Clinical Investigation
Hemodynamic Effect and Safety of Intermittent Sequential Pneumatic Compression Leg Sleeves in Patients With Congestive Heart Failure

https://doi.org/10.1016/j.cardfail.2014.07.004Get rights and content

Highlights

  • We examined the safety of pneumatic sleeves in congestive heart failure.

  • Pneumatic sleeves were found to be safe.

  • Pneumatic sleeve activation caused a transient increase in cardiac output.

  • Pneumatic sleeve activation resulted in a decrease in systemic vascular resistance.

Abstract

Background

Pneumatic leg sleeves are widely used after prolonged operations for prevention of venous stasis. In healthy volunteers they increase cardiac function. We evaluated the hemodynamic effects and safety of intermittent sequential pneumatic compression (ISPC) leg sleeves in patients with chronic congestive heart failure (CHF).

Methods and Results

We studied 19 patients with systolic left ventricular dysfunction and CHF. ISPC leg sleeves, each with 10 air cells, were operated by a computerized compressor, exerting 2 cycles/min. Hemodynamic and echocardiographic parameters were measured before, during, and after ISPC activation. The baseline mean left ventricular ejection fraction was 29 ± 9.2%, median 32%, range 10%–40%. Cardiac output (from 4.26 to 4.83 L/min; P = .008) and stroke volume (from 56.1 to 63.5 mL; P = .029) increased significantly after ISPC activation, without a reciprocal increase in heart rate, and declined after sleeve deactivation. Systemic vascular resistance (SVR) decreased significantly (from 1,520 to 1,216 dyne-s/cm5; P = .0005), and remained lower than the baseline level throughout the study. There was no detrimental effect on diastolic function and no adverse clinical events, despite increased pulmonary venous return.

Conclusions

ISPC leg sleeves in patients with chronic CHF do not exacerbate symptoms and transiently improve cardiac output through an increase in stroke volume and a reduction in SVR.

Section snippets

Methods

Every participant gave informed consent to be included in the study, which was approved by the local Ethics Committee. All patients had clinical symptoms of chronic CHF. Inclusion criteria included New York Heart Association (NYHA) functional class II–III and left ventricular ejection fraction (LVEF) ≤40% as assessed by transthoracic echocardiography (TTE). We excluded patients who could not sign an informed consent, had unstable angina, were <30 days after myocardial infarction or therapeutic

Results

The patients’ clinical characteristics are detailed in Table 1. As presented in Table 1, Table 2, the study population included 19 patients (16 male, 3 female), with an overall mean age of 66.8 ± 10.6 years (median 68, range 48–82). At baseline, the mean LVEF by which the patients were detected was 29 ± 9.2% (median 32%, range 10%–40%). Moderate right ventricular (RV) dysfunction was noted in 32% of the patients, and none had severe RV dysfunction. Severe TR was noted in 1 patient and moderate

Discussion

In this study we demonstrated that there was no deterioration in cardiac function (transient or constant) during activation of the ISPC leg sleeves in patients with chronic CHF (systolic and diastolic). The main early hemodynamic changes included increased cardiac output, ejection fraction, and stroke volume, together with reduced SVR. However, toward the end of ISPC activation, cardiac function returned to baseline. Nevertheless, cardiac dysfunction did not worsen during ISPC activation, as

Study Limitations

The present study is somewhat limited by the small number of patients and the relatively short duration of our examinations. The patients did not undergo the anesthetic and physiologic insult associated with a surgical procedure, so the data may not be extrapolated to “real surgical” patients. As stated in the Methods section, we did not study postoperative patients owing to possible inconvenience during mobilization for examinations, yet we think that our study population is representative of

Conclusion

The extensive use of pneumatic sleeves in medical procedures, together with the increasing number of elderly patients, as well as patients with CHF who undergo surgery, makes the selection of the pneumatic device highly important for improved clinical outcome. We have demonstrated that 10-cell ISPC leg sleeves may be safely used in patients with CHF (systolic as well as diastolic), and may also improve cardiac function through changes in preload and afterload parameters, without causing

Disclosures

None.

References (38)

  • U.S. Marathe et al.

    Alterations in hemodynamics and left ventricular contractility during carbon dioxide pneumoperitoneum

    Surg Endosc

    (1996)
  • G.E. Barnes et al.

    Cardiovascular responses to elevation of intra-abdominal hydrostatic pressure

    Am J Physiol

    (1985)
  • I.G. Kaklamanos et al.

    Time-related changes in hemodynamic parameters and pressure-derived indices of left ventricular function in a porcine model of prolonged pneumoperitoneum

    Surg Endosc

    (2000)
  • S. Lyass et al.

    Is laparoscopic appendectomy safe in pregnant women?

    Surg Endosc

    (2001)
  • S.P. Dexter et al.

    Hemodynamic consequences of high- and low-pressure capnoperitoneum during laparoscopic cholecystectomy

    Surg Endosc

    (1999)
  • J.L. Joris et al.

    Hemodynamic changes during laparoscopic cholecystectomy

    Anesth Analg

    (1993)
  • J.G. McLaughlin et al.

    The adverse hemodynamic effects of laparoscopic cholecystectomy

    Surg Endosc

    (1995)
  • D. Safran et al.

    Laparoscopy in high-risk cardiac patients

    Surg Gynecol Obstet

    (1993)
  • Y. Yavuz et al.

    Effect of increased intraabdominal pressure on cardiac output and tissue blood flow assessed by color-labeled microspheres in the pig

    Surg Endosc

    (2001)
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    See page 745 for disclosure information.

    ClinicalTrial.gov Protocol Registration System ID: NCT01691417.

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