarca, Colombia
3
Department of Medicine, Critical Care Resident, Universidad de La Sabana, Chía, Cundinamarca, Colombia
4
Department of Critical Care Medicine, Extracorporeal Life Support Unit, Fundación Clínica Shaio, Bogotá D.C., Colombia
These authors had equal contribution to this work
Submission date: 2025-01-20
Final revision date: 2025-10-27
Acceptance date: 2025-11-07
Publication date: 2025-12-19
Corresponding author
Anaesthesiol Intensive Ther 2025;57(1):381-387
KEYWORDS
TOPICS
ABSTRACT
Compartment syndrome (CS) arises from increased pressure within a confined space, compromising organ function due to reduced blood flow and subsequent tissue hypoxia and ischemia. Thoracic compartment syndrome (TCS), a subset of CS, occurs in diverse surgical and medical conditions, particularly cardiac surgery, chest trauma, and critical care scenarios, significantly contributing to morbidity and mortality. However, the absence of a standardized definition hinders timely diagnosis and treatment.
This study systematically explores the clinical presentation, pathophysiology, and causes of TCS, aiming to establish a comprehensive definition to guide diagnosis and research. A multi-stage review process was employed. Two independent reviewers screened titles, abstracts, and full texts of studies identified through databases such as PubMed, Scopus, Embase, Google Scholar, and SpringerLink, complemented by gray literature searches in NTIS and EAGLE. Inclusion criteria focused on adult patients, excluding pediatric and obstetric populations. The search spanned all relevant studies published up to December 20, 2024.
TCS remains under-recognized yet poses significant risks in critically ill patients. This article proposes a definition grounded in evidence and pathophysiological insights to aid diagnosis and future investigations into this life-threatening condition.
REFERENCES (28)
1.
Malbrain MLNG, Roberts DJ, Sugrue M, De Keulenaer BL, Ivatury R, Pelosi P, et al. The polycompartment syndrome: a concise state-of-the-art review. Anaesthesiol Intensive Ther 2014; 46: 433-450. DOI: 10.5603/AIT.2014.0064.
2.
Balogh ZJ, Butcher NE. Compartment syndromes from head to toe. Crit Care Med 2010; 38 (Suppl 9): S445-S451. DOI: 10.1097/CCM. 0b013e3181ec5d09.
3.
Shurtleff EM, Galante JM. Definition, pathomechanism of the thoracic compartment syndrome. In: Coccolini F, Malbrain ML, Kirkpatrick AW, Gamberini E (eds.). Compartment syndrome. Hot topics in acute care surgery and trauma. Cham: Springer; 2021, pp. 35-39.
4.
Huber W, Zanner R, Schneider G, Schmid R, Lahmer T. Assessment of regional perfusion and organ function: less and non-invasive techniques. Front Med (Lausanne) 2019; 6: 50. DOI: 10.3389/fmed. 2019.00050.
5.
Mauri T, Yoshida T, Bellani G, Goligher EC, Carteaux G, Rittayamai N, et al. Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives. Intensive Care Med 2016; 42: 1360-1373. DOI: 10.1007/s00134-016-4400-x.
6.
Riahi M, Tomatis LA, Schlosser RJ, Bertolozzi E, Johnston DW. Cardiac compression due to closure of the median sternotomy in open heart surgery. Chest 1975; 67: 113-114. DOI: 10.1378/chest.67.1.113.
7.
Kaplan LJ, Trooskin SZ, Santora TA. Thoracic compartment syndrome. J Trauma 1996; 40: 291-293. DOI: 10.1097/00005373-199602000-00021.
8.
Caputo G, Meda S, Piccioni A, Saviano A, Ojetti V, Savioli G, et al. Thoracic trauma: current approach in emergency medicine. Clin Pract 2024; 14: 1869-1885. DOI: 10.3390/clinpract14050148.
9.
Iaizzo PA. Handbook of cardiac anatomy, physiology, and devices. 3rd ed. Cham: Springer; 2015, pp. 1-817.
10.
Akhter SA. The heart and pericardium. Thorac Surg Clin 2011; 21: 205-217. DOI: 10.1016/j.thorsurg.2011.01.007.
11.
Drake RL, Vogl AW, Mitchell AWM (eds.). Gray’s anatomy for students. 4th ed. Philadelphia: Elsevier; 2020, pp. 1-1180.
12.
Bischin AM, Manning HL, Feller-Kopman D. Lung story short: differing physiology of tension pneumothorax in spontaneously breathing and mechanically ventilated patients. Ann Am Thorac Soc 2022; 19: 1760-1763. DOI: 10.1513/AnnalsATS.202203-188CC.
13.
Talmor D, Sarge T, Malhotra A, O’Donnell CR, Ritz R, Lisbon A, et al. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med 2008; 359: 2095-2104. DOI: 10.1056/NEJMoa0708638.
14.
Akay MH, Frazier OH. Thoracic compartment syndrome: a case report. Heart Surg Forum 2012; 15: E46-E48. DOI: 10.1532/HSF98. 20111071.
15.
Alviar CL, Miller PE, McAreavey D, Katz JN, Lee B, Moriyama B, et al. Positive pressure ventilation in the cardiac intensive care unit. J Am Coll Cardiol 2018; 72: 1532-1553. DOI: 10.1016/j.jacc.2018. 06.074.
16.
Sanfilippo F, Messina A, Scolletta S, Bignami E, Morelli A, Cecco- ni M, et al. The “CHEOPS” bundle for the management of left ventricular diastolic dysfunction in critically ill patients: an experts’ opinion. Anaesth Crit Care Pain Med 2023; 42: 101283. DOI: 10.1016/ j.accpm.2023.101283.
17.
Persichini R, Lai C, Teboul JL, Adda I, Guérin L, Monnet X. Venous return and mean systemic filling pressure: physiology and clinical applications. Crit Care 2022; 26: 150. DOI: 10.1186/s13054-022-04024-x.
18.
Rizzo AG, Sample GA. Thoracic compartment syndrome secondary to a thoracic procedure: a case report. Chest 2003; 124: 1164-1168. DOI: 10.1378/chest.124.3.1164.
19.
MacKay EJ, Niu NT, Cannon JW, Kaplan LJ, Pascual JL. Prolonged mechanical rib separation is a key element to prevent thoracic compartment syndrome in penetrating chest trauma: a case report. Trauma Case Rep 2021; 34: 100498. DOI: 10.1016/j.tcr.2021.100498.
20.
Wauters J, Claus P, Brosens N, McLaughlin M, Hermans G, Mal- brain M, Wilmer A. Relationship between abdominal pressure, pulmonary compliance, and cardiac preload in a porcine model. Crit Care Res Pract 2012; 2012: 763181. DOI: 10.1155/2012/763181.
21.
Robba C, Taccone FS. How I use transcranial doppler. Crit Care 2019; 23: 420. DOI: 10.1186/s13054-019-2700-6.
22.
Hess DR. Respiratory mechanics in mechanically ventilated patients. Respir Care 2014; 59: 1773-1794. DOI: 10.4187/respcare.03410.
23.
Belletti A, Lerose CC, Zangrillo A, Landoni G. Vasoactive-inotropic score: evolution, clinical utility, and pitfalls. J Cardiothorac Vasc Anesth 2021; 35: 3067-3077. DOI: 10.1053/j.jvca.2020.09.117.
24.
Pérez-Calatayud ÁA, Esper RC, Gasca-Aldama JC, Linarte-Basilio ME, Anica-Malagon ED, Briones-Garduño JC. Perioperative ultrasound neuromonitoring: transcraneal Doppler and optic nerve. Cir Cir 2019; 87: 580-586. DOI: 10.24875/CIRU.18000501.
25.
Xanthopoulos A, Starling RC, Kitai T, Triposkiadis F. Heart failure and liver disease: cardiohepatic interactions. JACC Heart Fail 2019; 7: 87-97. DOI: 10.1016/j.jchf.2018.10.007.
26.
Kimball EJ. Intra-abdominal hypertension and abdominal compartment syndrome: a current review. Curr Opin Crit Care 2021; 27: 164-168. DOI: 10.1097/MCC.0000000000000797.
27.
Sutherasan Y, Vargas M, Pelosi P. Protective mechanical ventilation in the non-injured lung: review and meta-analysis. Crit Care 2014; 18: 211. DOI: 10.1186/cc13778.
28.
Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016; 29: 277-314. DOI: 10.1016/j.echo.2016.01.011.
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| ISSN: | 1642-5758 |
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