Intermittent Pneumatic Leg Compression Research Articles

Effect of pneumatic leg compression on phenylephrine dose for hypotension prophylaxis via variable rate infusion at cesarean delivery: an unblinded randomized controlled trial

BackgroundPhenylephrine infusion is recommended to prevent spinal hypotension during cesarean delivery (CD) but may be associated with dose-dependent side effects. We hypothesized that adding intermittent pneumatic compression (IPC) of the lower legs to a variable-rate phenylephrine infusion will reduce the dose of phenylephrine required during CD. MethodsSeventy-six healthy women undergoing elective CD under combined spinal-epidural anesthesia were randomly assigned to IPC or control groups (n = 38 per group). After spinal anesthesia, IPC of the lower legs was initiated in the IPC group, and all women received a phenylephrine infusion starting at 25 μg·min−1 and increasing by 16.7 μg·min−1 for systolic blood pressure (SAP) < 90% baseline. If hypotension (SAP < 80% baseline) occurred, 100 μg phenylephrine bolus was administered. The primary outcome was the dose of phenylephrine per minute. ResultsThe dose of phenylephrine per minute (34.4 ± 7.3 μg·min−1 vs. 40.9 ± 9.5 μg·min−1, P = 0.001; mean difference −6.6 μg·min−1, 95% CI −10.5 to −2.7 μg·min−1) and the incidence of hypotension (24% vs. 55%, P = 0.005) were lower in the IPC group than in the control group. There were no significant differences between the two groups in the total dose of phenylephrine (603.2 ± 217.1 μg vs. 706.2 ± 247.5 μg, P = 0.058; mean difference −102.9 μg, 95% CI −209.4 to 3.5 μg), maternal side effects, or neonatal outcomes. ConclusionsIntermittent pneumatic compression combined with a variable-rate phenylephrine infusion reduced the phenylephrine dose per minute and the incidence of hypotension during CD under spinal anesthesia.

Can combined intermittent pneumatic leg compression and pharmacological prophylaxis prevent venous thromboembolism in people undergoing surgery?

Can combined intermittent pneumatic leg compression and pharmacological prophylaxis prevent venous thromboembolism in people undergoing surgery?

Combined Intermittent Pneumatic Leg Compression and Pharmacological Prophylaxis for Prevention of Venous Thromboembolism

Combined Intermittent Pneumatic Leg Compression and Pharmacological Prophylaxis for Prevention of Venous Thromboembolism

Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism.

Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism.

Stroke and Thromboprophylaxis in the Era of COVID-19

Stroke and Thromboprophylaxis in the Era of COVID-19

Combined Intermittent Pneumatic Leg Compression and Pharmacological Prophylaxis for Prevention of Venous Thromboembolism.

Combined Intermittent Pneumatic Leg Compression and Pharmacological Prophylaxis for Prevention of Venous Thromboembolism.

Invited commentary

We thoroughly enjoyed reading this study by Dr Labropolous and colleagues, in which they clearly demonstrate that the use of intermittent pneumatic compression (IPC) devices is fraught with difficulties, even after implementation of strategies to improve compliance. The physiologic effects of IPC can be grouped into hemodynamic, hematologic, flow-induced alterations of the endothelium of the veins and an increase in lymphatic drainage. IPC devices prevent venous thromboembolism (VTE) by reducing venous stasis and increasing endogenous fibrinolytic potential. It remains unknown which of these effects is most important for the prevention of VTE. Nonetheless, for the hemodynamic effects, correct calf application of IPC and continuous use are required to be effective. Several large meta-analyses have demonstrated that IPC use alone can reduce the incidence of deep venous thrombosis (DVT) by >60%, with even greater reduction by the combination of pharmacologic and mechanical prophylaxis. 1 Delos Reyes A.P. Partsch H. Mosti G. Obi A. Lurie F. Report from the 2013 meeting of the International Compression Club on advances and challenges of compression therapy. J Vasc Surg Venous Lymphat Disord. 2014; 2: 469-476 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar A recent Cochrane review concluded that on the basis of moderate-quality evidence, combining IPC with pharmacologic prophylaxis, compared with IPC or pharmacologic prophylaxis alone, decreased DVT compared with compression and decreased pulmonary embolism compared with anticoagulation. The addition of pharmacologic prophylaxis to IPC increased the risk of bleeding compared with IPC alone, but not the other way around. 2 Kakkos S.K. Caprini J.A. Geroulakos G. Nicolaides A.N. Stansby G.P. Reddy D.J. et al. Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism. Cochrane Database Syst Rev. 2016; 9: CD005258 PubMed Google Scholar The proper use of IPC is unequivocally an important preventive strategy. The staff and patient perspectives on compliance with mechanical prophylaxis for venous thromboembolismJournal of Vascular Surgery: Venous and Lymphatic DisordersVol. 6Issue 4PreviewThis study evaluated the accuracy of assessment and compliance with proper use of intermittent pneumatic compression (IPC) devices before and after implementation of education, accountability, and oversight measures for health care providers. Full-Text PDF

Can combined intermittent pneumatic leg compression and pharmacological prophylaxis prevent venous thromboembolism in people undergoing surgery?

Can combined intermittent pneumatic leg compression and pharmacological prophylaxis prevent venous thromboembolism in people undergoing surgery?

Thromboprophylaxis in Elderly Surgical Patients: Current State and Future Considerations.

Venous thromboembolism is the number one cause of preventable death for hospital inpatients. Aging general surgical patients are especially susceptible to DVT/PE and this risk increases in the presence of other comorbidities prevalent in the elderly. However, it is often unrecognised and undertreated. Various risk scores classify patients in low, moderate and high risk categories. Current guidelines for thromboprophylaxis advocate combination of mechanical methods in the form of elastic stockings or intermittent pneumatic leg compression and pharmacological agents such as low molecular weight heparins and oral anticoagulants. Increased bleeding risk is a concern in this population and the method of prophylaxis needs to be adjusted as a result. Decreased renal function also influences the choice and dosage of medication. The required duration of prophylaxis is unclear but can range from one week to more than a month depending on the underlying pathology and individual risk assessment.

Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism.

It is generally assumed by practitioners and guideline authors that combined modalities (methods of treatment) are more effective than single modalities in preventing venous thromboembolism (VTE), defined as deep vein thrombosis (DVT) or pulmonary embolism (PE), or both. This is an update of the review first published in 2008.The aim of this review was to assess the efficacy of combined intermittent pneumatic leg compression (IPC) and pharmacological prophylaxis versus single modalities in preventing venous thromboembolism.For this update the Cochrane Vascular Information Specialist (CIS) searched the Specialised Register (May 2016). In addition the CIS searched the Cochrane Register of Studies (CENTRAL (2016, Issue 4)). Clinical trials databases were searched for details of ongoing or unpublished studies.Randomized controlled trials (RCTs) or controlled clinical trials (CCTs) of combined IPC and pharmacological interventions used to prevent VTE.We independently selected trials and extracted data. Disagreements were resolved by discussion. We performed fixed-effect model meta-analyses with odds ratios (ORs) and 95% confidence intervals (CIs). We used a random-effects model when there was heterogeneity.We included a total of 22 trials (9137 participants) of which 15 were randomized trials (7762 participants). The overall risk of bias was mostly unclear or high due to selection and performance bias. We used GRADE to assess the quality of the evidence and this was downgraded from high to moderate or very low due to the risk of bias, imprecision or indirectness.The rate of PE in the studies comparing IPC alone with combined IPC and pharmacological prophylaxis was low, underpowering the analyses. The incidence of symptomatic PE was 0.79% with IPC, but ranged between 0.1 to 1% with combined IPC and pharmacological prophylaxis (OR 0.49, 95% CI 0.18 to 1.34; 12 studies, 3017 participants, moderate quality evidence). The incidence of DVT was 4.10% in the IPC group and 2.19% in the combined group showing a reduced incidence of DVT in favour of the combined group (OR 0.52, 95% CI 0.33 to 0.82; 11 studies, 2934 participants, moderate quality evidence). The addition of an anticoagulant to IPC, however, increased the risk of any bleeding compared to IPC alone; 0.66% (7/1053) in the IPC group and 4.0% (44/1102) in the combined group (OR 5.04, 95% CI 2.36 to 10.77; 7 studies, 2155 participants, moderate quality evidence). Major bleeding followed a similar pattern; 0.1% (1/1053) in the IPC group to 1.5% (17/1102) in the combined group (OR 6.81, 95% CI 1.99 to 23.28; 7 studies, 2155 participants, moderate quality evidence).We detected no difference between the type of surgery subgroups such as orthopedic and non-orthopedic participants for DVT incidence (P = 0.16). Tests for differences between type of surgery subgroups were not possible for PE incidence.Compared with pharmacological prophylaxis alone, the use of combined IPC and pharmacological prophylaxis modalities reduced the incidence of symptomatic PE from 2.92% to 1.20% (OR 0.39, 95% CI 0.23 to 0.64; 10 studies, 3544 participants, moderate quality evidence). The incidence of DVT was 6.2% in the pharmacological prophylaxis group and 2.9% in the combined group showing no difference between the combined and pharmacological prophylaxis groups (OR 0.42, 95% CI 0.18 to 1.03; 11 studies, 2866 participants, moderate quality evidence). Increased bleeding side effects were not observed for IPC when it was added to anticoagulation (bleeding: OR 0.80, 95% CI 0.30 to 2.14, very low quality evidence; major bleeding: OR 1.21, 95% CI 0.35 to 4.18, very low quality evidence, 3 studies, 244 participants).No difference was detected between the type of surgery subgroups for PE incidence (P = 0.68) or for DVT incidence (P = 0.10).Moderate quality evidence suggests that combining IPC and pharmacological prophylaxis, compared with IPC or pharmacological prophylaxis alone, decreases the incidence of DVT when compared to compression, and incidence of PE when compared to anticoagulation. Moderate quality evidence suggests that there is no difference between combined and single modalities in the incidence of PE when compared with compression alone and DVT when compared with anticoagulation alone. The quality of evidence for PE or DVT was downgraded to moderate due to imprecision or risk of bias in study methodology, highlighting the need for further research. Moderate quality evidence suggests the addition of pharmacological prophylaxis to IPC, increased the risk of bleeding compared to IPC alone, a side effect not observed for IPC when added to pharmacological prophylaxis (very low quality evidence), as expected for a physical method of thromboprophylaxis. The quality of evidence for bleeding was downgraded to moderate due to indirectness or very low due to risk of bias in study methodology, indirectness and imprecision highlighting the need for further research. Nevertheless, the results of the current review agree with current guideline recommendations, which support the use of combined modalities in hospitalised patients (limited to those with trauma or undergoing surgery) at risk of developing VTE. More studies on the role of combined modalities in VTE prevention are needed.

Wound Healing Society 2014 update on guidelines for arterial ulcers.

Wound Healing Society 2014 update on guidelines for arterial ulcers.

The effect of intermittent pneumatic compression of legs on the levels of nitric oxide related species in blood and on arterial function in the arm

BackgroundIntermittent pneumatic compression (IPC) of legs exerts beneficial local vascular effects, possibly through local release of nitric oxide (NO). However, studies demonstrating systemic transport of nitrogen oxide species and release of NO prompt the question of whether IPC could also exert nonlocal effects. We tested whether IPC (1) affects systemic levels of nitrite, S-nitrosothiols and red blood cell (RBC) NO, and (2) exerts vasoactive effects in the brachial artery (BA), although this hypothesis-generating pilot study did not investigate cause and effect relationship between (1) and (2). MethodsIn 10 healthy subjects, ages 24–39years, we measured plasma nitrite, plasma S-nitrosothiols and RBC-NO from venous blood samples drawn before and after IPC treatment. We also measured BA responses to 5min of upper arm occlusion at rest and during1h of leg IPC. ResultsThere was a significant decrease in plasma nitrite (112±26nM to 90±15nM, p=0.0008) and RBC-NO (129±72nM to 102±41nM, p=0.02). Plasma S-nitrosothiols were unchanged (5.79±4.81nM to 6.27±5.79nM, p=0.3). BA occlusion-mediated constriction (OMC) was significantly attenuated with IPC treatment (−43±13% to −33±12%, p=0.003). High-flow mediated BA dilation was unchanged (13.3±9.4% to 11.5±7.2%, p=0.2). ConclusionPlasma nitrite, RBC-NO, and BA OMC decreased with leg IPC. We hypothesize that this decrease in circulatory pool of plasma nitrite and RBC-NO may result from the transfer of their NO-bioactivity from blood to the hypoxic arm tissue, to be stored and released under hypoxic stress and oppose OMC. Future studies should investigate whether IPC-induced decreases in brachial OMC are caused by the changes in systemic NO activity, and whether leg IPC could benefit distant arterial function in systemic cardiovascular disease.

Heparin thromboprophylaxis in critically ill patients: Is it really changing outcome?

Heparin thromboprophylaxis in critically ill patients: Is it really changing outcome?

Does Intermittent Pneumatic Leg Compression Enhance Muscle Recovery after Strenuous Eccentric Exercise?

Intermittent pneumatic compression (IPC) has gained rapid popularity as a post-exercise recovery modality. Despite its widespread use and anecdotal claims for enhancing muscle recovery there is no scientific evidence to support its use. 10 healthy, active males performed a strenuous bout of eccentric exercise (3 sets of 100 repetitions) followed by IPC treatment or control performed immediately after exercise and at 24 and 48 h post-exercise. Muscular performance measurements were taken prior to exercise and 24, 48 and 72 h post-exercise and included single-leg vertical jump (VJ) and peak and average isometric [knee angle 75º] (ISO), concentric (CON) and eccentric (ECC) contractions performed at slow (30° · s⁻¹) and fast (180° · s⁻¹) velocities. Plasma creatine kinase (CK) samples were taken at pre- and post-exercise 24, 48 and 72 h. Strenuous eccentric exercise resulted in a significant decrease in peak ISO, peak and average CON (30° · s⁻¹) at 24 h compared to pre-exercise for both IPC and control, however VJ performance remained unchanged. There were no significant differences between conditions (IPC and control) or condition-time interactions for any of the contraction types (ISO, CON, ECC) or velocities (CON, ECC 30° · s⁻¹ and 180° · s⁻¹). However, CK was significantly elevated at 24 h compared to pre-exercise in both conditions (IPC and control). IPC did not attenuate muscle force loss following a bout of strenuous eccentric exercise in comparison to a control. While IPC has been used in the clinical setting to treat pathologic conditions, the parameters used to treat muscle damage following strenuous exercise in healthy participants are likely to be very different than those used to treat pathologic conditions.

Acute effects of intermittent pneumatic compression induced hemodynamics on vascular function in humans

Intermittent pneumatic leg compression (IPC) therapy is commonly used to treat symptoms associated with peripheral artery disease. One hypothesis is that IPC increases shear rate (SR) in the arteries and enhances endothelial cell (EC) function. To test this hypothesis we characterized the hemodynamic profile and used flow mediated dilation (FMD) to assess EC function in response to a single session of high frequency (HF) and low frequency (LF) IPC. Eleven male subjects (age: 23.5 ± 4.7 years) underwent an hour of HF (2s inflation/3s deflation) and LF (4s inflation/16s deflation) IPC treatment on separate days. Doppler/ultrasonography of the popliteal artery (PA) was used to measure diameter and blood velocity at the 5th and 45th minute of treatment and to assess FMD pre and post treatment. IPC had no effect on PA FMD (HF: pre: 2.45±.50%, post: 2.76 ±.32%; LF: pre: 3.16±.36%, post: 3.56±.52%). Cuff deflation elevated blood flow (BF) and SR and decreased oscillatory shear index (OSI) from baseline at the onset of both treatments (p&lt;.01). This effect was no longer evident by the 45th minute of HF treatment only. When compared to baseline both treatments significantly reduced BF and SR and increased OSI during cuff inflation (p&lt;.01). In conclusion, a single session of IPC does not acutely impact PA FMD despite significant alterations to the hemodynamic profile during treatment. HL35088 (MHL, BTR); ACSM Research Endowment (SCN)

Acute impact of intermittent pneumatic leg compression frequency on limb hemodynamics, vascular function, and skeletal muscle gene expression in humans

The mechanisms by which intermittent pneumatic leg compression (IPC) treatment effectively treats symptoms associated with peripheral artery disease remain speculative. With the aim of gaining mechanistic insight into IPC treatment, the purpose of this study was to investigate the effect of IPC frequency on limb hemodynamics, vascular function, and skeletal muscle gene expression. In this two study investigation, healthy male subjects underwent an hour of either high-frequency (HF; 2-s inflation/3-s deflation) or low-frequency (LF; 4-s inflation/16-s deflation) IPC treatment of the foot and calf. In study 1 (n = 11; 23.5 ± 4.7 yr), subjects underwent both HF and LF treatment on separate days. Doppler/ultrasonography was used to measure popliteal artery diameter and blood velocity at baseline and during IPC treatment. Flow-mediated dilation (FMD) and peak reactive hyperemia blood flow (RHBF) were determined before and after IPC treatment. In study 2 (n = 19; 22.0 ± 4.6 yr), skeletal muscle biopsies were taken from the lateral gastrocnemius of the treated and control limb at baseline and at 30- and 150-min posttreatment. Quantitative PCR was used to assess mRNA concentrations of genes associated with inflammation and vascular remodeling. No treatment effect on vascular function was observed. Cuff deflation resulted in increased blood flow (BF) and shear rate (SR) in both treatments at the onset of treatment compared with baseline (P < 0.01). BF and SR significantly diminished by 45 min of HF treatment only (P < 0.01). Both treatments reduced BF and SR and elevated oscillatory shear index compared with baseline (P < 0.01) during cuff inflation. IPC decreased the mRNA expression of cysteine-rich protein 61 from baseline and controls (P <0 .01) and connective tissue growth factor from baseline (P < 0.05) in a frequency-dependent manner. In conclusion, a single session of IPC acutely impacts limb hemodynamics and skeletal muscle gene expression in a frequency-dependent manner but does not impact vascular function.

Prevention of Venous Thromboembolic Events After Gynecologic Surgery

Venous thromboembolic events (deep vein thrombosis [DVT] and pulmonary embolism) are serious preventable complications associated with gynecologic surgery. Preoperative risk assessment of the individual patient will provide insight into the level of risk and the potential benefits of prophylaxis. Common risks include a history of venous thromboembolism, age, major surgery, cancer, use of oral contraceptives or hormone therapy, and obesity. Based on the presence of risk factors, the patient should be categorized into one of four risk groups and appropriate thromboprophylaxis prescribed. Randomized clinical trials in gynecologic surgery and general surgery have established the significant value of thromboprophylaxis. For moderate- and high-risk patients undergoing surgery for benign gynecologic conditions, low-dose unfractionated heparin, low molecular weight (LMW) heparins, intermittent pneumatic leg compression, and graded compression stockings all have demonstrated benefit. If using low-dose unfractionated heparin in high-risk patients, the heparin should be administered 5,000 units every 8 hours. Because DVT often begins in the perioperative period, it is important to initiate low-dose unfractionated heparin or administer the first LMW heparin dose either 2 hours preoperatively or 6 hours after the surgical procedure. Low molecular weight heparin has the advantage of being administered once daily but is more expensive than low-dose unfractionated heparin. In addition, LMW heparin has not been shown to be more effective and has similar risk of bleeding complications when compared with low-dose unfractionated heparin. In the very high-risk patient, a combination of two prophylactic methods may be advisable and continuing LMW heparin for 28 days postoperatively appears to be of added benefit.

Effect of Intermittent Pneumatic Compression of Legs On Blood Nitric Oxide and Brachial Artery Diameter

Effect of Intermittent Pneumatic Compression of Legs On Blood Nitric Oxide and Brachial Artery Diameter

Effects of intermittent pneumatic leg compression on peripheral circulation and systemic hemodynamics during hemodialysis

Effects of intermittent pneumatic leg compression on peripheral circulation and systemic hemodynamics during hemodialysis

Review: compression plus pharmacological prophylaxis reduces VTE more than monotherapy in high-risk patients

S K Kakkos Dr S K Kakkos, Henry Ford Hospital, Detroit, MI, USA; kakkosstavros@gmail.com; s.kakkos@imperial.ac.uk How does intermittent pneumatic leg compression (IPC) plus pharmacological prophylaxis compare with either monotherapy for...