Influence and reliability of lower-limb arterial occlusion pressure at different body positions.

Luke Hughes,Bruce Paton,Stephen D Patterson,Ben Rosenblatt,Conor Gissane,Mark Waldron,Owen Jeffries

doi:10.7717/peerj.4697

Abstract

BackgroundTotal arterial occlusive pressure (AOP) is used to prescribe pressures for surgery, blood flow restriction exercise (BFRE) and ischemic preconditioning (IPC). AOP is often measured in a supine position; however, the influence of body position on AOP measurement is unknown and may influence level of occlusion in different positions during BFR and IPC. The aim of this study was therefore to investigate the influence of body position on AOP.MethodsFifty healthy individuals (age = 29 ± 6 y) underwent AOP measurements on the dominant lower-limb in supine, seated and standing positions in a randomised order. AOP was measured automatically using the Delfi Personalised Tourniquet System device, with each measurement separated by 5 min of rest.ResultsArterial occlusive pressure was significantly lower in the supine position compared to the seated position (187.00 ± 32.5 vs 204.00 ± 28.5 mmHg, p < 0.001) and standing position (187.00 ± 32.5 vs 241.50 ± 49.3 mmHg, p < 0.001). AOP was significantly higher in the standing position compared to the seated position (241.50 ± 49.3 vs 204.00 ± 28.5 mmHg, p < 0.001).DiscussionArterial occlusive pressure measurement is body position dependent, thus for accurate prescription of occlusion pressure during surgery, BFR and IPC, AOP should be measured in the position intended for subsequent application of occlusion.

Highlights

The technique of occluding limb blood flow using pneumatic tourniquet cuffs is applied in various settings, such as during surgery (Bussani & McEwen, 1988), blood flow restriction exercise (BFRE) (Hughes et al, 2017) and ischemic preconditioning (IPC) (Griffin et al, 2017)
Post hoc analysis revealed that arterial occlusive pressure (AOP) in the supine position was significantly lower compared to the seated position (187.00 ± 32.5 vs 204.00 ± 28.5 mmHg, respectively, p < 0.001), and the standing position (187.00 ± 32.5 vs 241.50 ± 49.3 mmHg, respectively, p < 0.001)
The findings of the present study have several important clinical implications. It appears that AOP is body position dependent

Summary

Introduction

The technique of occluding limb blood flow using pneumatic tourniquet cuffs is applied in various settings, such as during surgery (Bussani & McEwen, 1988), blood flow restriction exercise (BFRE) (Hughes et al, 2017) and ischemic preconditioning (IPC) (Griffin et al, 2017). Calculation of arterial occlusive pressure (AOP) involves determination of the pressure required to fully occlude arterial flow to the involved limb (AORN Recommended Practices Committee, 2007). This is most often achieved using Doppler ultrasound (Bezerra de Morais et al, 2016) and can be used to prescribe pressure at a relative percentage of AOP to standardise the level of occlusion across cohorts (Laurentino et al, 2012; Hughes et al, 2017; Patterson et al, 2017). Total arterial occlusive pressure (AOP) is used to prescribe pressures for surgery, blood flow restriction exercise (BFRE) and ischemic preconditioning (IPC). Discussion: Arterial occlusive pressure measurement is body position dependent, for accurate prescription of occlusion pressure during surgery, BFR and IPC, AOP should be measured in the position intended for subsequent application of occlusion

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