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James R Urbaniak - One of the best experts on this subject based on the ideXlab platform.
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role of nitric oxide in vasodilation in upstream muscle during Intermittent Pneumatic Compression
Journal of Applied Physiology, 2002Co-Authors: Longen Chen, Anthony V Seaber, Wen Ning Qi, Elizabeth Joneschild, Jonathan S Stamler, James R UrbaniakAbstract:This study investigated the dosage effects of nitric oxide synthase (NOS) inhibitorN G-monomethyl-l-arginine(l-NMMA) on Intermittent Pneumatic Compression (IPC)-induced vasodilation in uncompressed...
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Influences of inflation rate and duration on vasodilatory effect by Intermittent Pneumatic Compression in distant skeletal muscle.
Journal of Orthopaedic Research, 1999Co-Authors: Longen Chen, Anthony V Seaber, James R UrbaniakAbstract:: Previous study has demonstrated that application of Intermittent Pneumatic Compression on legs can cause vasodilation in distant skeletal muscle at the microcirculation level. This study evaluated the influence of inflation rate and peak-pressure duration on the vasodilatory effects of Intermittent Pneumatic Compression. The cremaster muscles of 50 male rats were exposed and divided into five groups of 10 each. A specially designed Intermittent Pneumatic-Compression device was applied in a medial-lateral fashion to both legs of all rats for 60 minutes, with an inflation rate and peak-pressure duration of 0.5 and 5 seconds, respectively, in group A, 5 and 0 seconds in group B, 5 and 5 seconds in group C, 10 and 0 seconds in group D, and 10 and 5 seconds in group E. Diameters of arterial segments were measured in vessels of three size categories (10-20, 21-40, and 41-70 microm) for 120 minutes. The results showed that the greatest increase in diameter was produced by Intermittent Pneumatic Compression with the shortest inflation rate (0.5 seconds). A moderate increase resulted from Compression with an inflation rate of 5 seconds, and no effective vasodilation occurred during Compression with the longest inflation rate (10 seconds). When the groups with different inflation rates but the same peak-pressure duration were compared, there was a significant difference between any two groups among groups A, C, and E and between groups B and D. When the groups with different peak-pressure durations but the same inflation rate were compared, Compression with a peak-pressure duration of 5 seconds caused a generally similar degree of diameter change as did Compression without inflation at peak pressure. The findings suggest that inflation rate plays an important role in the modulation of distant microcirculation induced by Intermittent Pneumatic Compression whereas peak-pressure duration does not significantly influence the vasodilatory effects of the Compression. This may be due to the fact that rapid inflation produces a significant increase in shear stress on the vascular wall, which stimulates vascular endothelium to release nitric oxide, causing systemic vasodilation.
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Intermittent Pneumatic Compression of legs increases microcirculation in distant skeletal muscle
Journal of Orthopaedic Research, 1999Co-Authors: Longen Chen, Anthony V Seaber, Glenn W Johnson, James R UrbaniakAbstract:Intermittent Pneumatic Compression has been established as a method of clinically preventing deep vein thrombosis, but the mechanism has not been documented. This study observed the effects of Intermittent Pneumatic Compression of legs on the microcirculation of distant skeletal muscle. The cremaster muscles of 80 male rats were exposed, a specially designed Intermittent Pneumatic-Compression device was applied to both legs for 60 minutes, and the microcirculation of the muscles was assessed by measurement of the vessel diameter in three categories (10–20, 21–40, and 41–70 μm) for 120 minutes. The results showed significant vasodilation in arterial and venous vessels during the application of Intermittent Pneumatic Compression, which disappeared after termination of the Compression. The vasodilation reached a maximum 30 minutes after initiation of the Compression and could be completely blocked by an inhibitor of nitric oxide synthase, NG-monomethyl-L-arginine (10 μmol/min). A 120-minute infusion of NG-monomethyl-L-arginine, beginning coincident with 60 minutes of Intermittent Pneumatic Compression, resulted in a significant decrease in arterial diameter that remained at almost the same level after termination of the Compression. The magnitude of the decrease in diameter in the group treated with Intermittent Pneumatic Compression and NG-monomethyl-L-arginine was comparable with that in the group treated with NG-monomethyl-L-arginine alone. The results imply that the production of nitric oxide is involved in the positive influence of Intermittent Pneumatic Compression on circulation. It is postulated that the rapid increase in venous velocity induced by Intermittent Pneumatic Compression produces strong shear stress on the vascular endothelium, which stimulates an increased release of nitric oxide and thereby causes systemic vasodilation.
J M Watt - One of the best experts on this subject based on the ideXlab platform.
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Intermittent Pneumatic Compression to prevent proximal deep venous thrombosis during and after total hip replacement a prospective randomized study of Compression alone Compression and aspirin and Compression and low dose warfarin
Journal of Bone and Joint Surgery American Volume, 1991Co-Authors: Steven T. Woolson, J M WattAbstract:A prospective, randomized study of the effectiveness of intraoperative and postoperative use of Intermittent Pneumatic Compression, alone or in combination with oral administration of either aspirin or low-dose warfarin, was done of a consecutive series of patients who had a total hip replacement and were more than thirty-nine years old. All patients began walking by the third postoperative day. One hundred and ninety-six patients who had 217 total hip arthroplasties were included. Twenty-eight per cent of the procedures were revisions of a previous total hip replacement or of an endoprosthesis, and the remainder were primary arthroplasties. Patients were randomized as to the type of prophylaxis that they received: Intermittent Pneumatic Compression alone, seventy-six hips; Intermittent Pneumatic Compression and aspirin, seventy-two hips; or Intermittent Pneumatic Compression and low-dose warfarin, sixty-nine hips. Before discharge from the hospital, and at an average of seven days after the operation, all patients were evaluated for the presence of proximal deep-vein thrombosis with either venography on the side of the operation or with bilateral venous ultrasonography. The relative frequency with which thrombosis occurred in a proximal vein was not significantly different in the three groups; the over-all relative frequency was 10 per cent. Intermittent Compression during and after the operation effectively reduces the rate of proximal-vein thrombosis after total hip replacement. With the number of patients in our study, the effectiveness of this technique could not be shown to be augmented by oral administration of either aspirin or low-dose warfarin.
Steven T. Woolson - One of the best experts on this subject based on the ideXlab platform.
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Intermittent Pneumatic Compression Prophylaxis for Proximal Deep Venous Thrombosis after Total Hip Replacement
Journal of Bone and Joint Surgery American Volume, 1996Co-Authors: Steven T. WoolsonAbstract:The efficacy of Intermittent Pneumatic Compression in the prevention of proximal deep venous thrombosis was determined in a consecutive series of patients who had primary or revision total hip replacement. Two hundred and eighty-nine patients (242 primary and eighty revision hip replacements) who were at least forty years old were managed intraoperatively and postoperatively with Intermittent Pneumatic Compression with use of thigh-high sequential Compression sleeves and thigh-high elastic Compression stockings as the only form of prophylaxis. Venous ultrasonography of the ipsilateral lower extremity was performed, at an average of five days postoperatively, to determine the presence of a thrombus in the femoral and popliteal veins. The prevalence of proximal deep venous thrombosis was 6 per cent (twenty of 322 procedures), and no patient had a clinically detected pulmonary embolism. The prevalence of a proximal thrombus was 4 per cent (ten of 233 procedures) when a regional anesthetic had been used and 11 per cent (ten of eighty-nine procedures) when a general anesthetic had been used; this difference was significant (p = 0.02). The prevalence of a proximal thrombus was 3 per cent (eight of 245 procedures) for patients who were less than seventy-five years old and 16 per cent (twelve of seventy-seven procedures) for patients who were seventy-five years old or more (p < 0.0001). No patient had a major bleeding complication. Twenty-nine other patients who had an additional risk factor for thrombosis, such as a history of deep venous thrombosis, were managed with Intermittent Pneumatic Compression and low-dose warfarin. The prevalence of proximal deep venous thrombosis in this group of patients was 19 per cent (six of thirty-one procedures). Intraoperative and postoperative Intermittent Pneumatic Compression, combined with the use of a regional anesthetic, was found to be highly effective in the prevention of proximal deep venous thrombosis after total hip replacement. Despite the limitations inherent in comparisons among series, it is noteworthy that the prevalence of proximal thrombosis in our series was similar to the reported prevalences in several large series of patients who had a total hip replacement and were managed with either low-dose warfarin or low-molecular-weight heparin. However, there was no risk of major postoperative bleeding in the current study.
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Intermittent Pneumatic Compression to prevent proximal deep venous thrombosis during and after total hip replacement a prospective randomized study of Compression alone Compression and aspirin and Compression and low dose warfarin
Journal of Bone and Joint Surgery American Volume, 1991Co-Authors: Steven T. Woolson, J M WattAbstract:A prospective, randomized study of the effectiveness of intraoperative and postoperative use of Intermittent Pneumatic Compression, alone or in combination with oral administration of either aspirin or low-dose warfarin, was done of a consecutive series of patients who had a total hip replacement and were more than thirty-nine years old. All patients began walking by the third postoperative day. One hundred and ninety-six patients who had 217 total hip arthroplasties were included. Twenty-eight per cent of the procedures were revisions of a previous total hip replacement or of an endoprosthesis, and the remainder were primary arthroplasties. Patients were randomized as to the type of prophylaxis that they received: Intermittent Pneumatic Compression alone, seventy-six hips; Intermittent Pneumatic Compression and aspirin, seventy-two hips; or Intermittent Pneumatic Compression and low-dose warfarin, sixty-nine hips. Before discharge from the hospital, and at an average of seven days after the operation, all patients were evaluated for the presence of proximal deep-vein thrombosis with either venography on the side of the operation or with bilateral venous ultrasonography. The relative frequency with which thrombosis occurred in a proximal vein was not significantly different in the three groups; the over-all relative frequency was 10 per cent. Intermittent Compression during and after the operation effectively reduces the rate of proximal-vein thrombosis after total hip replacement. With the number of patients in our study, the effectiveness of this technique could not be shown to be augmented by oral administration of either aspirin or low-dose warfarin.
Nicola Maffulli - One of the best experts on this subject based on the ideXlab platform.
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Intermittent Pneumatic Compression in fracture and soft tissue injuries healing
British Medical Bulletin, 2008Co-Authors: Anil Khanna, Nikolaos Gougoulias, Nicola MaffulliAbstract:Introduction: Current methods of fracture care use various adjuncts to try and decrease time to fracture union, improve fracture union rates and enhance functional recovery. Intermittent Pneumatic Compression (IPC), one such modality, is used in the management of both fractures and soft-tissue injuries. Methods and results: A search of PubMed, Medline, CINAHL, DH data and Embase databases was performed using the following keywords ‘Intermittent Pneumatic Compression’, ‘fracture healing’ and ‘soft tissue healing’. Sixteen studies on the use of IPC in fracture and soft-tissue healing were identified. These studies demonstrated that IPC facilitates both fracture and soft-tissue healing with rapid functional recovery. Conclusions: IPC appears to be an effective modality to enhance fracture and soft-tissue healing. However, the number of subjects in human studies is small, and adequately powered randomized controlled trials in humans are required to produce stronger clinically relevant evidence.
Juliessa M Pavon - One of the best experts on this subject based on the ideXlab platform.
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effectiveness of Intermittent Pneumatic Compression devices for venous thromboembolism prophylaxis in high risk surgical patients a systematic review
Journal of Arthroplasty, 2016Co-Authors: Juliessa M Pavon, Soheir S Adam, Zayd A Razouki, Jennifer R Mcduffie, Paul F Lachiewicz, Andrzej S Kosinski, Christopher A Beadles, Thomas L OrtelAbstract:Abstract Background Thromboprophylaxis regimens include pharmacologic and mechanical options such as Intermittent Pneumatic Compression devices (IPCDs). There are a wide variety of IPCDs available, but it is uncertain if they vary in effectiveness or ease of use. This is a systematic review of the comparative effectiveness of IPCDs for selected outcomes (mortality, venous thromboembolism [VTE], symptomatic or asymptomatic deep vein thrombosis, major bleeding, ease of use, and adherence) in postoperative surgical patients. Methods We searched MEDLINE (via PubMed), Embase, CINAHL, and Cochrane CENTRAL from January 1, 1995, to October 30, 2014, for randomized controlled trials, as well as relevant observational studies on ease of use and adherence. Results We identified 14 eligible randomized controlled trials (2633 subjects) and 3 eligible observational studies (1724 subjects); most were conducted in joint arthroplasty patients. Intermittent Pneumatic Compression devices were comparable to anticoagulation for major clinical outcomes (VTE: risk ratio, 1.39; 95% confidence interval, 0.73-2.64). Limited data suggest that concurrent use of anticoagulation with IPCD may lower VTE risk compared with anticoagulation alone, and that IPCD compared with anticoagulation may lower major bleeding risk. Subgroup analyses did not show significant differences by device location, mode of inflation, or risk of bias elements. There were no consistent associations between IPCDs and ease of use or adherence. Conclusions Intermittent Pneumatic Compression devices are appropriate for VTE thromboprophylaxis when used in accordance with current clinical guidelines. The current evidence base to guide selection of a specific device or type of device is limited.