Clinical InvestigationHemodynamic Effect and Safety of Intermittent Sequential Pneumatic Compression Leg Sleeves in Patients With Congestive Heart Failure
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)
- et al.
Improving the adverse changes in cardiac autonomic nervous control during laparoscopic surgery, using an intermittent sequential pneumatic compression device
Am J Surg
(2004) - et al.
Systemic hemodynamic effects of sequential pneumatic compression of the lower limbs: a prospective study in healthy volunteers
J Clin Anesth
(2008) - et al.
The physiological impact of intermittent sequential pneumatic compression (ISPC) leg sleeves on cardiac activity
Am J Surg
(2011) - et al.
Correlation of peripheral venous pressure and central venous pressure in surgical patients
J Cardiothorac Vasc Anesth
(2001) - et al.
Enhanced external counterpulsation improves exercise tolerance in patients with chronic heart failure
J Am Coll Cardiol
(2006) - et al.
Enhanced external counterpulsation improves exercise tolerance, reduces exercise-induced myocardial ischemia and improves left ventricular diastolic filling in patients with coronary artery disease
J Am Coll Cardiol
(2001) - et al.
Pneumatic external counterpulsation: a new noninvasive method to improve organ perfusion
Am J Cardiol
(1999) - et al.
Tissue Doppler imaging in patients with advanced heart failure: relation to functional class and prognosis
J Heart Lung Transpl
(2006) - et al.
Central and peripheral adverse hemodynamic changes during laparoscopic surgery and their reversal with a novel intermittent sequential pneumatic compression device
Ann Surg
(2001) - et al.
Laparoscopic insufflation of the abdomen depresses cardiopulmonary function
Surg Endosc
(1993)
Alterations in hemodynamics and left ventricular contractility during carbon dioxide pneumoperitoneum
Surg Endosc
Cardiovascular responses to elevation of intra-abdominal hydrostatic pressure
Am J Physiol
Time-related changes in hemodynamic parameters and pressure-derived indices of left ventricular function in a porcine model of prolonged pneumoperitoneum
Surg Endosc
Is laparoscopic appendectomy safe in pregnant women?
Surg Endosc
Hemodynamic consequences of high- and low-pressure capnoperitoneum during laparoscopic cholecystectomy
Surg Endosc
Hemodynamic changes during laparoscopic cholecystectomy
Anesth Analg
The adverse hemodynamic effects of laparoscopic cholecystectomy
Surg Endosc
Laparoscopy in high-risk cardiac patients
Surg Gynecol Obstet
Effect of increased intraabdominal pressure on cardiac output and tissue blood flow assessed by color-labeled microspheres in the pig
Surg Endosc
Cited by (0)
See page 745 for disclosure information.
ClinicalTrial.gov Protocol Registration System ID: NCT01691417.