Pathophysiology: The compartment syndrome occurs when pressure within the thorax exceeds the tissue perfusion pressure. If the patient has had an expansion of the heart and/or lungs, then trying to close the thorax can result in increased pressure. These conditions may include:
(1) pulmonary edema
(2) acute ventricular dilatation
(3) cardiomegaly from myocardial edema
Occurrence of thoracic compartment syndrome:
(1) after cardiac surgery
(2) after thoracic surgery to repair a gunshot wound or other severe trauma involving the heart and aorta
Presentation: Closure of the sternum at surgery results in hemodynamic instability or collapse. The may show:
(1) decrease in arterial oxygen saturation
(2) increased airway pressures, first manifested as a rising peak inspiratory pressure during closure
(3) hypotension and asystole
This can be prevented by
(1) delayed sternal or thoracic wall closure, allowing the organs to reduce in size prior to closure.
(2) therapy to reduce pulmonary edema
