Skeletal Muscle Necrosis in Pressurized Compartments Associated with Hemorrhagic Hypotension

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Abstract
Skeletal muscle necrosis is quantified using 99mTc stannous pyrophosphate (99mTc-PYP) in pressurized muscle compartments after severe blood loss. Six dogs (15-20 kg) were anesthetized by pentobarbital sodium (25 mg/kg i.v.) and hemorrhaged to a hypotensive state. Left hind-leg muscle compartments were pressurized to a level of 20 mm Hg for 6 h by infusing autologous plasma. Intracompartmental pressure was continuously monitored by the wick catheter. The right leg served as a control. Forty-eight hours following pressurization, 99mTc-PYP was injected i.v. and 3 h later the dog was sacrificed and pressurized and control muscles were resected simultaneously, weighed and counted for 99mTc-PYP uptake. Significant uptake appeared in muscle compartments pressurized for 6 h at 20 mm Hg, indicating that 20 mm Hg in a hypotensive state produces a degree of necrosis as great as that produced by 40-50 mm Hg in a normotensive state. An acute compartment syndrome occurs in a hypotensive individual at an intramuscular pressure level considerably less than the threshold pressure level in an individual with normal blood pressure.