A comparison of different modes of pneumatic compression on muscle tissue oxygenation: An intraparticipant, randomised, controlled volunteer study

Abstract

Intermittent pneumatic compression (IPC) to the lower limbs is widely used as a mechanical means to prevent deep vein thrombosis in hospitalised patients. Due to a theoretical concern about impairing blood flow, thromboembolicdeterrent stockings and IPC are considered contraindicated for patients with peripheral vascular diseases by some clinicians. This study assessed whether IPC would alter peripheral limb muscle tissue oxygenation (StO 2 ), and whether such changes were different during 10 minutes of sequential and single-compartment compressions. Twenty volunteers were randomised to have their left or right arm treated with a sequential or single-compartment IPC for 10 minutes, using the contralateral arm without compression as an intraparticipant control. After a five-minute wash-out period, the procedure was repeated on the same arm using the alternative mode of IPC. Both hands' thenar muscles StO 2 was monitored every two minutes for 10 minutes using the same near-infrared spectroscopy StO 2 monitor. Both sequential (3.5%, 95% confidence intervals (CI) 2.7-4.2; p < 0.001) and single-compartment IPC (1.6%, 95% CI 0.4-2.8; p ¼ 0.039) significantly increased muscle StO 2 within 10 minutes compared to no compression; and the increments were higher during sequential compressions compared to during single-compartment compressions (2.1%, 95% CI 0.7-3.5; p ¼ 0.023). This mechanistic study showed that both modes of IPC increased upper limb muscle StO 2 compared to no compression, but the StO 2 increments were higher with the multiple-chamber sequential compressions mode. Contrary to the theoretical concern that IPC may impair peripheral limb tissue oxygenation, our results showed that IPC actually increases oxygenation of the peripheral limb muscles, especially during the sequential compressions mode.

Intermittent pneumatic compression for prolonged standing workers with leg edema and pain

“…In healthy people, IPC led to a greater increase in flow velocity and volume flow when compared with that shown in a simple leg elevation [10] . Despite concerns that IPC may cause blood vessel obstruction, which could in turn reduce blood flow, a recent study examining peripheral limb muscle tissue oxygenation after applying IPC in healthy volunteers found that both single chamber and multichamber sequential compression increased limb muscle oxygenation [11] …”

Global guidelines trends and controversies in lower limb venous and lymphatic disease

“…102,103 A just published investigation reported how both sequential and single-compartment compressions are able to increase tissue oxygenation, with a significantly higher effect using the multi-chamber device. 104 On the thrombo-embolism side, in 2016 Cochrane 105 analysis showed a benefit in adding IPC to pharmacological thrombo-prophylaxis in high-risk trauma and surgical patients, while, in 2019, New England Journal of Medicine underlined no significant benefit in adding IPC in critically ill patients already covered by drugs for venous thrombo-prophylaxis. 106…”

“…A just published investigation reported how both sequential and single-compartment compressions are able to increase tissue oxygenation, with a significantly higher effect using the multi-chamber device. 104…”

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

“…It also causes the largest increase in venous outflow in the foot and calf [ 44 ]. The risk for blood vessel obstruction with IPC use has been reported, but the application of IPC to healthy subjects increases the oxygenation of muscle cells in the lower limb [ 45 ]. Like MCS, there are still no international consensus pressure values or modes in IPC.…”