Intermittent Pneumatic Compression (IPC)
- Wed, 6/17/09 - 12:14pm
- 0 Comments
- 5218 reads
Dear Readers:
Within 5 years after experiencing a deep vein thrombosis (DVT), 1 in 3 individuals will develop swelling and skin changes associated with post-thrombotic syndrome (PTS).1 Graduated, high-compression bandages and stockings are effective at healing venous leg ulcers, preventing progression of PTS and managing lymphedema,2 but are most effective in ambulatory individuals. How much does walking help, and could increased calf muscle activity enhance the benefits of recognized compression therapies?
Intermittent pneumatic compression (IPC) mimics rhythmic calf muscle contractions and increases venous blood flow. A German guideline3 recommends IPC to prevent post-surgical DVT, heal diabetic foot and venous ulcers, reduce edema and lymphedema, and improve compromised arterial circulation. Intermittent pneumatic compression increases fibrinolysis in ambulatory normal individuals, as well as those with PTS,4 underscoring its importance in managing more than just symptoms. The recent advent of portable IPC devices allows for patients to be mobile during therapy. This offers opportunities for continued IPC use after hospital discharge, while engaging in normal daily activities. If these devices work safely, they may improve consistency of use and outcomes. This month’s Evidence Corner summarizes a recent review of studies that extrapolated evidence of efficacy and safety for IPC devices from hospital use to all appropriate immobile patients across the continuum of care. The second featured study reported on the efficacy and safety of a portable IPC device in improving PTS outcomes in ambulatory patients, suggesting that the benefits of IPC extend beyond those who are inactive or immobile.
Laura Bolton, PhD, FAPWCA
Adjunct Associate Professor
Department of Surgery, UMDNJ
WOUNDS Editorial Advisory Board Member and Department Editor
Improving Venous Flow With IPC
Reference: Partsch H. Intermittent pneumatic compression in immobile patients. Int Wound J. 2008;5(3):389–397.
Rationale: Experience has shown that IPC is useful in preventing lower limb edema in immobile patients who sit with their legs dependent. There is ample evidence for those in similar situations, but no specific reference for IPC use on immobile patients, for whom IPC is underused.
Objective: Summarize experimental and clinical findings to support a rationale for extrapolating use of IPC to improve venous and lymphatic return in immobile patients.
Methods: A systematic review of IPC use on indications that may be clinically relevant to immobile patients was performed. Mechanisms and clinical consequences of edema accumulation in patients with deficient venous and lymphatic return were described. The author summarized benefits, issues, and adverse effects of other edema-reducing modalities including diuretics, compression stockings, and bandages to compare safety and efficacy with IPC. Evidence on physiological parameters affected by IPC was tabulated and practical and clinical issues with using IPC in various settings, including home use, were reviewed.
Results: In addition to post-operative DVT prevention, evidence supports benefits of IPC use in patients with arterial occlusive disease, rheumatoid lower limb flexion deformities, fractures, reduced bone density, and in healing venous ulcers. By simulating the hemodynamic action of walking, IPC can enable nonambulatory patients to maintain pulsatile venous blood flow.
Among modalities used to control edema, long-term diuretic use can cause renal damage and ultimately increases edema.
1. Kolbach DN, Sandbrink MW, Neumann HA, Prins MH. Compression therapy for treating stage I and II (Widmer) post-thrombotic syndrome. Cochrane Database Syst Rev. 2003;(4):CD004177.
2. Partsch H, Flour M, Smith PC, International Compression Club. Indications for compression therapy in venous and lymphatic disease consensus based on experimental data and scientific evidence. Under the auspices of the IUP. Int Angiol. 2008;27(3):193–219.
3. Wienert V, Partsch H, Gallenkemper G, et al. Intermittierende pneumatische Kompression (IPK oder AIK) Entwicklungsstufe S2. Phlebologie. 2005;34(3):176–180.
4. Comerota AJ, Chouhan V, Harada RN, et al. The fibrinolytic effects of intermittent pneumatic compression: mechanism of enhanced fibrinolysis. Ann Surg. 1997;226(3):306–314.
5. Villalta S, Bagatella P, Piccoli A, et al. Assessment and validity and reproducibility of a clinical scale for the post-thrombotic syndrome [Abstract]. Hemostasis. 1994;24(Suppl 1):158a.
6. Lamping DL, Schroter S, Kurz X, Kahn SR, Abenhaim L. Evaluation of outcomes in chronic venous disorders of the leg: development of a scientifically rigorous, patient-reported measure of symptoms and quality of life. J Vasc Surg. 2003;37(2):410–419.
7. Galili O, Mannheim D, Rapaport S, Karmeli R. A novel intermittent mechanical compression device for stasis prevention in the lower limbs during limited mobility situations. Thromb Res. 2007;121(1):37–41.
