Exploring Pandora’s box: a review of thoracic compartment syndrome

Compartment syndrome (CS) arises from increased pressure within a confined space, compromising organ function due to reduced blood flow and subsequent tissue hypo-xia 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.