Pneumatic Compression Devices Research Articles

Conventional versus facilitated hemostatic dressings after radial artery puncture: a systematic review and meta-analysis

Abstract In the last thirty years, transradial access (TRA) became the gold standard access site for minimal invasive coronary diagnostics and therapy. Though the complication rate is relatively low, TRA is frequently iterated, therefore the slightest improvement could be utmost beneficial for a big proportion of cardiology patients. In recent few years, facilitated hemostatic dressings with the utilisation of chitosan and potassium ferrate molecules were introduced into the clinical practice to improve postprocedural hemostasis. The available evidence suggests that the novel dressings are decreasing complication numbers, but currently no coherent meta-analysis is available on the subject. We hypothesised that better clinical outcomes can be expected with the novel facilitated hemostatic dressings in terms of radial artery occlusion, radial artery damage, time to hemostasis and hematoma events compared to conventional mechanical compression devices. A systematic search was performed in Medline, Central Web of Science, Scopus and Embase on 13th January, 2023. Randomised controlled trials comparing chitosan and potassium-ferrate covered dressings to pneumatic or screwable mechanical compression devices. Observational studies, trials not reporting outcomes or containing scientifically unproven devices were excluded. The RoB 2 tool was used for risk of bias assessment, which was low across the included studies. As primary endpoint, radial artery occlusion (RAO) was determined, the secondary endpoints were hematoma events, time to hemostasis and radial artery damage (dissection, pseudoaneurysm). Raw data from the selected studies were pooled using a random effects model with the Mantel-Haenszel method and the Hartung-Knapp adjustment. Statistical heterogeneity across trials was assessed by means of Cochrane Q test, and the I2 values. Data of a total of 3524 patients were collected from 7 randomised controlled trials. Concerning the primary endpoint, RAO, a 0.70 relative risk (RR) was found (p=0.028, confidence interval (CI): 0.52-0.95) in favour of the facilitated hemostatic devices. In the chitosan subgroup a lower tendency of RAO in the facilitated group (RR: 0.66 p=0.059 CI: 0.42-1.03) was found. In the potassium ferrate subgroup no significant difference was observed between the devices (RR: 0.93 p=0.819 CI: 0.27-3.20). Low grade (EASY I/II) hematoma events were not significantly different between the two examined groups (RR: 0.76 p=0.268 CI: 0.43-1.32). Time to hemostasis was 95.8 (mean difference, p≺0.001 CI: 46.8-144.9) minutes shorter in the facilitated devices group from 5 studies containing 2132 patient’s data. This meta-analysis includes the largest number of patients for facilitated hemostatic dressings to date. These devices lower the incidence of RAO by 30% compared to mechanical compression devices with the additional advantage of reduced compression times. More randomised controlled clinical trials are needed in the subject.

Prevention of venous thromboembolism in acute spontaneous intracerebral haemorrhage: A survey of opinion

IntroductionPeople immobilized following acute spontaneous intracerebral haemorrhage (ICH) are at risk of venous thromboembolism (VTE) but the role of short-term prophylactic anticoagulation remains uncertain. We surveyed UK clinical practice and opinion regarding preventing VTE after ICH. Patients and methodsAn online survey was sent to stroke healthcare professionals within the United Kingdom and Ireland via a professional society (British and Irish Association of Stroke Physicians (BIASP)). ResultsOne hundred and twenty-three staff members responded to the survey, of whom 80% were consultant stroke physicians. All responders except one considered the issue to be important or extremely important, but only 5 (4%) were “extremely certain” and 51 (41%) “fairly certain” regarding the optimal treatment approach. Intermittent pneumatic compression (IPC) devices alone were the most used method (in 60%) followed by IPC devices and switching to low molecular weight heparin (LMWH) (in 30%). We identified high levels of uncertainty regarding the role of anticoagulation, and its optimal timing; uncertainty was greater in lobar compared to deep ICH. Most respondents (93%) consider a randomised controlled trial investigating the role of pharmacological VTE prophylaxis after acute ICH as important and would consider participation. Discussion and conclusionThe optimal method for the prevention of VTE in non-traumatic ICH patients remains an area of clinical uncertainty. Clinical trials assessing short-term anticoagulation in patients after acute ICH would be beneficial in providing evidence to resolve this clinical dilemma.

Coverage News You Can Use: Pneumatic Compression Devices and Surgical Dressings.

Coverage News You Can Use: Pneumatic Compression Devices and Surgical Dressings.

The Wound Express System, A Potential Treatment for Patients with Ulcers and Non-Operable Arterial Disease: A Pilot Safety Study

Background: Intermittent pneumatic compression (IPC) devices apply intermittent compression to the thigh, which is thought to facilitate wound healing by improving wound perfusion in patients with chronic limb-threatening ischemia and no option for revascularization. Wound Express is an IPC device but its safety and efficacy are currently unclear. In this study, we aimed to determine the safety of the Wound Express IPC system in this high-risk cohort.Methods: This was a prospective, non-controlled, non-randomized pilot safety study. In total, 19 patients were screened for inclusion and 10 were recruited. IPC was applied for 2 hours per day for 12 weeks. The primary endpoint was any treatment-related adverse event in the first 3 months. Secondary endpoints included pain using the visual analogue scale, limb status assessed using the Wound, Ischemia, Foot Infection (WIFi) score and quality of life using the Vascular Quality of Life Questionnaire (VASUQOL) score.Results: Of the 10 patients who were enrolled, eight completed the 12-week course. There were no treatment-related adverse events. One patient died from coronavirus disease 19-related disease and two withdrew for reasons unrelated to treatment. Median pain scores were reduced from 6 to 0, while median VASUQOL increased from 10 to 16.5. WIFi scores were reduced in three out of eight of participants (37.5%).Conclusion: Wound Express appears to be safe and may decrease pain, improve wound healing and improve quality of life for chronic limb-threatening ischemia patients. Adequately powered, prospectively randomized trials of the Wound Express system to assess its efficacy and safety are warranted.

An Evidenced-Based Review of the Prevention of Venous Thromboembolism in Traumatic Patients with Intermittent Pneumatic Compression Devices.

To search, evaluate, and summarize the best evidence of intermittent pneumatic compression devices to prevent venous thromboembolism in trauma patients. Evidence retrieval was conducted from top to bottom according to the "6S" evidence model, including guidelines, clinical decision making, evidence summary, expert consensus, and systematic reviews. The retrieval time limit was from the establishment of the database to August 31, 2022. Two researchers independently evaluated the quality of the literature, extracted evidence, and summarized evidence. A total of 140 studies were obtained in the literature retrieval, and 50 studies were obtained after rechecking and reading the title and abstract. After combining the inclusion and exclusion criteria, 19 studies were finally included. Among them, there were 12 guidelines, 1 clinical decision making, 1 evidence summary, 1 expert consensus, and 4 systematic reviews. The 27 best pieces of evidence were summarized from the four dimensions of pretreatment evaluation, contraindications and applicable conditions, treatment strategies, training, and patient education. This study summarized the evidence of using an intermittent pneumatic compression device to prevent venous thromboembolism in trauma patients and provided the basis for scientific and effective standardized management of mechanical thromboembolism prevention. When applying evidence, it is necessary to combine clinical practice and patient wishes and select evidence pertinent to improving the effectiveness of intermittent pneumatic compression devices in preventing venous thromboembolism. In addition, compliance with the clinical application of IPC is relatively low, so we should start from two aspects before the application of evidence. We should not only increase the number of IPCs but also strengthen the training of VTE prevention knowledge and practical skills of medical staff to provide good health education for patients and their families to improve compliance with the clinical application of IPC.

A Prospective Preliminary Study Examining the Physiological Impact of Pneumatic Compression Dosing in the Treatment of Lower Extremity Lymphedema.

Background: Optimal frequency and duration of pneumatic compression device (PCD) therapy for lymphedema is undetermined. This prospective, randomized preliminary study evaluated the impact of different PCD dosing protocols on physiological and patient-reported outcomes (PROs) to estimate treatment effects, assess the responsiveness of various measurement techniques, and identify endpoints for a definitive PCD dosing trial. Methods and Results: Twenty-one patients with lower extremity lymphedema were randomized into three groups for treatment with the Flexitouch advanced PCD: (A) once per day for 1 hour, 12 consecutive days; (B) twice per day in 1-hour treatments, 5 consecutive days; or (C) twice per day in 2-hour treatments, 5 consecutive days. Outcomes measured were changes in limb volume (LV), tissue fluid, tissue tone, and PROs. Those in group A experienced mean (standard deviation) LV reductions of 109 (58) mL (p = 0.003) on day 1 and of 97 (86) mL (p = 0.024) on day 5. Group A also showed possible single-treatment decreases in extracellular fluid volume by bioimpedance spectroscopy (BIS) on day 5. There were no consistent changes in groups B and C. Long-term assessment of LV and BIS showed no clear change. Tonometry, ultrasound, local tissue water, and PROs showed wide variation among participants. Conclusions: LV measurements showed potential benefit for 1-hour daily PCD treatment. A definitive dosing trial should include LV, BIS, and PROs in a comparison of 1- and 2-hour daily treatment protocols conducted over a study period of 4 weeks. These data may inform appropriate outcome measures for other intervention studies in lymphedema.

Final Analysis (NILE): A Randomized Control Cross-Over Clinical Study Comparing Dayspring: A Novel Wearable Compression Technology to Pneumatic Compression Device in the Treatment of Lymphedema

Final Analysis (NILE): A Randomized Control Cross-Over Clinical Study Comparing Dayspring: A Novel Wearable Compression Technology to Pneumatic Compression Device in the Treatment of Lymphedema

Intermittent pneumatic compression devices: time to reassess the evidence.

ANZ Journal of SurgeryEarly View PERSPECTIVE Intermittent pneumatic compression devices: time to reassess the evidence Natalie Lott MClinEpi, RN, Natalie Lott MClinEpi, RN orcid.org/0000-0001-5905-6357 Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia Hunter Surgical Clinical Research Unit, John Hunter Hospital, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Contribution: Conceptualization, Resources, Validation, Visualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorStephen Smith MS, PhD, Stephen Smith MS, PhD Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia Hunter Surgical Clinical Research Unit, John Hunter Hospital, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Department of Surgery, Calvary Mater Hospital, New South Wales, Newcastle, Australia Contribution: Conceptualization, Supervision, Validation, Visualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorJonathan Gani MBChB, MD, Jonathan Gani MBChB, MD orcid.org/0000-0003-0655-1877 Hunter Surgical Clinical Research Unit, John Hunter Hospital, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Contribution: Supervision, Validation, Visualization, Writing - review & editingSearch for more papers by this authorPenny Reeves BEc, PhD, Penny Reeves BEc, PhD School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Health Economics, Hunter Medical and Research Institute, Newcastle, New South Wales, Australia Contribution: Supervision, Validation, Visualization, Writing - review & editingSearch for more papers by this author Natalie Lott MClinEpi, RN, Natalie Lott MClinEpi, RN orcid.org/0000-0001-5905-6357 Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia Hunter Surgical Clinical Research Unit, John Hunter Hospital, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Contribution: Conceptualization, Resources, Validation, Visualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorStephen Smith MS, PhD, Stephen Smith MS, PhD Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia Hunter Surgical Clinical Research Unit, John Hunter Hospital, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Department of Surgery, Calvary Mater Hospital, New South Wales, Newcastle, Australia Contribution: Conceptualization, Supervision, Validation, Visualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorJonathan Gani MBChB, MD, Jonathan Gani MBChB, MD orcid.org/0000-0003-0655-1877 Hunter Surgical Clinical Research Unit, John Hunter Hospital, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Contribution: Supervision, Validation, Visualization, Writing - review & editingSearch for more papers by this authorPenny Reeves BEc, PhD, Penny Reeves BEc, PhD School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Health Economics, Hunter Medical and Research Institute, Newcastle, New South Wales, Australia Contribution: Supervision, Validation, Visualization, Writing - review & editingSearch for more papers by this author First published: 27 February 2023 https://doi.org/10.1111/ans.18342Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Pneumatic compression therapy using the EQ Press accelerates lymphatic flow in healthy equine forelimbs as determined by lymphoscintigraphy.

Limb lymphedema in horses can be debilitating and painful. Pneumatic compression therapy has shown significant benefits for people suffering from lymphedema. The objective of this study was to determine the effect of a novel, equine-specific pneumatic compression device on the lymphatic flow of healthy horse forelimbs as determined by Tc-99m sulfur colloid lymphoscintigraphy. 6 healthy Thoroughbreds. In a randomized crossover design, horses underwent bilateral forelimb lymphoscintigraphy following subcutaneous injection of Tc-99m sulfur colloid at the coronary band as untreated control or with pneumatic compression therapy using the EQ Press. Lateral, static images were obtained of the distal limb (time 0 to 60 minutes) and proximal limb (time 30 to 60 minutes) using a standard gamma camera. Lymphatic flow was determined by assigning a score to the time point at which Tc-99m sulfur colloid was first visualized at the level of the accessory carpal bone (1 to 7) in the distal limb and the cubital lymph node (1 to 4) in the proximal limb. EQ Press treatment led to a significantly faster lymphatic flow of Tc-99m sulfur colloid to the predetermined anatomic locations of the accessory carpal bone (P = .002) in the distal limb and the cubital lymph node (P = .001) in the proximal limb. Pneumatic compression therapy as provided by an equine-specific device encouraged lymphatic flow in healthy, nonedematous equine forelimbs. These data support further study of the EQ Press for pneumatic compression therapy in horses clinically affected by lymphedema and lymphatic drainage disorders.

Feasibility study of percutaneous thoracic duct embolization with lower-limb intermittent pneumatic compression devices

To demonstrate intranodal thoracic duct embolization (TDE) for treating chyle leaks following thoracic surgery and the feasibility of applying lower-limb intermittent pneumatic compression devices during TDE. Between December 2017 and October 2020, 12 consecutive TDEs for post-operative chyle leaks were performed in 11 patients using intranodal lymphangiogram (IL) with an intermittent pneumatic compressive device applied to the lower limb. The procedure's duration, technical/clinical success, and complications were retrospectively evaluated. IL was successful at imaging the thoracic duct in all procedures (100%), and TDE had an intention- to-treat success rate of 92% (11/12). No related complications were observed during follow-up, which took place at a mean of 27 days. The time from the commencement of lymphangiogram until visualization of the thoracic duct was a mean of 21.6 min, and the mean overall procedure time was 87.3 min. This study supports IL-guided TDE as a safe and effective option to treat post-thoracic surgery chyle leaks. We revealed shorter lymphangiogram times compared with previously published studies, and we postulate that the application of intermittent lower-limb pneumatic compressive devices contributed toward this study's results by expediting the return of lymph from the lower limb. This study is the first to illustrate this approach in TDE and advocates for randomized controlled studies to further evaluate the influence of intermittent pneumatic compressive devices on the procedure.

EE414 Cost-Effectiveness of Mobile Intermittent Pneumatic Compression Devices (IPCD) Compared to Traditional IPCD for Early Postoperative Total Knee Replacement: The Hospital’s Perspectives

EE414 Cost-Effectiveness of Mobile Intermittent Pneumatic Compression Devices (IPCD) Compared to Traditional IPCD for Early Postoperative Total Knee Replacement: The Hospital’s Perspectives

Comparison of intermittent pneumatic compression device and compression stockings for workers with leg edema and pain after prolonged standing: a prospective crossover clinical trial

BackgroundDuring prolonged standing, insufficient calf muscle pumping accompanies venous stasis and hypertension in the lower legs, resulting in valve dysfunction, venous wall problems, and sub-sequent inflammation. Compression therapy, which includes medical compression stockings (MCS) and mechanical intermittent pneumatic compression (IPC), is one of the most effective therapeutic interventions for treating chronic venous diseases. This study aimed to compare the therapeutic effect among resting, IPC and MCS alone, and IPC with MCS in long-standing workers (> 8 h daily).MethodsThis crossover trial was conducted with 39 participants with complaints of leg edema and pain whose work involved standing for more than 8 h daily. Four treatment protocols were established for each visit as follows: protocol A (not wear MCS during work and rest without IPC after work), protocol B (wear MCS during work and rest without IPC after work), protocol C (not wear MCS during work and treat with IPC after work), and protocol D (wear MCS during work and treat with IPC after work). The primary outcome was the visual analogue scale (VAS) score for leg pain. The secondary outcomes were leg volume (mL), circumference (cm), extracellular fluid/total body fluid (ECF/TBF), and extracellular water/total body water (ECW/TBW) through bioelectrical impedance analysis. Outcomes were assessed before work (T0), after work (T1), and 60 min after intervention (T2).ResultsAll four protocols had significantly increased leg pain after work (T0-1) but improved 60 min after intervention (T1-2), particularly protocol C (decreased VAS by 1.9). When leg swelling was compared at T0 and T1, protocols A and C showed significant increases in leg volume and circumference, indicating significant work-induced edema, whereas protocols B and D showed no change or even a decrease. After interventions, leg volume and circumference significantly decreased in protocols A and C, although protocols B and C did not show significant improvement. The ECF/TBF and ECW/TBW of all protocols decreased after interventions.ConclusionsLeg pain and edema after prolonged standing (T1-T2) in adults were safely and effectively improved by both IPC alone and IPC with MCS. Although the use of MCS during the workday did not show improvement in leg pain immediately after work (T0-T1), both MCS with resting and MCS with IPC decreased leg pain at T1-T2 and prevented leg edema at T0-T1.Trial registrationThis trial protocol was registered at the Clinical Research Information Service (KCT0005383, the date of first registration: 08/09/2020).

Clinical Impact of Severe Obesity in Patients with Lymphoedema

With the rate of obesity increasing worldwide, patients with lymphoedema with and without a concomitant diagnosis of severe obesity (SO) were compared in regard to their baseline demographics, health related characteristics, treatment plans, and patient outcomes. This was a retrospective observational cohort study The IBM MarketScan database was examined (2013 - 2019) for patients with a new diagnosis of lymphoedema. Of 60 284 patients with lymphoedema identified, 6 588 had SO defined by a body mass index > 40 kg/m2. The demographics and other characteristics of SO were compared with patients with lymphoedema without SO. SO and lymphoedema diagnosis increased two fold from 2013 to 2019. The lymphoedema SO+ group was younger (57.8 vs. 60.8 years, p < .001) and with a higher proportion of men (37.7% vs. 24.9%, p < .001) than the lymphoedema SO- group. More comorbidities were observed in the lymphoedema SO+ group than the lymphoedema SO- group: diabetes 46.0% vs. 24.9 % (p < .001), heart failure 18.3% vs. 7.4% (p < .001), hypertension 75.0% vs. 47.6% (p < .001), and renal disease 24.8% vs. 11.9% (p < .001). Use of diuretics in the lymphoedema SO+ group was greater: 57.6% vs. 38.0% (p < .001). Patients with lymphoedema SO+ had higher risk of cellulitis: 34.5% vs. 13.5% (p < .001). Specific lymphoedema treatment was given more often to lymphoedema SO-: 66.3% vs. 64.3% (p= .003). This was significant for manual lymphatic drainage (46.6% vs. 40.0%; p < .001) and physical therapy (55.4% vs. 51.6%; p<.001), but not for compression garments (18.2% vs. 17.7%; p= .38). However, more patients with lymphoedema SO+ received pneumatic compression device treatment: 20.9% vs. 13.7% (p < .001). There was an increase in SO associated lymphoedema. Patients with lymphoedema SO+ have over a two and half fold increase in cellulitis incidence, with a significant increase in medical resource use and cost. Despite this, patients with lymphoedema and SO receive less specific therapy such as compression, which has proven to reduce cellulitis incidence.

Thromboprophylaxis with unilateral pneumatic device led to less edema and blood loss compared to enoxaparin after knee arthroplasty: randomized trial

BackgroundPharmacological and mechanical thromboprophylaxis are frequently used together after total knee arthroplasty (TKA). Most studies in this context compare anticoagulants versus a combination of these drugs with an intermittent pneumatic compression device (IPCD). However, there is uncertainty about the need for the combination of both and whether a unilateral IPCD would alone affect other important clinical outcomes: edema and blood loss. We compared the effects of enoxaparin versus unilateral portable IPCD after TKA on edema and blood loss. We hypothesised that unilateral IPCD would cause the same level of edema and the same blood loss as enoxaparin.MethodsIn this open, randomized trial (1:1), adults with no history of coagulation disorders, anticoagulant use, venous thromboembolism, liver or malignant diseases underwent TKA. For 10 days, participants received the IPCD, used 24 h/day on the operated leg from the end of surgery, or 40 mg of enoxaparin, starting 12 h after surgery. All underwent the same rehabilitation and were encouraged to walk on the same day of surgery. We measured edema (thigh, leg and ankle circumference) before and on the third postoperative day. Blood loss (volume accumulated in the suction drain and drop of hemoglobin and hematocrit in 48 h) was a secondary outcome.ResultsWe randomized 150 patients and lost 3 to follow-up with enoxaparin and 2 with IPCD. There was no case of symptomatic venous thromboembolism. Four patients needed transfusions (three receiving enoxaparin), one had infection and one hemarthrosis (both in the enoxaparin group). Leg circumference increased by approximately 2 cm for enoxaparin group and 1.5 cm in IPCD (p < 0.001). The increase in ankle circumference was about 1.5 cm in the enoxaparin group (p < 0.001), and almost zero in IPCD (p = 0.447). Enoxaparin group lost 566.1 ml (standard deviation, SD, 174.5) of blood in the first 48 h, versus 420.8 ml (SD 142.5) in the IPCD.ConclusionsExclusively mechanical prophylaxis after TKA with portable IPCD only on the operated leg reduces leg and ankle swelling and post-operative blood loss compared to exclusively pharmacological prophylaxis with enoxaparin. Portable devices that can prevent deep vein thrombosis and pulmonary embolism without increasing blood loss or other risks should be further investigated.Trial registrationREBEC RBR-8k2vpx. Registration date: 06/04/2019.

Risk assessment and preventive strategies of Deep Vein Thrombosis among patients admitted in Intensive Care Units of a selected hospital in Mangaluru

Deep Vein thrombosis (DVT) is thrombophlebitis of deep veins and is known to be associated with fatal complications. Use of appropriate measures through risk assessment are of vital importance in preventing DVT related complications. Well’s criteria is a beneficial tool in categorizing the patients, therefore may guide in using appropriate preventive strategies and promoting wellbeing of immobilized patients. The present study aimed at assessing the risk and preventive strategies of Deep Vein Thrombosis among patients admitted in Intensive Care Units (ICU) of a selected hospital in Mangaluru. The study was conducted by a descriptive cross sectional design. The study was conducted among 120 ICU admitted patients of Father Muller Medical College Hospital. Purposive sampling technique was used to select sample. The tools used were Well’s criteria for risk assessment of deep vein thrombosis (DVT) and checklist for preventive strategies used. The patients were assessed after 48 hours of admission to ICU. The findings of the study revealed that there is a significant association between age above 55years (p=0.02) and diagnosis related to medical conditions of the subjects (p=0.02). Out of total 120 subjects assessed, 26 subjects had high DVT risk and 94 subjects had moderate DVT risk. Further assessment on use of preventive measures revealed that among subjects with high DVT risk, 3 subjects were on pneumatic compression devices, 18 on crepe bandages and 1 with LMWH. And out of 94 subjects with moderate DVT risk, 3 were on pneumatic compression devices, 7 on crepe bandages and 2 with LMWH. It is found that mechanical devices for prevention of DVT even though advised are seldom considered due to lack of awareness among the health care personnel towards its positive effect.

Efficacy of intermittent compression devices for thromboembolic prophylaxis in major abdominal surgery: a systematic review and meta-analysis.

The benefits of mechanical prophylaxis for the prevention of venous thromboembolism (VTE) in abdominal and pelvic surgery are uncertain, with different guidelines stating that graduated compression stockings (GCS) and intermittent pneumatic compression devices (IPCDs) can be used either alone or in combination. To review the efficacy of IPCDs in preventing VTE following abdominal and pelvic surgery. A systematic review was conducted, identifying relevant literature reporting clinical trials conducted in abdominopelvic surgery, comparing the effect of IPCDs alone or in combination with no prophylaxis, GCS and chemical prophylaxis. The review identified studies reported from 1966 to 2022 in Medline, Embase, PubMed and Cochrane databases for randomized controlled trials. Thirteen RCTs involving 1914 participants were identified. IPCDs were superior to placebo (OR VTE 0.39; 95% CI 0.20-0.76) but not superior to other forms of prophylaxis (OR 0.83; 95% CI 0.30-2.27) or to GCS alone (OR 0.9; 95% CI 0.24-3.36). The addition of IPCDs to GCS compared with GCS alone was beneficial (OR 0.45; 95% CI 0.23-0.91) as was the addition of IPCDs to standard perioperative chemoprophylaxis (OR 0.25; 95% CI 0.09-0.74). The overall quality and reliability of trials were low, with high risk of bias. IPCDs are more effective than placebo in reducing VTE rates but are not more effective than other forms of thrombo-prophylaxis (chemical or mechanical) following abdominal and pelvic surgery. There is poor quality evidence to suggest that they might have a role as additional prophylaxis when combined with GCS and chemical prophylaxis.

Patient-reported barriers and facilitators for intermittent pneumatic compression device use on the antepartum unit

Objective To examine patient barriers to intermittent pneumatic compression (IPC) device compliance during antepartum hospital admissions. Methods This was a prospective survey study of a diverse group of pregnant patients who were admitted to the antepartum floor in a quaternary care hospital from June 2019 through March 2021. Patients receiving pharmacotherapy for venous thromboembolism prophylactic or therapeutic indications were excluded. The primary outcome was patient reported barriers to use of IPC during antepartum hospital admission. Responses were summarized using descriptive statistics. Results A total of 40 patients were surveyed. All participants correctly identified the purpose of IPC. When asked regarding IPC importance, 7.5% reported not important, 40% reported somewhat important but not a priority, 5% important only on the first day they were given, and 47.5% reported important whenever the patient was in bed. The most bothersome characteristics of IPC use identified by the respondents on a Likert scale from 1 to 5 were sweating, made the legs too hot, restricted movement, and inconvenience and time spent putting on and taking off the IPC. Making the device wireless/cordless (77.5%), using a lighter weight or cooler material for the cuffs (55%), and better availability of nurses to assist with putting on, taking off, and troubleshooting the IPC (17.5%) were identified by patients as ways to increase compliance with IPC. Conclusions This survey identified several modifiable barriers to the use of IPC on the antepartum floor.

All the gear: The prevalence and perceived effectiveness of recovery strategies used by triathletes

BackgroundTo minimise the deleterious effects of fatigue and muscle soreness and maintain availability for training and competition, triathletes may implement recovery strategies that act on various physiological, biomechanical, neurological or psychological domains. However, the use of common recovery strategies is yet to be investigated in this population. Methods322 triathletes (109 female, 212 male) of varying competition levels from 39 countries participated in the current study. Participants completed an anonymous online survey to determine their use and perceived effectiveness of various recovery strategies. Multiple chi-square tests were conducted to examine the association between training week type (normal vs post-competition), preferred event distance (short or long course), competition level and use of recovery strategies. ResultsThe most frequently used recovery strategies during normal training weeks were active recovery (51%), stretching (47%) and additional sleep (32%), while foam rolling (35%), massage guns (20%) and compression garments (19%) were the most commonly used recovery devices. The use of active recovery, additional sleep and professional massage was significantly (p = <.002) more common in the week following a competitive event than during a normal training week. Long course triathletes were more likely to use intermittent pneumatic compression (IPC) devices (p = .008) and hydrotherapy (p = .05) than were short-course triathletes. ConclusionActive recovery, additional sleep and stretching are the preferred recovery choices for triathletes of all levels, though the use of foam rolling, massage guns and compression garments is common in this population. Active recovery, additional sleep and professional massage are more frequently used by triathletes in the week following a competitive event and are perceived to be the most effective recovery strategies overall.

Safety and effectiveness of a novel nonpneumatic active compression device for treating breast cancer-related lymphedema: A multicenter randomized, crossover trial (NILE)

ObjectiveAdvanced pneumatic compression devices (APCDs) have been shown to be an effective intervention for lymphedema when used as part of a self-care maintenance treatment regimen. However, adherence to self-care has been poor, and APCDs require patients to be immobile during treatment. We evaluated the safety and efficacy of a novel nonpneumatic compression device (NPCD) for treating lymphedema vs an APCD. MethodsA randomized, crossover head-to-head investigation was performed at five U.S. sites in 2021. The patients had been randomized to either the NPCD or a commercially available APCD. The patients used the randomly assigned initial device for 28 days with a 4-week washout period before a comparable 28-day use of the second device. ResultsData from 50 adult women with unilateral breast cancer-related lymphedema were analyzed. Compared with the APCD, the NPCD was associated with a greater mean reduction in the limb edema volume (64.6% vs 27.7%; P < .001), significantly greater mean improvements in quality of life scores, greater adherence (95.6% vs 49.8%; P < .001), and greater satisfaction with the device (90% vs 14%; P < .001). The patients indicated that use of the NPCD facilitated exercise and was convenient for travel. No adverse events were reported. ConclusionsThe results have shown that the novel NPCD is an effective maintenance treatment for reducing the limb volume in patients with breast cancer-related lymphedema. The NPCD device was more effective than an APCD and resulted in greater adherence to self-care interventions and greater patient satisfaction.

Material, structure, and design of textile-based compression devices for managing chronic edema

Background: Compression bandages, stockings, and pneumatic compression devices are common classifications of compression products, used alone or in combination. The structure of these compression products is complex: they are typically multi-layered, overlapped, stretched and applied to a three-dimensional curved surface part of the body. This research aims to review the materials, designs, and fabrication processes/technologies of a variety of compression devices used in management of chronic edema by considering contributions of materials/textiles, as well as prototyping technologies. Method: Relevant papers/patents for review were identified using keywords associated with materials, designs, and fabrication processes of textile-based compression devices/products for treatments of the edematous lower limb. Results: Modern Compression therapies employ textile materials with a variety of fiber types, yarns and fabric structures, and wide range of elasticity and extensibility (i.e. inelastic to elastic, short stretch to long stretch) to provide the required pressure to the lower leg. Compression fabrics are fabricated using a variety of production technologies and machineries, and they have a wide range of physical and performance attributes. Conclusions: Appropriate selection of materials and fabrication technologies for use in compression therapy is essential to enhance the success in the management of chronic edema. This review might aid in the development and implementation of textiles/materials, and improvement in design of the textile-based compression devices to increase the efficacy of compression therapies in the management of chronic edema, allowing patients to improve their long-term health.