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This study aimed to identify the characteristics and efficacy of Intermittent Pneumatic Compression (IPC) interventions for preventing Venous Thromboembolism (VTE) in critically ill patients. Methods: The CENTRAL, Embase, OVID, CINAHL, KMbase, KoreaMed, and KoreaScience databases were searched from January 7 to 11, 2023. The search included all records from the inception of each database up to January 2023, with publication language restrictions to English and Korean. Three reviewers independently carried out the entire process, which included data search, quality assessment, and data extraction. Results: Out of 1066 articles, six Randomized Controlled Trials (RCTs) were included. One of the four studies that reported on the incidence of DVT, and one of the six studies that measured the incidence of Pulmonary Embolism (PE), found that IPC alone was effective in reducing the incidence of DVT and PE. One of the four studies that reported on VTE incidence demonstrated a significant reduction in VTE incidence with a triple intervention of IPC, anticoagulants, and elastic compression stockings compared to a combined intervention of anticoagulants and graduated compression stockings. Four studies that reported data on the incidence of bleeding reported no effect on reducing bleeding. Conclusion: Our findings suggest that IPC interventions may reduce the incidence of DVT as a preventive strategy in critically ill patients. Further RCTs are necessary to evaluate the effect of IPC interventions on DVT prevention in this patient population and to provide robust evidence for critical care nursing. [ABSTRACT FROM AUTHOR]

Abstract Background Surgical prophylaxis for venous thrombo-embolic disease (VTE) includes risk assessment, chemical prophylaxis and mechanical prophylaxis (graduated compression stockings [GCS] and/or intermittent pneumatic compression devices [IPCD]). Although there is overwhelming evidence for the need and efficacy of VTE prophylaxis in patients at risk, only about a third of those who are at risk of VTE receive appropriate prophylaxis. Objective There is debate as to the best combination of VTE prophylaxis following abdominal surgery due to lack of evidence. The aim of this survey was to understand this gap between knowledge and practice. Methods In 2019 and 2020, a survey was conducted to investigate the current practice of venous thromboembolism (VTE) prophylaxis for major abdominal surgery, with a focus on colorectal resections. The study received ethics approval and involved distributing an 11-item questionnaire to members of two professional surgical societies: the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) and the General Surgeons Australia (GSA). Results From 214 surgeons: 100% use chemical prophylaxis, 68% do not use a risk assessment tool, 27% do not vary practice according to patient risk factors while > 90% use all three forms of VTE prophylaxis at some stage of treatment. Most surgeons do not vary practice between laparoscopic and open colectomy/major abdominal surgery and only 33% prescribe post-discharge chemical prophylaxis. 42% of surgeons surveyed had equipoise for a clinical trial on the use of IPCDs and the vast majority (> 95%) feel that IPCDs should provide at least a 2% improvement in VTE event rate in order to justify their routine use. Conclusion Most surgeons in Australia and New Zealand do not use risk assessment tools and use all three forms of prophylaxis regardless. Therfore there is a gap between practice and VTE prophylaxis for the use of mechanical prophylaxis options. Further research is required to determine whether dual modality mechanical prophylaxis is incrementally efficacious. Trial Registration- Not Applicable.

Unusual clinical course Clavicle fractures are a relatively common injury, and are not problematic when occurring alone. Venous thoracic outlet syndrome (TOS) is generally caused by compression of the subclavian vein between the first rib and oblique muscles, and is often complicated by the presence of upper extremities deep vein thrombosis (UEDVT). Herein, we present a case of venous TOS complicated with UEDVT due to a dislocated clavicle fracture. A 29-year-old man was injured in a motorcycle accident. The patient's right clavicle was fractured, and the distal part of the fracture had dislocated into his right thorax. Contrast-enhanced computed tomography showed an obstruction of the subclavian vein by the dislocated clavicle and thrombus on the distal side of the obstruction. Anticoagulant therapy was not indicated because of other injuries, such as traumatic subarachnoid hemorrhage. No vena cava filter was placed in the superior vena cava owing to the relatively low volume of the thrombus. Alternatively, intermittent pneumatic compression to the right forearm was initiated. On day 6, surgical reduction of the clavicle was performed. The thrombus remained after the reduction. The patient received anticoagulation therapy with heparin followed by oral anticoagulants. The patient was discharged without any complications of UEDVT or bleeding. Venous TOS with UEDVT caused by trauma is rare. Anticoagulation therapy, pneumatic limb compression, and vena cava filter placement should be considered according to the degree of the obstruction and other associated injuries. [ABSTRACT FROM AUTHOR]

Abstract Background During 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). Methods This 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). Results All 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. Conclusions Leg 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 registration This trial protocol was registered at the Clinical Research Information Service (KCT0005383, the date of first registration: 08/09/2020).

Abstract Objective The present study describes the preferences and current practices of a sample of knee surgeons in Brazil regarding thromboprophylaxis in total knee arthroplasty (TKA). Method In the present internet survey, surgeons from the Brazilian Knee Surgery Society (SBCJ, in the Portuguese acronym) voluntarily answered an anonymous questionnaire including time of personal surgical experience, perceptions about the best thromboprophylaxis options, and actual practices in their work environment. Results From December 2020 to January 2021, 243 participants answered the questionnaire. All, except for 3 (1.2%), reported using thromboprophylaxis, and most (76%) combined pharmacological and mechanical techniques. The most prescribed drug was enoxaparin (87%), which changed to rivaroxaban (65%) after discharge. The time of thromboprophylaxis initiation varied according to the length of training of the knee surgeon (p ≤ 0.03), and their preferences and practices differed according to the Brazilian region (p< 0.05) and the health system in which the surgeons work (public or private sector; p= 0.024). The option for mechanical thromboprophylaxis also depended on the training time of the surgeon. Conclusion Thromboprophylaxis preferences and practices in TKA are diverse across Brazilian regions and health systems (public or private sectors). Given the lack of a national clinical guideline, most orthopedists follow either their hospital guidelines or none. The mechanical prophylaxis method and the little use of aspirin are the points that most diverge from international guidelines and practices.

Background: External and internal head and neck cancer related lymphedema (HNCRL) is a common consequence of radiation treatment (RT). Currently, internal HNCRL can be clinically assessed endoscopically using a visuoperceptual, ordinal rating scale. Use of fluoroscopy to identify and measure internal HNCRL has been explored but is not widely used in clinical practice. Advanced Pneumatic Compression (APC) has shown external HNCRL reduction after a single treatment, whereas internal HNCRL reduction has not yet been assessed., Methods: Fluoroscopic lateral scouts and TIMS Review software (TIMS Medical) were used to assess immediate internal HNCRL measures of 30 HNC patients with RT history following a single APC treatment. Pre and post external measures were also obtained. Paired t-test was used to assess changes in pre and post measures. A post-treatment survey was completed., Results: All 30 patients had both immediate external and internal HNCRL reductions, and all reductions were statistically significant. All reported positive benefit., Conclusions: A single, external APC treatment immediately impacted the extent of pharyngeal and laryngeal edema in post-radiated HNC survivors. Fluoroscopy can be a clinically useful and complementary modality to detect, surveil, and measure internal HNCRL., (© 2024 Wiley Periodicals LLC.)

Background: Intermittent pneumatic compression (IPC) therapy may benefit stroke patients by eliciting more intensive training sessions that may result in better health, mobility and ultimately quality of life. The purpose of this randomized controlled trial was to assess the effect of using a home-based IPC device on functional outcomes and vascular health in individuals with chronic stroke., Methods: Thirty-one stroke survivors (64.3 ± 14.3y; 4.3 ± 2.7y since stroke) completed pre- and post-intervention assessments of functional capacity (six-minute walk test [6MWT], timed-up-and-go, 10m walk test), vascular health (pulse wave analysis, carotid-femoral pulse wave velocity), and physical activity. Following the pre-assessment, individuals were randomly assigned to either a daily, 12-week, home-based IPC group, or to a usual care control (CON) group. Outcomes were assessed using analysis of covariance (ANCOVA), controlling for age and any baseline differences., Results: Following ANCOVA, a significant increase in 6MWT walking distance was observed post-assessment for the IPC (Mean ±  SD [95%CI]; 188 ±  19 m [177-199m]) but not the CON group (167 ±  19 m [157-178m]) (p <  0.05). A significant reduction in peripheral systolic blood pressure was reported at the post-assessment for the IPC group (136.2 ±  8.0 mmHg [131.9-140.4 mmHg]) but not for CON (142.2 ±  8.0 mmHg [138.1-144.6 mmHg]) (p <  0.05). Similar findings were observed for central systolic blood pressure. Physical activity levels significantly increased at the post-assessment for IPC (1857 ±  879 MET·min-1·week-1 [1390-2325 MET·min-1·week-1]) but not for the CON group (1161 ± 879 MET·min-1·week-1 [677-1645 MET·min-1·week-1]), while for time spent sitting, a significantly greater reduction was observed at the post-assessment for the IPC group (396 ±  86 mins [350-442 mins]) compared to CON (486 ± 86 mins [439-534 mins]) (both p <  0.05)., Conclusions: The observed improvements in functional mobility, cardiovascular health, increased physical activity and reduced sedentary time demonstrates important clinical implications of 'home-based' IPC therapy as a clinical training aid for stroke rehabilitation. Home-based IPC therapy could serve as an adjunct to conventional rehabilitation, however, further research is needed to determine whether IPC therapy can sustain or improve function over time for individuals in the chronic stage of recovery., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Faulkner et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The diagnostic performance of the available risk assessment models for VTE in patients who are critically ill receiving pharmacologic thromboprophylaxis is unclear., Research Question: For patients who are critically ill receiving pharmacologic thromboprophylaxis, do risk assessment models predict who would develop VTE or who could benefit from adjunctive pneumatic compression for thromboprophylaxis?, Study Design and Methods: In this post hoc analysis of the Pneumatic Compression for Preventing VTE (PREVENT) trial, different risk assessment models for VTE (ICU-VTE, Kucher, Intermountain, Caprini, Padua, and International Medical Prevention Registry on VTE [IMPROVE] models) were evaluated. Receiver-operating characteristic curves were constructed, and the sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated. In addition, subgroup analyses were performed evaluating the effect of adjunctive pneumatic compression vs none on the study primary outcome., Results: Among 2,003 patients receiving pharmacologic thromboprophylaxis, 198 (9.9%) developed VTE. With multivariable logistic regression analysis, the independent predictors of VTE were Acute Physiology and Chronic Health Evaluation II score, prior immobilization, femoral central venous catheter, and invasive mechanical ventilation. All risk assessment models had areas under the curve < 0.60 except for the Caprini model (0.64; 95% CI, 0.60-0.68). The Caprini, Padua, and Intermountain models had high sensitivities (> 85%) but low specificities (< 20%) for predicting VTE, whereas the ICU-VTE, Kucher, and IMPROVE models had low sensitivities (< 15%) but high specificities (> 85%). The positive predictive values were low (< 20%) for all studied cutoff scores, whereas the negative predictive values were mostly > 90%. Using the risk assessment models to stratify patients into high- vs low-risk subgroups, the effect of adjunctive pneumatic compression vs pharmacologic prophylaxis alone did not differ across the subgroups (P interaction > .05)., Interpretation: The risk assessment models for VTE performed poorly in patients who are critically ill receiving pharmacologic thromboprophylaxis. None of the models identified a subgroup of patients who might benefit from adjunctive pneumatic compression., Clinical Trial Registration: ClinicalTrials.gov, No.: NCT02040103, URL: www., Clinicaltrials: gov. ISRCTN44653506; International Standard Randomised Controlled Trial No.: ISRCTN44653506, URL: https://www.isrctn.com., Competing Interests: Financial/Nonfinancial Disclosures None declared., (Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Aims/Background Deep venous thrombosis (DVT) represents a significant postoperative complication after artificial femoral head replacement, with the incidence increasing proportionally with patient age. This study aimed to evaluate the effect of early postoperative use of intermittent pneumatic compression devices (IPC), followed by the combined use of low molecular weight heparin (LMWH) after 48 hours, for the prevention of postoperative lower limb DVT in elderly patients undergoing hip arthroplasty. Methods The retrospective study included 100 elderly patients who underwent unilateral femoral head replacement. The control group (n = 55) received combined LMWH initiated 12 hours postoperatively, while the observation group (n = 45) started combined LMWH 48 hours postoperatively. Changes in coagulation parameters, perioperative complications, and the incidence of postoperative lower limb DVT were compared between the two groups. Results Coagulation parameters showed significant changes post-intervention in both groups, with no statistically significant inter-group differences observed post-intervention ( p > 0.05). The incidence of postoperative lower limb DVT did not differ significantly between the two groups ( p > 0.05). However, the observation group demonstrated significantly lower postoperative blood loss, incidence of periwound hematoma, and transfusion rates compared to the control group ( p < 0.05). Conclusion The sequential application of IPC in the early postoperative period, followed by combined LMWH administration after 48 hours, demonstrates comparable efficacy in preventing lower limb DVT formation in elderly patients undergoing hip arthroplasty when compared to the initiation of combined LMWH starting 12 hours postoperatively. In addition, this approach significantly reduces the risk of postoperative bleeding and exhibits a high safety profile.

Objective: Advanced pneumatic compression devices (APCDs) have been shown to be effective in treatment of lower extremity lymphedema in the home setting. However, adherence to self-care has been poor, and APCDs require patients to remain immobile during treatment. We evaluated the safety and efficacy of a novel nonpneumatic compression device (NPCD) for treating lower extremity lymphedema vs an APCD., Methods: A randomized, crossover head-to-head study was performed at nine sites in 2023. Patients were randomized to either the NPCD or a commercially available APCD. Patients used the randomly assigned initial device for 90 days with a 4-week washout period before a comparable 90-day use of the second device., Results: A total of 71 patients (108 affected limbs) with lower extremity lymphedema were analyzed. Compared with the APCD, the NPCD was associated with a greater mean decrease in limb edema volume (a mean limb volume decrease of 369.9 ± 68.19 mL [P < .05] vs 83.1 ± 67.99 mL [P < .05]). Significant improvement in Quality of Life was achieved for NPCD and but not for APCD treatment (score improvement of 1.01 ± 0.23 [P < .05] for NPCD vs 0.17 ± 0.18 [P > .05] for APCD). Patients reported greater adherence (81% vs 56%; P < .001) and satisfaction with the NPCD (78% vs 22%) compared with APCD. No device-related adverse events were reported., Conclusions: The novel NPCD is an effective treatment for decreasing limb volume in patients with lower extremity lymphedema. The NPCD was more effective than an APCD and resulted in superior limb volume decrease, greater improved quality of life, adherence, mobility, and patient satisfaction., Competing Interests: Disclosures S.G.R. and T.S.M. serve on advisory board and receive consulting fees and currently own no shares of Koya Medical, manufacturer of Dayspring., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: During 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).Methods: This 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).Results: All 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.Conclusions: Leg 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 Registration: This trial protocol was registered at the Clinical Research Information Service (KCT0005383, the date of first registration: 08/09/2020). [ABSTRACT FROM AUTHOR]

Background: Pharmacological 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.Methods: In 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.Results: We 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.Conclusions: Exclusively 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 Registration: REBEC RBR-8k2vpx. Registration date: 06/04/2019. [ABSTRACT FROM AUTHOR]

Background: Intermittent pneumatic compression (IPC) and neuromuscular electrical stimulation can improve deep vein hemodynamics in the lower limbs. We developed a new, small and convenient, and easy to wear common peroneal nerve electrical stimulator (CPNES) and to investigate the effectiveness and safety of CPNES intervention on deep venous hemodynamics., Methods: Thirty healthy volunteers were recruited and randomly divided into group A and B. In group A, the hemodynamics of the left superficial femoral artery and the superficial femoral vein were measured after IPC compression, and then the CPNES was activated and the hemodynamics was measured again. In group B, the order of intervention was reversed., Results: In group A, the peak velocity, time average blood flow velocity (TAMV), and flow velocity of femoral vein after IPC and CPNES intervention were higher than these of the baseline (P < .05, respectively). No significant differences of these blood flow parameters were found between IPC and CPNES intervention (P > .05, respectively). In group B, these blood flow parameters of femoral vein after IPC and CPNES intervention were higher than these of the baseline (P < .05, respectively). No significant difference of these blood flow parameters (P > .05, respectively) were noted between IPC and CPNES intervention as well. No differential change of these flow velocity of femoral artery after IPC and CPNES intervention in group A or group B. The hemodynamics of superficial femoral arteries and veins after intervention in group A and B were similar (P > .05, respectively)., Conclusion: The effectiveness of CPNES intervention on the hemodynamics of the lower extremity is similar with that of IPC, increasing blood flow and may prevent venous thrombosis without adverse reaction., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background Objective: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complication in craniotomy patients and is associated with increased morbidity and mortality. The duration of surgery is a known risk factor. Other factors such as positioning and tumor entity have hardly been investigated or are controversial. In two pilot studies, the determination of plasma D-dimer concentration led to a high detection rate of DVT, while the use of intermittent pneumatic venous compression (IPC) drastically reduced the incidence of VTE. In the present study we investigated the efficacy of the two approaches, either alone or in combination, in a large patient cohort., Methods: 1759 patients who underwent elective craniotomy between 2009 and 2023 were retrospectively analyzed. The staggered use of D-dimer determination and intraoperative use of IPC resulted in 3 groups: Group 1: no procedure; Group 2: D-dimer evaluation; Group 3: IPC and D-dimer evaluation. If the D-dimer level was ≥ 2 mg/l (Fibrinogen equivalent units; FEU), venous ultrasound was performed. Age, gender, tumor entity, duration and extent of surgery, patient positioning, type of VTE were also recorded and analyzed., Results: The introduction of postoperative D-dimer evaluation increased the rate of detection of thrombosis from 1.7% in group 1 to 22.6% in group 2. The addition of IPC reduced the rate of thrombosis to 4.4%. Age, gender and patient positioning did not affect the rate of VTE. We were able to confirm the duration of surgery as an individual risk factor and showed that WHO grade 4 tumors and metastasis have an increased VTE risk., Conclusions: If D-Dimer levels are not analyzed routinely about 20% of craniotomy patients suffer from a clinically silent thrombosis. Each with the risk of fate PE. Intraoperative use of IPC during craniotomy dramatically reduces the risk of VTE., Competing Interests: Declarations. Disclosures: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. Competing interest: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Venous thromboembolism (VTE) is a leading preventable cause of death in hospitalized patients. Current intermittent pneumatic compression (IPC) devices used to provide external mechanical compression for VTE prevention are associated with a multitude of clinical challenges that often result in subtherapeutic use. A comparative study was conducted of the real-world clinical use of a novel mechanical compression device (MCD) and a current IPC device., Purpose: The purpose of this quality improvement project was to compare use of the novel MCD and the standard IPC device on three clinical inpatient hospital units. Comparisons were based on the following patient outcome measures: evaluation of wear time, adherence to optimal wear time, evaluation of both patient comfort and device satisfaction, and perceived impact on mobility goals. Nurses' satisfaction with the clinical usability for mobility was also measured., Methods: This project used a pre-post design. A convenience sample of 89 surgical patients on the three clinical study units and 63 nursing staff members were recruited for the study. Data were collected using electronic health records, MCD data records, patient surveys, and nursing staff surveys. Data were analyzed using descriptive statistics and independent sample t tests. In the preintervention period, data were collected using the current IPC device. Nursing staff were then trained on use of the MCD. In the postintervention period, the MCDs were used in place of the IPC devices., Results: MCD patients had significantly longer (P ≤ 0.001) wear time (mean, 19.3 hours/day) compared with IPC patients (mean, 12.9 hours/day). MCD patients also reported significantly better sleep (P = 0.04), fewer problems with sweaty legs (P ≤ 0.001), and improved assistance with mobility goals (P ≤ 0.001) than IPC patients. Nursing staff reported significantly improved accuracy of mobility documentation (P ≤ 0.001) with the MCD, but no differences in their perception of patient satisfaction with meeting mobility goals., Conclusions: Use of the MCD device for VTE prophylaxis resulted in actual and perceived improvements from the perspective of both patients and nurses. While these results provide initial data in support of a potentially promising system, more research is needed., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Phenylephrine 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., Methods: Seventy-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., Results: The 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., Conclusions: Intermittent 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., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Phlebolymphedema is a challenging condition to manage, with limited options for effective treatment. For patients, this may be debilitating and lead to infection, loss of independence and affect quality of life. This study aims to evaluate patient-reported outcomes of an advanced pneumatic compression device (APCD) in the treatment of lower extremity phlebolymphedema., Methods: Patients with diagnosis of lower extremity phlebolymphedema at an acute care facility within the New York City Health and Hospitals Cooperation treated with the Flexitouch (FLX) (Tactile Systems Technology, Inc, Minneapolis, Minnesota) APCD from December 2021 to March 2023 were evaluated. Patient-perceived subjective outcomes were assessed via a short questionnaire, with subsequent analysis using chi-squared test. Primary end points were subjective improvements in 1) swelling, 2) pain, and 3) ease of use of device as surrogates for patient satisfaction. Secondary end point was subjective patient-reported compliance, obtained by investigating 1) if patients were trained to use device, and 2) if patients were using the device., Results: A total of 52 participants were included in this study, consisting of 30.8% male and 69.2% female patients with a mean age of 71.7 years. While selection criteria did not exclude unilateral disease or alternative etiologies, we note that the entire study population had been diagnosed with bilateral lower extremity lymphedema in the setting of chronic venous insufficiency. Other patient characteristics including race, comorbidities and smoking status were documented in Table 1. Table 2 demonstrates the results of chi-squared analysis. This study noted significant patient-perceived improvement in swelling and pain (91.4% with P < 0.00001; 85.7% with P = 0.00002 respectively) and patient-reported ease of use of the FLX device (85.7% with P = 0.00002). Additional secondary findings included a majority of patients reporting being trained on how to use FLX and also maintaining compliance with the device (69.2% with P = 0.005; 67.3% with P = 0.012 respectively)., Conclusions: FLX APCD use has been found to demonstrate desirable patient-reported outcomes as a general trend. The participants in this study noted statistically significant subjective improvement in swelling and pain, ease of use of device and adherence to training and compliance with device. FLX appears to be positively received by patients, and the authors recommend its consideration for management of bilateral lower extremity phlebolymphedema., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Aims/Background Femoral neck fractures in elderly patients carry a high risk of developing deep vein thrombosis (DVT) due to prolonged immobilization and surgical intervention. This study examines the effectiveness of combining intermittent pneumatic compression (IPC) with low-molecular-weight heparin (LMWH) for preventing DVT in elderly patients following femoral neck fracture surgery. Methods A total of 150 elderly patients with femoral neck fractures, admitted between January 2022 and January 2024, were retrospectively selected, and their clinical data were analyzed. Based on the treatment methods, the patients were divided into a control group (n = 71) and a study group (n = 79). The control group received LMWH treatment, while the study group received a combination of LMWH and IPC. The incidence of DVT, surgical outcomes, hip joint function, coagulation function indicators, hemodynamic indicators, and serum pro-inflammatory factors were compared between the two groups. Results The results showed that the incidence of DVT in the study group was lower than in the control group ( p = 0.017). There were no significant differences between the two groups in terms of intraoperative blood loss, postoperative drainage volume, or Harris scores ( p > 0.05). After the intervention, the study group demonstrated higher levels of average velocity (Va), peak blood flow velocity (Vp), and blood flow (BF) compared to the control group ( p < 0.05). Additionally, the activated partial thromboplastin time (APTT) and prothrombin time (PT) were longer, while the D-dimer (D-D) level was lower in the study group ( p < 0.05). The study group also exhibited lower levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-8 (IL-8) ( p < 0.05). Conclusion The results indicate that combining IPC with LMWH effectively reduces the incidence of postoperative DVT in elderly patients with femoral neck fractures, improves venous blood flow in the lower limbs, reduces vascular inflammation, and ensures safety.

Objectives: Venous thromboembolism (VTE) is still considered to be a significant medical issue. Physical measures to prevent perioperative venous thrombosis include early mobilization and intermittent pneumatic compression (IPC). The aim of this study was to evaluate whether IPC can reduce the incidence of postoperative thromboembolic events in patients with oral squamous cell carcinoma (OSCC) undergoing maxillofacial surgery., Materials and Methods: Between March 2020 and May 2021, 75 patients with OSCC who did not receive perioperative prophylaxis using IPC were retrospectively examined to determine the occurrence of postoperative thromboembolism. Accordingly, 79 patients who received perioperative thrombosis prophylaxis using an IPC system as part of surgical tumor therapy from May 2021 to September 2023 were included in the study. The primary outcome measure was the occurrence of postoperative thromboembolism., Results: In the control group without IPC, thromboembolic events were observed in five out of 75 patients during postoperative hospitalization. In the intervention group, no thromboembolic occurrences were identified among the 79 patients studied (p = 0.02). The mean Caprini score in the control group was 7.72, whereas in the intervention group it averaged 8.30 (p = 0.027)., Conclusions: The implementation of IPC-devices as supplementary perioperative thrombosis prophylaxis resulted in a notable decrease in postoperative venous thromboembolism (Number Needed to Treat = 15), which is why implementation of the system as a regular part of the clinical routine for perioperative management of OSCC patients can be considered a sensible approach., Clinical Relevance: The use of IPC enhances patient outcomes and may lead to improved postoperative care protocols in this high-risk patient population., (© 2024. The Author(s).)

Background: Venous thromboembolic events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), are frequent complications in patients with intracerebral hemorrhage (ICH). Various prophylactic strategies have been employed to mitigate this risk, such as heparin, intermittent pneumatic compression (IPC), and graduated compression stockings (GCS). The optimal thromboembolic prophylaxis approach remains uncertain due to the lack of randomized controlled trials (RCTs) comparing all interventions., Aims: We conducted a network meta-analysis and meta-analysis to systematically review and synthesize evidence from RCTs and non-randomized studies on the efficacy and safety of thromboembolic prophylaxis strategies in hospitalized ICH patients., Summary of Findings: Our study followed a registered protocol (PROSPERO CRD42023489217) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines incorporating the extension for network meta-analyses. Search for eligible studies was performed up to December 2023. We considered the occurrence of DVT, PE, hematoma expansion (HE), and all-cause mortality as outcome measures. A total of 16 studies, including 7 RCTs and 9 non-randomized studies, were included in the analysis. Network meta-analysis revealed that IPC demonstrated the highest efficacy in reducing DVT incidence (odds ratios (OR) 0.30, 95% confidence interval (CI) 0.08-1.16), particularly considering only RCTs (OR 0.33, 95% CI 0.16-0.67). GCS showed the highest safety profile for HE (OR 0.67, 95% CI 0.14-3.13), but without efficacy. Chemoprophylaxis did not reduce the risk of PE events (OR 1.10, 95% CI 0.17-7.19) with a higher occurrence of HE (OR 1.33, 95% CI 0.60-2.96), but the differences were not significant., Conclusion: Our study supports the use of IPC as the primary thromboembolic prophylaxis measure in ICH patients. Further research, including head-to-head RCTs, is needed to strengthen the evidence base and optimize clinical decision-making for thromboembolic prophylaxis in this vulnerable patient population., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Cryotherapy is a widely used intervention in sports settings to facilitate the return of injured athletes to competition, despite a lack of high-quality evidence. Given the possibility cryotherapy may increase the risk of injury, by reducing nerve conduction velocity, muscle force production, and proprioceptive afferent information, further research is needed to evaluate its effects on proprioception, particularly in the shoulder joint, which has the greatest range of motion of any joint in the body, where there is a dearth of studies., Methods: We conducted a pre-registered, 1:1 block randomized, baseline controlled, double blind (outcome assessor and statistician), crossover trial of cryotherapy without compression and cryotherapy with compression., Results: Analysis indicated there were no statistically significant changes in the accuracy of achieving the target angle because of either the cryotherapy or compression intervention. The small effect sizes observed between the groups indicate that cryotherapy is unlikely to have a clinically significant negative impact on shoulder joint position sense., Conclusion: Consequently, returning athletes to the field of play after cryotherapy treatment is not expected to pose an increased risk of injury due to proprioceptive deficits. These findings align with the majority of studies investigating the effects of cryotherapy on proprioception., Impact Statement: This pre-registered, randomized, crossover trial on the effects of cryotherapy on joint position sense (JPS) in physical therapy and rehabilitation provides valuable insights into a widely used treatment modality. The small effect sizes observed in our study suggest that cryotherapy is unlikely to have a clinically significant negative effect on shoulder JPS. Cryotherapy remains a viable therapeutic option, without concerns for adverse effects or further injury risk, in returning athletes to the field of play., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The authors declare no competing interests and no funding was received for this work., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Intermittent pneumatic compression (IPC) systems apply external pressure to the lower limbs and enhance peripheral blood flow. We previously introduced a cardiac-gated compression system that enhanced arterial blood velocity (BV) in the lower limb compared to fixed compression timing (CT) for seated and standing subjects. However, these pilot studies found that the CT that maximized BV was not constant across individuals and could change over time. Current CT modelling methods for IPC are limited to predictions for a single day and one heartbeat ahead. However, IPC therapy for may span weeks or longer, the BV response to compression can vary with physiological state, and the best CT for eliciting the desired physiological outcome may change, even for the same individual. We propose that a deep reinforcement learning (DRL) algorithm can learn and adaptively modify CT to achieve a selected outcome using IPC. Herein, we target maximizing lower limb arterial BV as the desired outcome and build participant-specific simulated lower limb environments for 6 participants. We show that DRL can adaptively learn the CT for IPC that maximized arterial BV. Compared to previous work, the DRL agent achieves 98% ± 2 of the resultant blood flow and is faster at maximizing BV; the DRL agent can learn an "optimal" policy in 15 minutes ± 2 on average and can adapt on the fly. Given a desired objective, we posit that the proposed DRL agent can be implemented in IPC systems to rapidly learn the (potentially time-varying) "optimal" CT with a human-in-the-loop.

Background: The management of pain after shoulder surgery typically includes the use of cryotherapy and the prescription of opioid analgesics. Much focus has been placed lately on the opioid epidemic, which in part is fueled by excessive prescription of opioid medication. Previous studies have found a combination of cryotherapy and compression effective at reducing analgesic consumption and increasing recovery in patients undergoing knee and spine surgery; however, efficacy in patients undergoing shoulder surgery has not been evaluated., Purpose: To evaluate the effectiveness of a cryo-pneumatic compression device on postoperative shoulder pain, narcotic use, and quality of life when compared with standard care cryotherapy., Study Design: Randomized controlled trial; Level of evidence, 2., Methods: In total, 200 patients older than 18 years scheduled for unilateral shoulder surgery were enrolled. Patients were randomized to receive either postoperative cryo-pneumatic compression or standard care. The intervention group received a cryo-pneumatic device, while the standard care group received the treating surgeon's preferred method of postoperative care, including standard cryotherapy. Narcotic use was evaluated by the number of oral morphine milligram equivalents consumed during the postoperative period, as well as the time to cessation of narcotic use. Patient-reported outcome measures consisted of a numeric rating scale pain score, 36-item Short Form Survey, patient experience assessed using the net promoter score, and adverse events. Outcomes were evaluated at 2, 6, and 12 weeks postoperatively., Results: Patients receiving cryo-pneumatic compression reported a significant decrease in opioid consumption when compared with standard care (oral morphine milligram equivalents median, 56.1 vs 112; P = .02468). A significant increase in self-reported function was seen in the cryo-pneumatic compression group at 2 weeks when compared with standard care (mean, 61.2 vs 54.2; P = .0412)., Conclusion: In patients undergoing unilateral shoulder surgery, the use of cryotherapy with pneumatic compression, when compared with standard care, resulted in significantly decreased opioid consumption as well as increased function at 2 weeks., Registration: NCT04185064 (ClinicalTrials.gov identifier)., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Abstract: Gonçalves, DS, Moscaleski, LA, da Silva, GM, Morgans, R, Okano, AH, and Moreira, A. The effect of combined transcranial direct current stimulation and pneumatic compression as part of a comprehensive recovery strategy in professional male top-level soccer players. J Strength Cond Res 38(9): 1658-1666, 2024-This retrospective study aimed to examine the effect of transcranial direct current stimulation (tDCS) combined with lower limb pneumatic compression during the postmatch recovery period in top-level professional male soccer players' physiological and perceptual markers of recovery status. During the 2022 season (baseline), pneumatic compression was performed as part of the recovery strategy, applied the day after official match play and psychophysiological measurements (pain, sleep, perceived recovery, and creatine kinase [CK] sampling) were performed on the second day postmatch. During the 2023 season, the tDCS protocol was introduced, with its application being performed simultaneously (in conjunction) with pneumatic compression. Recovery sessions following 10 matches in the 2022 season and following 10 matches in the 2023 season were included in the analyses. Compared with 2022 (baseline; pneumatic compression isolated), the players perceived an increased recovery on the second day postmatch when tDCS was used in conjunction with the pneumatic compression (mean = 12%; p = 0.008) and rated improved sleep quality for the nights after applying tDCS combined with pneumatic compression (mean = 7.5%; p = 0.029). On the second day postmatch, a significant reduction was observed in muscle pain/soreness (mean = 64%; p < 0.0001) and the CK concentration decreased when baseline (pneumatic compression isolated) was compared with tDCS + pneumatic compression (mean = 76%; p = 0.001). In summary, combining pneumatic compression with tDCS may enhance the effects of both interventions, leading to greater overall improvements in recovery. Further research is warranted to confirm these findings and explore the underlying mechanisms in more detail., (Copyright © 2024 National Strength and Conditioning Association.)

This review aimed to determine the effectiveness of Intermittent Pneumatic Compression (IPC) intervention on Deep Vein Thrombosis (DVT) in surgical patients. An electronic database search was conducted with PubMed, OVID-MEDLINE, EMBASE, and CENTRAL, from September 22 to 28, 2023. Three researchers independently selected the studies, assessed their methodological quality, and extracted relevant data. We conducted a meta-analysis of the effect of IPC versus the control group and summarized the intervention results from the included studies. Of the 2,696 articles identified 16 randomized control trials met the inclusion criteria for review. IPC interventions significantly affected DVT prevention (OR = 0.81, 95% CI: 0.59-1.11). In the subgroup analysis, there was a significant pooled effect (OR = 0.41, 95% CI: 0.26-0.65]), when the comparison group was no prophylaxis group. However, when the comparison groups were the pharmacologic prophylaxis group ([OR = 1.32, 95% CI 0.78-2.21]) and IPC combined with the pharmacologic prophylaxis group (OR = 2.43, 95% CI: 0.99-5.96) did not affect DVT prevention. The pooled effects of Pulmonary Embolism (PE) (OR = 5.81, 95% CI: 1.25-26.91) were significant. IPC intervention showed a significant effect on bleeding prevention (OR = 0.17, 95% CI: 0.08-0.36) when compared to IPC combined with the pharmacologic groups. IPC intervention effectively prevented DVT, PE, and bleeding in surgical patients. Therefore, we propose that IPC intervention be applied to surgical patients to avoid DVT, pulmonary embolism, and bleeding in the surgical nursing field as scientific evidence suggests., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Kim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: There are multiple postexercise recovery technologies available in the market based on the assumption of blood-flow enhancement. Lower-limb intermittent pneumatic compression (IPC) has been widely used, but the available scientific evidence supporting its effectiveness remains scarce, requiring a deeper investigation into its underlying mechanisms. The aim of this study was to assess the hemodynamic effects caused by the use of IPC at rest., Methods: Twenty-two soccer and track and field athletes underwent two 15-minute IPC protocols (moderate- [80 mm Hg] and high-pressure [200 mm Hg]) in a randomized order. Systolic peak velocity, end-diastolic peak velocity, arterial diameter, and heart rate were measured before, during (at the eighth minute), and 2 minutes after each IPC protocol., Results: Significant effects were observed between before and during (eighth minute) the IPC protocol for measures of systolic (P < .001) and end-diastolic peak velocities (P < .001), with the greater effects observed during the high-pressure protocol. Moreover, 2 minutes after each IPC protocol, hemodynamic variables returned to values close to baseline. Arterial diameter presented significant differences between pressures during the IPC protocols (P < .05), while heart rate remained unaltered., Conclusion: IPC effectively enhances transitory blood flow of athletes, particularly when applying high-pressure protocols.

Objective: This prospective, longitudinal, pragmatic study describes at home treatment with a proprietary advanced pneumatic compression device (APCD) for patients with lower extremity lymphedema (LED)., Methods: Following institutiona review board approval, four participating Veterans Affairs centers enrolled LED patients from 2016 to 2022. The primary outcome measures were health-related quality of life (HR-QoL) questionnaires (lymphedema quality of life-leg and the generic SF-36v2) obtained at baseline and 12, 24, and 52 weeks. The secondary outcome measures were limb circumference, cellulitis events, skin quality, and compliance with APCD and other compression therapies., Results: Because a portion of the trial was conducted during the coronavirus disease 2019 pandemic, 179 patients had 52 weeks of follow-up, and 143 had complete measurements at all time points. The baseline characteristics were a mean age of 66.9 ± 10.8 years, 91% were men, and the mean body mass index was 33.8 ± 6.9 kg/m 2 . LED was bilateral in 92.2% of the patients. Chronic venous insufficiency or phlebolymphedema was the most common etiology of LED (112 patients; 62.6%), followed by trauma or surgery (20 patients; 11.2%). Cancer treatment as a cause was low (4 patients; 2.3%). Patients were classified as having International Society for Lymphology (ISL) stage I (68.4%), II (27.6%), or III (4.1%). Of the primary outcome measures, significant improvements were observed in all lymphedema quality of life-leg domains of function, appearance, symptoms, and emotion and the overall score after 12 weeks of treatment (P < .0001) and through 52 weeks of follow-up. The SF-36v2 demonstrated significant improvement in three domains at 12 weeks and in the six domains of physical function, bodily pain, physical component (P < .0001), social functioning (P = .0181), role-physical (P < .0005), and mental health (P < .0334) at 52 weeks. An SF-36v2 score <40 indicates a substantial reduction in HR-QoL in LED patients compared with U.S. norms. Regarding the secondary outcome measures at 52 weeks, compared with baseline, the mean limb girth decreased by 1.4 cm (P < .0001). The maximal reduction in mean limb girth was 1.9 cm (6.0%) at 12 weeks in ISL stage II and III limbs. New episodes of cellulitis in patients with previous episodes (21.4% vs 6.1%, P = .001) were reduced. The 75% of patients with skin hyperpigmentation at baseline decreased to 40% (P < .01) at 52 weeks. At 52 weeks, compliance, defined as use for 5 to 7 days per week, was reported for the APCD by 72% and for elastic stockings by 74%., Conclusions: This longitudinal study of Veterans Affairs patients with LED demonstrated improved generic and disease-specific HR-QoL through 52 weeks with at home use of an APCD. Limb girth, cellulitis episodes, and skin discoloration were reduced, with excellent compliance., Competing Interests: Disclosures None., (Published by Elsevier Inc.)

Intermittent pneumatic compression of the lower limbs has been shown to have beneficial effects in patients with chronic ulceration. However, the intermittent compression cuff will normally be applied over the wound, which may produce discomfort or interfere with other treatments. Thigh‐only approaches to intermittent pneumatic compression could solve this problem. This study aimed to demonstrate if such a system would have positive effects on venous and arterial blood flow distal to the compression site, but proximal to wound sites. The distal venous and arterial effects of a prototype thigh‐only 3‐chamber sequential intermittent pneumatic compression system were tested in 20 healthy volunteers, and 13 patients with ulcers of various aetiologies using Doppler ultrasound. The system produced hyperaemic responses in the arterial flow of both test groups. The peak venous velocity on deflation of the first and second chambers of the cuff was also greater in the patients with ulceration than in the healthy volunteers (11.6 cm/s vs 8.3 cm/s, P =.1). This work demonstrates that compression of the thigh alone can produce positive haemodynamic effects in the calves of patients with chronic wounds, and that this approach should be investigated as a therapy to improve blood flow to wound sites. [ABSTRACT FROM AUTHOR]

Background: The management of perioperative venous thrombembolism (VTE) prophylaxis is highly variable between neurosurgical departments and general guidelines are missing. The main issue in debate are the dose and initiation time of pharmacologic VTE prevention to balance the risk of VTE-based morbidity and potentially life-threatening bleeding. Mechanical VTE prophylaxis with intermittend pneumatic compression (IPC), however, is established in only a few neurosurgical hospitals, and its efficacy has not yet been demonstrated. The objective of the present study was to analyze the risk of VTE before and after the implementation of IPC devices during elective neurosurgical procedures., Methods: All elective surgeries performed at our neurosurgical department between 01/2018-08/2022 were investigated regarding the occurrence of VTE. The VTE risk and associated mortality were compared between groups: (1) only chemoprophylaxis (CHEMO; surgeries 01/2018-04/2020) and (2) IPC and chemoprophylaxis (IPC; surgeries 04/2020-08/2022). Furthermore, general patient and disease characteristics as well as duration of hospitalization were evaluated and compared to the VTE risk., Results: VTE occurred after 38 elective procedures among > 12.000 surgeries. The number of VTEs significantly differed between groups with an incidence of 31/6663 (0.47%) in the CHEMO group and 7/6688 (0.1%) events in the IPC group. In both groups, patients with malignant brain tumors represented the largest proportion of patients, while VTEs in benign tumors occurred only in the CHEMO group., Conclusion: The use of combined mechanical and pharmacologic VTE prophylaxis can significantly reduce the risk of postoperative thromboembolism after neurosurgical procedures and, therefore, reduce mortality and morbidity., (© 2024. The Author(s).)

Purpose: Postoperative pulmonary embolism is a leading cause of mortality in patients undergoing major urologic surgeries, presenting a complex challenge in balancing the risks of venous thromboembolism (VTE) and perioperative bleeding. This study examines the current evidence on thromboprophylaxis in urological procedures, focusing on procedure-specific considerations., Methods: Literature on thromboprophylaxis in urological procedures was reviewed during the past decade., Results: Various mechanical thromboprophylaxis methods, such as compression stockings, pneumatic compression devices, foot pumps, mobilization, and exercises, are available preventive measures. Additionally, unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are commonly used pharmacological agents for VTE prevention, with the choice between mechanical, pharmacological, or combined approaches tailored to individual patient characteristics and surgical requirements. Patient risk stratification into low, medium, and highrisk categories based on age, BMI, and VTE history guides the selection of thromboprophylaxis strategies. Surgical procedures are categorized as oncological or non-oncological, with uro-oncological surgeries posing a higher VTE risk than non-oncological procedures. Consequently, a combination of pharmacological and mechanical prophylaxis is typically recommended for uro-oncological patients, while pharmacological prophylaxis is reserved for high-risk individuals undergoing non-oncological surgeries. Mechanical prophylaxis is advised for high-risk patients undergoing procedures with elevated VTE risk., Conclusion: This study summarized an optimal thromboprophylaxis protocol taking into account patient risk factors and the specific urological procedure.

Background: Among venous thromboembolism, pulmonary thromboembolism (PTE) is one of the most serious postoperative complications. Deep venous thrombosis (DVT) is the main cause. Considering the unknown prevalence of DVT and PTE in the postoperative period of cardiovascular surgery in Japan, we investigated the incidence in consecutive patients who underwent cardiovascular surgery., Methods: A total of 225 patients who underwent cardiovascular surgery at four hospitals consented to participate in the study. We assessed DVT using lower extremity venous ultrasound preoperatively and postoperatively. Seven patients with preexisting DVT were excluded. Postoperative antithrombotic therapy was administered at the discretion of the attending physician at each institution. The postoperative intermittent pneumatic compression therapy followed the standard prophylaxis protocol at each institution. Patients were grouped into DVT and non-DVT cohorts for comparison. Continuous variables were expressed as means ± standard deviations and compared by the t-test., Results: The analysis of lower extremity venous ultrasound images indicated that DVT developed in 16 of the 218 study patients (DVT, 7.3%). No patient had PTE. Procedure-related data revealed significantly higher total blood transfusion (DVT group: 61.2 ± 49.9 IU vs. non-DVT group: 27.7 ± 30.2 IU: p  = 0.018, effect size = 1.048) in the DVT group. The multivariate logistic regression predictor of DVT based on preoperative, intraoperative, and postoperative factors was blood transfusion ( p  = 0.005, 95% confidence interval 1.010-1.059, odds ratio 1.034)., Conclusions: The incidence of postoperatively developed DVT was 7.3% in this study., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Intermittent pneumatic compression (IPC) applies gradual pressure to facilitate lymph and blood flow movement to reduce exercise-induced tissue fluid accumulation and plasma volume loss. This study aimed to evaluate the cardiovascular system response during the recovery with IPC compared with passive recovery (Sham)., Methods: Sixteen volunteers (7 females and 9 males) executed a cycling-based exhausting sprint interval exercise (8 × 20 s all out), followed by a 30-min IPC or Sham condition. Participants performed two trials in a randomised, counterbalanced, and crossover design. Several cardiovascular parameters (blood pressure, heart function, and peripheral vascular resistance) were recorded at baseline (5'), through the recovery protocol (30'), and afterwards (5')., Results: The use of IPC during the recovery phase led to a faster recovery, stated in relative values to pre-exercise, in mean blood pressure (102.5 ± 19.3% vs. 92.7 ± 12.5%; P < 0.001), and cardiac output (139.8 ± 30.0% vs. 146.2 ± 40.2%; P < 0.05) in comparison to Sham condition. Furthermore, during the IPC-based recovery, there was a slower recovery in cardiac pressure change over time (92.5 ± 25.8% vs. 100.5 ± 48.9%; P < 0.05), and a faster return to pre-exercise values in the peripheral vascular resistance (75.2 ± 25.5% vs. 64.8 ± 17.4%; P < 0.001) compared to Sham., Conclusion: The application of IPC after high-intensity exercise promotes the recovery of the cardiovascular system, reducing cardiovascular strain. Future investigations should consider the effects on the sympathetic-parasympathetic balance, such as heart rate variability, to assess further bonds between the use of IPC and autonomous control., (© 2023. The Author(s).)

This was a prospective observational pilot study of a unique intermittent pneumatic compression (IPC) device designed to be applied in the thigh region of the affected limb in patients with lower limb ulceration of both venous and mixed (venous and arterial) aetiologies. This compression system consists of a circumferential three‐chamber thigh garment and an electronic pneumatic compression pump operating over a repeated 4‐minute cycle. Patients were recruited from outpatient wound clinics. Those recruited were treated with standard therapy in addition to IPC, which was applied for 2 hours per day, and followed up for a total of 8 weeks. The primary objective of the study was to examine the effects of IPC on wound healing over an 8‐week period. The other objectives were to assess patients' experiences of pain and the acceptability of IPC device. Twenty‐one patients were recruited, and wounds progressed towards healing in 95.24% (20/21) of the patients. Pain scores decreased in 83.33% (15/18) of the patients. Most patients felt that the thigh‐applied IPC device was comfortable and easy to apply and remove. The thigh‐administered IPC device can be recommended for use in routine clinical practice, especially when other treatment options are limited. [ABSTRACT FROM AUTHOR]

Context: Postspinal hypotension remains a frequent complication of subarachnoid block during cesarean section causing further maternal and fetal adverse effects. Aims: This study aims to evaluate and compare a continuous pressure nonpneumatic anti-shock garment (NASG) and an intermittent sequential compression device (SCD) with a control group for prevention of postspinal hypotension in women undergoing elective cesarean section. Settings and Design: A randomized, observer blind, controlled study at single university hospital. Subjects and Methods: Ninety singleton term parturients between 18 and 35 years of age undergoing cesarean section with spinal anesthesia were randomly assigned to be applied with NASG, SCD, or no device; n = 30 in each group. A standardized protocol for cohydration and anesthetic technique was followed. The primary outcome measure was incidence of hypotension defined as a decrease in systolic blood pressure of more than 20% from baseline or an absolute value <100 mmHg, whichever was higher. The secondary outcome measures were median dose of ephedrine required, incidence of maternal nausea and vomiting, and neonatal Apgar scores. Statistical Analysis Used: Results were expressed as mean (±standard deviation), median (range), or number (%) as appropriate. Nominal data were compared using Chi-square/Fischer's exact test. Continuous data were compared using ANOVA one-way test. Nonparametric data were compared using Kruskal--Wallis test. Results: In Groups NASG, SCD, and C, incidence of hypotension was 60%, 83%, and 90%, respectively (P = 0.021), with significant reduction in incidence of hypotension in Group NASG versus Group C (P < 0.001, odds ratio 0.17, 95% confidence interval 0.04--0.68). Median (interquartile range) dose of ephedrine required was significantly less in Group NASG compared with Groups SCD and C, respectively (P = 0.002, P < 0.001). Conclusions: NASG proved to be a more effective device for prevention of postspinal hypotension when compared with application of SCD or no device. [ABSTRACT FROM AUTHOR]

This meta-analysis assessed the effect of pneumatic compression therapy on the wound healing of venous ulcers, with the aim of providing a basis for the selection of clinical treatment. Randomised controlled trials (RCTs) on the application of pneumatic compression therapy to venous ulcers were collected by searching PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, VIP, and Wanfang databases, with a timeframe from database inception to August 2023. After two researchers independently screened the literature, extracted information, and evaluated the quality of the included studies, a meta-analysis was performed using RevMan 5.4 software. Six RCTs with 367 patients were included, with 172 patients in the intervention group and 195 in the control group. The results showed that pneumatic and bandage compression therapies had a similar impact on wound healing rates of venous ulcers (54.65% vs. 53.84%, odds ratio [OR]: 1.02, 95% confidence interval [CI]: 0.49-2.12, p = 0.96), changes in wound area (standardised mean difference: -0.16, 95% CIs: -0.45 to 0.12, p = 0.26), adverse event rates (76.56% vs. 67.07%, OR: 1.62, 95% CI: 0.77-3.39, p = 0.20), and the differences were not statistically significant. Thus, current evidence suggests that the effects of pneumatic compression therapy on wound healing rates, changes in wound area, and the incidence of adverse events in patients with venous ulcers are similar to those of bandage pressure therapy. However, owing to the limitations in the number and quality of studies, more high-quality RCTs are needed to clarify the feasibility and economics of pneumatic compression therapy in patients with venous ulcers., (© 2023 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Lymphedema is a chronic disabling disease that affects 250 million people worldwide. To this date, it has been proven that treatment of this category of patients should be truly integrated - combining surgical, therapeutic methods and recovery procedures., Objective: To study the influence of intermittent pneumatic compression (IPC) on microvasculature in patients with lymphedema of the lower extremities., Material and Methods: Prospective randomized clinical trial included the observation of 60 patients with lower extremities' lymphedema of stages I-III, divided into 2 groups. The 1st group consisted of 30 patients who received IPC in addition to the baseline therapy (lymphotonic agents for 3 weeks and elastic compression using therapeutic garment of the 3 rd compression class for 1 month); the 2 nd group included 30 patients who received only baseline therapy. Laser doppler flowmetry (LDF) was applied to study microhemodynamics., Results: Most patients complained of swelling and heaviness sensation in the affected extremity, increased fatigue at admission. The presence of dense, painless swellings in the foot arch and tibia was revealed during physical examination. The difference in circumference of lower third of the tibia with a healthy extremity was equal 4.1±1.73 cm on average. The data obtained from LDF indicated that patients with lymphedema had impaired endothelial function, arterioles spasticity and decreased level of capillary perfusion. The 1st group patients had improvement of all LDF indicators after the treatment course. The 2 nd group patients had a positive dynamics only in two LDF indicators., Conclusion: Patients with lymphedema of the lower extremities had changes in all microvasculature components according to the LDF. The inclusion of IPC in a comprehensive rehabilitation program for this category of patients led to the elimination of impaired endothelial function that contributed to vasodilatation of arterioles and microhemodynamics improvement in general. Regression of the disease's clinical symptoms was found in a greater degree in patients receiving IPC compared to control group.

Access to trained lymphedema care providers remains limited making patient-driven management solutions essential. One such option, sequential intermittent pneumatic compression (IPC), has gained traction as a supportive tool for lymphedema management. While newer IPC devices and innovative applications are being introduced to the market, questions regarding the safety and efficacy of this technology persist. This underscores the importance of reviewing current literature to understand IPC's evolving role in lymphedema care and to identify existing knowledge gaps. A scoping review of literature was conducted across various databases using PRISMA-ScR guidelines. The eligibility criteria included articles published in English language from database's inception to June 2023, discussing IPC's safety, and/or efficacy, and/or optimal modes and settings for lymphedema management. Review articles and case reports and original studies with unclear outcome measures were excluded. The review identified 49 eligible studies from an initial pool of 614 articles, consisting of 12 randomized controlled trials, 25 cohort studies, and 12 experimental studies. Most studies (44) focused on limb lymphedema, while five examined non-limb regions. Sample sizes varied widely, ranging from 10 to 718 participants, reflecting differences in studies' power. Minor adverse events were reported in six studies, including transient skin irritation, paresthesia, and rare cases of genital edema. Efficacy data indicated that IPC, whether used with or without manual lymphatic drainage (MLD), improved limb volume, quality of life, and reduced infection rates, although results varied according to treatment protocols and limb type. The addition of IPC improved compliance of decongestive therapy and increased patient satisfaction. IPC sessions ranged from 45 to 120 minutes per day, conducted 3 to 7 days per week, with pressures set at 60 to 120 mmHg for lower limbs and 25 to 60 mmHg for upper limbs. Higher pressures were associated with more significant limb volume reduction in the lower limbs. A cost analysis indicated that IPC could potentially lead to healthcare savings by reducing infections and hospital admissions. IPC application also showed promising results in head and neck lymphedema, though results for trunk lymphedema were equivocal. Future research should aim to refine IPC protocols in different regions of the body and ascertain its long-term benefits., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright by International Society of Lymphology.)

Background: Venous thrombosis and compartment syndrome are potentially serious complications of prolonged, lithotomy position surgery. It is unclear whether mechanical thromboprophylaxis in this group of patients modifies the risk of compartment syndrome. This qualitative systematic review examines the evidence base to guide clinical practice.Method: A systematic review was performed guided by Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) criteria, to identify studies reporting relationships between lithotomy position, compartment syndrome and mechanical thromboprophylaxis. The aim was to determine if mechanical thromboprophylaxis influenced compartment syndrome risk in the lithotomy position.Results: Sixteen studies were identified: eight case reports or case series (12 patients), two completed audit cycles (approximately 2000 patients), four reviews and two volunteer case control studies (33 subjects). There were no randomised studies. Nine studies associated mechanical thromboprophylaxis with compartment syndrome risk but in each case a causative relationship was speculative. In contrast, five papers, including an experimental, cohort study and two observational, population studies recommended intermittent pneumatic compression as prevention against compartment syndrome in lithotomy position. One review and one case report were unable to make a recommendation.Conclusions: The level of evidence addressing the interaction between the lithotomy position, compartment syndrome and mechanical thromboprophylaxis is weak. There is no conclusive evidence that mechanical thromboprophylaxis causes compartment syndrome in the lithotomy position. There is limited evidence to suggest intermittent pneumatic compression may be a safe method of mechanical thromboprophylaxis if accompanied by strict adherence to other measures to reduce the chance of compartment syndrome. However further studies are required. [ABSTRACT FROM AUTHOR]

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Purpose and hypothesis: Adjuvant intermittent pneumatic compression (IPC) during leg immobilization following Achilles tendon rupture (ATR) has been shown to reduce the risk of deep venous thrombosis. The purpose of this study was to investigate whether IPC can also promote tendon healing.Methods: One hundred and fifty patients with surgical repair of acute ATR were post-operatively leg immobilized and prospectively randomized. Patients were allocated for 2 weeks of either adjuvant IPC treatment (n = 74) or treatment-as-usual (n = 74) in a plaster cast without IPC. The IPC group received 6 h daily bilateral calf IPC applied under an orthosis on the injured side. At 2 weeks post-operatively, tendon healing was assessed using microdialysis followed by enzymatic quantification of tendon callus production, procollagen type I (PINP) and type III (PIIINP) N-terminal propeptide, and total protein content. 14 IPC and 19 cast patients (control group) consented to undergo microdialysis. During weeks 3-6, all subjects were leg-immobilized in an orthosis without IPC. At 3 and 12 months, patient-reported outcome was assessed using reliable questionnaires (ATRS and EQ-5D). At 12 months, functional outcome was measured using the validated heel-rise test.Results: At 2 weeks post-rupture, the IPC-treated patients exhibited 69% higher levels of PINP in the ruptured Achilles tendon (AT) compared to the control group (p = 0.001). Interestingly, the IPC-treated contralateral, intact AT also demonstrated 49% higher concentrations of PINP compared to the non-treated intact AT of the plaster cast group (p = 0.002). There were no adverse events observed associated with IPC. At 3 and 12 months, no significant (n.s.) differences between the two treatments were observed using patient-reported and functional outcome measures.Conclusions: Adjuvant IPC during limb immobilization in patients with ATR seems to effectively enhance the early healing response by upregulation of collagen type I synthesis, without any adverse effects. Whether prolonged IPC application during the whole immobilization period can also lead to improved long-term clinical healing response should be further investigated. The healing process during leg immobilization in patients with Achilles tendon rupture can be improved through adjuvant IPC therapy, which additionally prevents deep venous thrombosis.Level of evidence: Randomized controlled trial, Level I. [ABSTRACT FROM AUTHOR]