Prolonged Doppler US-guided pneumatic compression of a radial artery pseudoaneurysm after percutaneous coronary intervention: a simple and effective solution for a rare and challenging problem / Compressão pneumática prolongada e guiada por ultrassom de um pseudoaneurisma da artéria radial após intervenção coronariana percutânea: solução simples e eficaz para um problema raro e desafiador

Abstract Transradial access is associated with fewer access site-related complications, earlier patient mobilization, and greater postprocedural comfort. Pseudoaneurysms are an extremely rare complication after transradial procedures and the radial artery itself is the most atypical arterial site of occurrence. We report a case in which a non-surgical, non-invasive, simple, and effective solution (prolonged pneumatic compression) was used to manage a radial artery pseudoaneurysm, a very rare and challenging complication of transradial procedures.

Resumo O acesso arterial transradial está associado a menos complicações relacionadas ao sítio de punção, com deambulação precoce do paciente e maior conforto pós-procedimento. O pseudoaneurisma é uma complicação extremamente rara após procedimentos transradiais, sendo a artéria radial, por si só, o sítio mais incomum para tal ocorrência. Relata-se um caso de um pseudoaneurisma de artéria radial, uma complicação rara e desafiadora, resolvido com êxito e de maneira simples, não invasiva e não cirúrgica (compressão pneumática prolongada).

Preferences and Practices of Brazilian Orthopedists for Thromboprophylaxis Techniques in Total Knee Arthroplasty: Survey Among Members of the Brazilian Society of Knee Surgery (SBCJ) / Preferências e práticas de ortopedistas brasileiros por técnicas de tromboprofilaxia na artroplastia total do joelho: Levantamento entre membros da Sociedade Brasileira de Cirurgia do Joelho (SBCJ)

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.

Resumo Objetivo Descrever as preferências e práticas atuais de uma amostra de cirurgiões de joelho do Brasil quanto à forma de tromboprofilaxia na artroplastia total do joelho (ATJ). Método presente pesquisa realizada pela internet, cirurgiões associados à Sociedade Brasileira de Cirurgia do Joelho (SBCJ) foram convidados a responder voluntariamente a um questionário anônimo incluindo o tempo de experiência cirúrgica pessoal, percepções sobre as melhores opções de tromboprofilaxia e as reais práticas no ambiente onde trabalham. Resultados Entre dezembro de 2020 e janeiro de 2021, 243 participantes responderam ao questionário completo. Exceto por 3 (1,2%) participantes, todos declararam praticar tromboprofilaxia, a maioria (76%) combinando as formas farmacológica e mecânica. A droga mais prescrita é a enoxaparina (87%), com modificação para rivaroxabana (65%) após a alta. O momento de início da tromboprofilaxia variou conforme o tempo de formação do cirurgião de joelho (p ≤ 0,03) e as preferências e práticas variaram conforme a região do país (p< 0,05) e o sistema de saúde no qual trabalham os cirurgiões (público ou privado; p= 0,024). A opção por tromboprofilaxia mecânica também dependeu do tempo de formação do cirurgião. Conclusão As preferências e práticas de tromboprofilaxia na ATJ são diversas nas regiões do Brasil e sistemas de saúde (público ou privado). Dada a inexistência de uma diretriz clínica nacional, a maior parte dos ortopedistas segue ou a diretriz de seu próprio hospital ou nenhuma. O método de profilaxia mecânica e a pouca utilização do ácido acetilsalicílico são os pontos que mais destoam das diretrizes e práticas internacionais.

Evidence summary of intermittent pneumatic compression devices in preventing venous thromboembolism for trauma patients / 中国实用护理杂志

Objective:To summarize the best evidence for intermittent pneumatic compression devices in preventing venous thromboembolism for trauma patients.Methods:According to "6S" evidence model, computer evidence retrieval was carried out. Guidelines, clinical decisions, evidence summaries, expert consensuses, and systematic reviews regarding intermittent pneumatic compression in preventing of venous thromboembolism for trauma patients were considered. The retrieval time limit was from the establishment of the database to October 31, 2021. Two researchers independently appraised articles, and extracted data for eligible studies.Results:A total of 21 articles were enrolled, including 13 guidelines, 1 clinical decision, 1 evidence summary, 2 expert consensuses, 4 systematic reviews. Totally 27 items of best evidence were summarized from four aspects: pretherapeutic evaluation, contraindications and applicable conditions, therapeutic strategies, training and education.Conclusions:This study summarized the best evidence of using intermittent pneumatic compression devices to prevent venous thromboembolism for trauma patients, which can provide evidence-based practice bases for nurses to implement scientific and effective standardized management of mechanical thromboprophylaxis. It is necessary to select evidence according to clinical practice and patients ′ wishes, so as to improve the effectiveness of using IPC in preventing thrombosis.

Clinical effectiveness of a pneumatic compression device combined with low-molecular-weight heparin for the prevention of deep vein thrombosis in trauma patients: A single-center retrospective cohort study / 世界急诊医学杂志（英文）

@#BACKGROUND: To investigate the clinical effectiveness of a pneumatic compression device (PCD) combined with low-molecular-weight heparin (LMWH) for the prevention and treatment of deep vein thrombosis (DVT) in trauma patients. METHODS: This study retrospectively analyzed 286 patients with mild craniocerebral injury and clavicular fractures admitted to our department from January 2016 to February 2020. Patients treated with only LMWH served as the control group, and patients treated with a PCD combined with LMWH as the observation group. The incidence of DVT, postoperative changes in the visual analogue scale (VAS) score, and coagulation function were observed and compared between the two groups. Excluding the influence of other single factors, binary logistic regression analysis was used to evaluate the use of a PCD in the patient's postoperative coagulation function. RESULTS: After excluding 34 patients who did not meet the inclusion criteria, 252 patients were were included. The incidence of DVT in the observation group was significantly lower than that in the control group (5.6% vs. 15.1%, χ2=4.605, P<0.05). The postoperative VAS scores of the two groups were lower than those before surgery (P<0.05). The coagulation function of the observation group was significantly higher than that of the control group, with a better combined anticoagulant effect (P<0.05). There were no significant differences between the two groups in preoperative or postoperative Glasgow Coma Scale scores, intraoperative blood loss, postoperative infection rate, or length of hospital stay (P>0.05). According to logistic regression analysis, the postoperative risk of DVT in patients who received LMWH alone was 1.764 times that of patients who received LMWH+PCD (P<0.05). The area under the receiver operating characteristic (AUROC) curve of partial thromboplastin time (APTT) and platelet (PLT) were greater than 0.5, indicating that they were the influence indicators of adding PCD to prevent DVT. Excluding the influence of other variables, LMWH+PCD effectively improved the coagulation function of patients. CONCLUSIONS: Compared with LMWH alone, LMWH+PCD could improve blood rheology and coagulation function in patients with traumatic brain injury and clavicular fracture, reduce the incidence of DVT, shorten the length of hospital stay, and improve the clinical effectiveness of treatment.

Effect of the beginning time of intermittent pneumatic compression on hemodynamic and deep vein thrombosis of patients with major orthopedic surgery / 中国实用护理杂志

Objective:To investigate the effects of beginning time of intermittent pneumatic compression (IPC) on hemodynamics and deep vein thrombosis (DVT) of patients with major orthopedic surgery.Methods:A total of 99 patients who underwent major orthopaedic surgery in the Department of Orthopaedics, West China Hospital, Sichuan University from January 2018 to December 2019 were selected as the research objects, which were assigned to ultra-early group, early group and control group, each group contained 33 cases. The IPC were used 3 days before surgery in the ultra-early group, 1 day before surgery in the early group, and after surgery in control group. The incidence of DVT and deep skin pressure injury within 14 days was observed, the blood flow velocity of deep femoral vein and plasma D-dimer in the three groups were also compared.Results:There was no significant difference in the incidence of DVT among the three groups ( P> 0.05), however, the deep tissue injury rate was 18.18% (6/33) in the ultra-early group, significantly higher than 3.03% (1/33) in the early group and 0 in control group, the difference was statistically significant ( χ2 value was 9.531, P<0.05). After 1 day and 3, 5, 7 days of surgery, the blood flow velocity of deep femoral vein in the ultra-early group and the early group were (26.48±2.24), (25.79±2.18), (26.67±3.74), (25.88±2.83) ml/s and (25.76±1.87), (25.39±1.98), (25.45±2.93), (25.48±3.75) ml/s, significantly higher than (23.39±1.75), (23.73±2.61), (23.79±2.30), (22.21±4.42) ml/s in the control group, the difference was statistically significant ( F values were 7.428-22.350, P<0.01). After 3, 5, 7 days of surgery, the levels of plasma D-dimer in the ultra-early group and the early group were (1.11±0.26), (1.03±0.23), (0.98±0.28) mg/L and (1.18±0.32), (1.12±0.24), (1.05±0.31) mg/L, significantly lower than (1.38±0.40), (1.32±0.39), (1.20±0.26) mg/L in the control group, the difference was statistically significant ( F values were 5.809, 8.442, 4.962, P<0.01). Conclusion:Using IPC one day before operation can significantly increase the blood flow velocity of deep femoral vein, reduce the level of plasma D-dimer, and do not increase the incidence of deep skin pressure injury in patients with major orthopedic surgery.

Effect of different use time of intermittent pneumatic compression on the incidence of deep vein thrombosis of lower extremities after arthroplasty / 中国修复重建外科杂志

Objective: To investigate the effect of different use time of intermittent pneumatic compression (IPC) on the incidence of deep vein thrombosis (DVT) of lower extremities after arthroplasty. Methods: Between October 2018 and February 2019, 94 patients who planned to undergo unilateral total hip or knee arthroplsty and met the selection criteria were randomly divided into a control group (47 cases) and a trial group (47 cases). There was no significant difference in gender, age, surgical site, and surgical reason between the two groups ( P>0.05). After returning to the ward, all patients were treated with IPC. And the IPC was used until 9:00 pm on the day after operation in the trial group and until 8:00 am the next day after operation in the control group. The levels of hemoglobin, platelet count, D-dimer, hospital stay, treatment costs, patients' satisfaction with IPC, the parameters of thromboelastrography [kinetics (K value), freezing angle (α angle), reaction time (R value), maximum amplitude (MA value)], visual analogue scale (VAS) score, circumference difference of calf before and after operation, Pittsburgh sleep assessment score, and the incidence of DVT of lower limbs were recorded and compared between the two groups. Results: The K value and D-dimer before operation were significant different between the two groups ( P0.05). There was no significant difference in pre- and post-operative VAS scores and post-operative circumference difference of calf between the two groups ( P>0.05). The sleep assessment score of the trial group at 1 day after operation was significant lower than that of the control group ( t=2.107, P=0.038). There was no significant difference in the hospital stay and treatment costs between the two groups ( P>0.05). There was 1 case (2.1%) of DVT, 3 cases (6.4%) of intermuscular venous thrombosis, and 1 case (2.1%) of infection in the trial group, and 2 cases (4.3%), 4 cases (8.5%), and 0 (0) in the control group. The differences were not significant ( P>0.05). After the completion of postoperative IPC treatment, the satisfaction rates of using IPC were 89.4%(42/47) in the trial group and 70.2% (33/47) in the control group, and the difference was not significant ( χ2=0.097, P=0.104). Conclusion: IPC using for a short period of time after arthroplasty do not increase the degrees of the pain and the swelling of calf; it can effectively prevent DVT of the lower extremity, improve the quality of sleep in patients, and is good for the limbs rehabilitation.

Hemodynamic effects of different types of pneumatic compression of the lower extremities during anesthesia induction: a prospective randomized controlled trial / 대한마취과학회지

BACKGROUND: The current study evaluated the hemodynamic effects of different types of pneumatic compressions of the lower extremities during anesthesia induction. In addition, the hemodynamic effects were compared between patients older than 65 age years and those aged 65 years or younger. METHODS: One hundred and eighty patients (90: > 65 years and 90: ≤ 65 years) were enrolled. Each age group of patients was randomly assigned to one of three groups; Group 1 (no compression), Group 2 (sequential pneumatic compression), and Group 3 (sustained pneumatic compression without decompression). Invasive blood pressure, cardiac index (CI), and stroke volume variation (SVV) were measured. RESULTS: In patients aged ≤ 65 years, mean arterial pressure (MAP) and CI were significantly higher and SVV was lower in Group 3 compared to Group 1 before tracheal intubation, but there were no differences between Groups 1 and 2. However, there were no differences in MAP, CI, and SVV among the three groups in patients aged > 65 years. The number of patients who showed a MAP 65 years. CONCLUSIONS: Sustained pneumatic compression of the lower extremities has more hemodynamic stabilizing effects compared to sequential compression during anesthesia induction in patients aged 65 years or younger. However, no difference between methods of compression was observed in patients older than 65 years.

Intermittent Pneumatic Compression for the Prevention of Venous Thromboembolism after Total Hip Arthroplasty

BACKGROUND: Venous thromboembolism (VTE) is a relatively common and potentially life threatening complication after major hip surgery. There are two main types of prophylaxis: chemical and mechanical. Chemical prophylaxis is very effective but causes bleeding complications in surgical wounds and remote organs. On the other hand, mechanical methods are free of hemorrhagic complications but are less effective. We hypothesized that mechanical prophylaxis is effective enough for Asians in whom VTE occurs less frequently. This study evaluated the effect of intermittent pneumatic compression (IPC) in the prevention of VTE after major hip surgery. METHODS: Incidences of symptomatic VTE after primary total hip arthroplasty with and without application of IPC were compared. A total of 379 patients were included in the final analysis. The IPC group included 233 patients (106 men and 127 women) with a mean age of 54 years. The control group included 146 patients (80 men and 66 women) with a mean age of 53 years. All patients took low-dose aspirin for 6 weeks after surgery. IPC was applied to both legs just after surgery and maintained all day until discharge. When a symptom or a sign suspicious of VTE, such as swelling or redness of the foot and ankle, Homans' sign, and dyspnea was detected, computed tomography (CT) angiogram or duplex ultrasonogram was performed. RESULTS: Until 3 months after surgery, symptomatic VTE occurred in three patients in the IPC group and in 6 patients in the control group. The incidence of VTE was much lower in the IPC group (1.3%) than in the control group (4.1%), but the difference was not statistically significant. Complications associated with the application of IPC were not detected in any patient. Patients affected by VTE were older and hospitalized longer than the unaffected patients. CONCLUSIONS: The results of this study suggest that IPC might be an effective and safe method for the prevention of postoperative VTE.

Adaptation and Effects of the Evidence-based IPC Nursing Protocol on Prevention of Postoperative Venous Thromboembolism / 간호행정학회지

PURPOSE: This study was conducted to adapt the standardized evidence-based nursing protocol using the IPC (intermittent pneumatic compression) intervention to prevent venous thromboembolism in surgical patients. Further, an investigation was done to measure knowledge on prevention of venous thromboembolism, surrogate incidence of venous thromboembolism and to assess IPC compliance in the study patients compared with those in surgical patients who underwent IPC intervention due to previous clinical experience. METHODS: An analysis was done of the nine modules suggested by National Evidence-based Healthcare Collaborating Agency (NECA) in the adaptation manual of the clinical practice guideline for protocol adaptation. A nonequivalent control group post test design as a quasi-experiment was used to verify the effect of the IPC protocol. RESULTS: There was a significant difference in knowledge of prevention of venous thromboembolism, IPC application time after intervention and the number of IPC applications between the experimental group (n=50) using the IPC nursing protocol and the control group (n=49). However, the symptoms of deep vein thrombosis and pulmonary thromboembolism were not observed in either the experimental group or the control group after the intervention. CONCLUSION: Results confirm that the standardized IPC nursing protocol provides effective intervention to prevent venous thromboembolism in surgical patients.

Avaliação linfocintilográfica qualitativa de pacientes com linfedema de membros inferiores tratados com compressão pneumática intermitente por quatro semanas / Qualitative lymphoscintigraphic evaluation of patients with lower limb lymphedema, treated with sequential intermittent pneumatic compression for four weeks

Introdução: O tratamento conservador do linfedema periférico consta de drenagem linfática manual, exercícios terapêuticos, contenção elástica e inelástica e também a compressão pneumática intermitente sequencial. Objetivo: Avaliar o efeito da compressão pneumática intermitente sequencial associada ao uso de contenção inelástica e elástica e exercícios miolinfocinéticos, durante quatro semanas, em pacientes com linfedema das extremidades inferiores, utilizando a análise qualitativa da linfocintilografia e a perimetria. Material e métodos: Dez pacientes portadores de linfedema das extremidades inferiores selecionados por conveniência, totalizando 14 membros acometidos, foram submetidos a quatro semanas de tratamento com compressão pneumática intermitente sequencial, contenção inelástica e elástica e exercícios miolinfocinéticos. Para a avaliação dos membros realizou-se a análise qualitativa da linfocintilografia e também a perimetria dos membros antes e após o tratamento proposto. Resultados: Não foi encontrada diferença estatisticamente significativa nos achados linfocintilográficos pré e pós-tratamento. Contudo, encontrou-se redução significativa da perimetria dos membros (p < 0,01) cuja redução máxima encontrada foi de 5,9% na perimetria do tornozelo e a mínima de 1,8% na perimetria da coxa. Conclusão: O tratamento realizado foi eficaz na redução da perimetria do membro tratado, porém não foi observada alteração significativa nos padrões linfocintilográficos qualitativos para estes pacientes. (AU)

Introduction: Conservative treatment of peripheral lymphedema consists of manual lymphatic drainage, therapeutic exercises, elastic and inelastic compression and sequential intermittent pneumatic compression. Objective: The objective of this study was to evaluate the effect of four weeks of sequential intermittent pneumatic compression combined with elastic and inelastic compression and lymphokinetic exercises on patients with lymphedema of the lower extremities by means of qualitative analysis with lymphoscintigraphy and circumference measurements. Methods: Ten people with lymphedema of the lower limbs, totaling 14 limbs treated, selected by convenience, underwent lymphoscintigraphy before and after four weeks of treatment with sequential intermittent pneumatic compression, elastic and inelastic sleeves and lymphokinetic exercises. For evaluating limbs, were carried out qualitative analysis of lymphoscintigraphy and also circumference measurements before and after the proposed treatment. Results: No statistically significant differences were detected in lymphoscintigraphic findings before and after treatment. However, there was a significant reduction in the circumference measurements (p <0.01) of the limbs. The maximum reduction was found 5.9% in the ankle circumference and the minimum was 1.8% thigh circumference. Conclusion: The treatment was effective at reducing limb circumference, however, no significant changes were observed on the qualitative lymphoscintigraphic analysis for these patients. (AU)

Incidences of Deep Vein Thrombosis and Pulmonary Embolism after Total Knee Arthroplasty Using a Mechanical Compression Device with and without Low-Molecular-Weight Heparin

PURPOSE: To investigate the incidence of thromboembolic events and complications related to bleeding after total knee arthroplasty (TKA) with a mechanical compression device alone or in combination with low-molecular-weight heparin (LMWH). MATERIALS AND METHODS: A total of 489 TKA patients (776 knees) were retrospectively reviewed for the incidence of thromboembolic events and complications related to bleeding. While 233 patients (354 knees) were treated with a mechanical compressive device without LMWH, 256 patients (422 knees) were treated with the mechanical compressive device along with LMWH. RESULTS: The incidences of deep vein thrombosis (DVT) and pulmonary embolism (PE) were 15 of 375 knees (4.0%) and 5 of 375 knees (1.3%), respectively, in the group that used only a mechanical compressive device, and 14 of 401 knees (3.4%) and 5 of 401 knees (1.2%), respectively, in the group that used the mechanical compressive device with LMWH. There was no significant difference between the two groups (p=0.125 and p=0.146, respectively). The postoperative hemovac drainage amount was 635±57 mL in the group with a mechanical compressive device only and 813±84 mL in the group with the device and LMWH; therefore, the amount of drainage was significantly greater in the latter group (p=0.013). CONCLUSIONS: Mechanical compression alone for prophylaxis against DVT and PE after TKA can be an attractive option in Korean patients.

The preventive effect of rivaroxaban combine with intermittent pneumatic compression in patients after hip replacement / 中国生化药物杂志

Objective To explore the preventive effect of rivaroxaban combined with intermittent pneumatic compression in patients after hip replacement.Methods 84 cases with hip arthroplasty were randomly divided into control group and experiment group.The control group of 42 cases(47 hips)were given low molecular weight heparin combined with intermittent pneumatic compression.The experiment group of 42 cases(48 hips)were given rivaroxaban combined with intermittent pneumatic compression.Coagulation indicator and hemorheology were compared before treatment,1 weeks after treatment and 2 weeks after treatment,and patients were detected by lower extremity ultrasound detection,prevention of thrombosis and bleeding recorded during treatment status.Results APTT and TT of the experiment group were lower than the control group after 2 weeks of treatment with statistical significance(P<0.05);The deep venous thrombosis of experiment group was 2 cases(4.76%)and the control group was 6 cases(14.29%),with no statistical significance.Two groups of patients with perioperative bleeding after drainage was not statistically significant.Conclusion Compared with low molecular heparin,rivaroxaban combine with intermittent pneumatic compression has a lower extremity deep venous thrombosis prevention after hip replacement surgery,without increasing the risk of bleeding.

Prevention of venous thromboembolism after primary intracerebral hemorrhage / 国际脑血管病杂志

Venous thromboembolism includes deep venous thrombosis and pulmonary embolism. It is a more common and preventable complication in neurology. The prevention of venous thromboembolism is an important component in the treatment of the patients with cerebral hemorrhage. The measures include mechanical prevention and drug prevention. The mechanical prevention measures include intermittent pneumatic compression devices and pressure gradient elastic stockings. Studies have suggested that anticoagulants also plays an important role in the prevention of venous thromboembolism. The comprehensive and systematic understanding of the prevention of venous thromboembolism wil help to guide the clinical therapy and improve the outcomes of patients after primary intracerebral hemorrhage.

Preventing Venous Thromboembolism with Use of Intermittent Pneumatic Compression after Total Hip Arthroplasty in Korean Patients

Intermittent Pneumatic Compression (IPC) device has been used to prevent venous thromboembolism (VTE). This study investigated the effectiveness of IPC device. We evaluated incidences of deep vein thrombosis (DVT) and pulmonary embolism (PE) in total hip arthroplasty (THA) patients after use of IPC device, and compared with historical incidences from our institution. We applied IPC device in 741 patients who underwent 870 elective primary THAs from January 2010 to December 2013, DVT was detected in 3 patients (0.3%) by sonography, and one (0.1%) of them was symptomatic. Symptomatic PE occurred in 1 patient (0.1%) and there were no cases of fatal PE. The incidence of symptomatic DVT was significantly lower than the historical control (P = 0.042). The IPC is a safe and effective prophylaxis of VTE after primary THA in Korea.

Preventing Venous Thromboembolism with Use of Intermittent Pneumatic Compression after Total Hip Arthroplasty in Korean Patients

Intermittent Pneumatic Compression (IPC) device has been used to prevent venous thromboembolism (VTE). This study investigated the effectiveness of IPC device. We evaluated incidences of deep vein thrombosis (DVT) and pulmonary embolism (PE) in total hip arthroplasty (THA) patients after use of IPC device, and compared with historical incidences from our institution. We applied IPC device in 741 patients who underwent 870 elective primary THAs from January 2010 to December 2013, DVT was detected in 3 patients (0.3%) by sonography, and one (0.1%) of them was symptomatic. Symptomatic PE occurred in 1 patient (0.1%) and there were no cases of fatal PE. The incidence of symptomatic DVT was significantly lower than the historical control (P = 0.042). The IPC is a safe and effective prophylaxis of VTE after primary THA in Korea.

Terapias compressivas no tratamento de úlcera venosa: estudo bibliométrico / Terapias compresivas en el tratamiento de úlcera venosa: estudio bibliométrico / Compressive Therapy in the Treatment of Venous Ulcers: Bibliometric Study

Introdução: Úlceras de origem venosas são lesóes cutâneas que geralmente acometem o terço inferior das pernas. O tratamento dessas feridas é dinâmico e depende da evolução das fases da reparação tecidual. Esse tratamento inclui métodos clínicos e cirúrgicos, sendo a terapia compressiva o método não cirúrgico mais frequentemente utilizado. Dentre as terapias compressivas, destacam-se as bandagens inelásticas e elásticas, meias elásticas e pressão pneumática intermitente. Objetivo: O presente estudo pretendeu identificar o perfil da produção científica nacional e internacional que descrevesse terapia compressiva e úlcera venosa classificando-o de acordo com: cronologia de publicação, procedência, periódicos em que estão publicadas, avaliação do "Qualis" - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes), distribuição da abordagem metodológica, análise do conteúdo das publicaçóes e comparar, quando possível, os dados apresentados nessa revisão. Método: Estudo bibliométrico realizado nas bases de dados Medline, Lilacs e CINAHL no qual se utilizaram os descritores "Varicose Ulcer/therapy", "Compression Bandages", "Wound Healing" e o operador booleano AND entre os anos de 2009 a 2013. Resultados: Foram selecionados 47 artigos; a maioria publicada em 2012 (n = 12; 25,53%), nos Estados Unidos (n = 14; 29,78%) e Reino Unido (n = 14; 29,78%), em revistas de especialidade vascular (n = 19; 40,42%), com avaliaçóes A2 (n = 13; 27,65%) e B1 (n = 13; 27,65%). A maior parte da metodologia utilizada nos estudos selecionados era tipo "estudos clínicos" (n = 30; 63,82%). Dentre os estudos clínicos e metanálises, apenas 30% (n= 14) apresentavam como objetivo principal avaliação da terapia compressiva e pretenderam estudar comparativamente eficácia de bandagens elásticas, inelásticas, meias elásticas, pressão pneumática intermitente e ausência de terapia compressiva no tratamento de úlceras venosas. Conclusão: Há preocupação da comunidade científica com a busca do tratamento eficaz para as úlceras venosas, porém a distribuição mundial de publicaçóes é desigual. Evidenciou-se que a terapia compressiva não é o objeto principal na maioria dos trabalhos selecionados, o que leva ao interesse em terapias adjuvantes ou complementares a essa. Ficou evidente a necessidade da terapia compressiva, porém não há consenso sobre qual pressão deva ser utilizada para se obter melhores resultados na cicatrização; portanto, são necessários mais estudos que avaliem as interferências das diversas pressóes sobre o processo de reparo tecidual. Também há carência de estudos que comprovem a ação da pressão pneumática intermitente com associaçóes ou não de bandagens elásticas.

Introducción: úlceras de origen venosas son lesiones cutáneas que generalmente acometen el tercio inferior de las piernas. El tratamiento de estas heridas es dinámico y depende de la evolución de las fases de la reparación del tejido. Este tratamiento incluye métodos clínicos y quirúrgicos, y la terapia compresiva es el método no quirúrgico más utilizado. Entre las terapias compresivas, se destacan los vendajes inelásticos y elásticos, medias elásticas y presión neumática intermitente. Objetivo: este estudio buscó identificar el perfil de la producción científica nacional e internacional que describiera la terapia compresiva y la úlcera venosa para clasificarla de acuerdo con: cronología de publicación, procedencia, periódicos en que están publicadas, evaluación del "Qualis" - coordinación de perfeccionamiento de personal de nivel superior (Capes), distribución del abordaje metodológico, análisis del contenido de las publicaciones y comparar, cuando fuera posible, los datos presentados en esta revisión. Método: estudio bibliométrico realizado en las bases de datos Medline, Lilacs y CINAHL en el que se utilizaron los descriptores "Varicose Ulcer/therapy", "Compression Bandages", "Wound Healing" y el operador booleano AND entre los años de 2009 a 2013. Resultados: se seleccionaron 47 artículos; la mayoría de ellos publicados en 2012 (n = 12; 25,53%), en Estados Unidos (n = 14; 29,78%) y Reino Unido (n = 14; 29,78%), en revistas de especialidad vascular (n = 19; 40,42%), con evaluaciones A2 (n = 13; 27,65%) y B1 (n = 13; 27,65%). La parte más grande de la metodología utilizada en los estudios seleccionados fue tipo "estudios clínicos" (n= 30; 63,82%). Entre los estudios clínicos y metanálisis, apenas 30% (n= 14) presentaban como objetivo principal evaluación de la terapia compresiva y estudiaban comparativamente eficacia de vendajes elásticos, inelásticos, medias elásticas, presión neumática intermitente y ausencia de terapia compresiva en el tratamiento de úlceras venosas. Conclusión: hay preocupación de la comunidad científica sobre la búsqueda del tratamiento eficaz para las úlceras venosas; sin embargo, la distribución mundial de publicaciones es desigual. Se evidenció que la terapia compresiva no es el objeto principal en la mayoría de los trabajos seleccionados, lo que lleva al interés en terapias adyuvantes o complementarias a esta. Quedó evidente la necesidad de la terapia compresiva, pero no hay consenso sobre cuál presión deba ser utilizada para obtener mejores resultados en la cicatrización; por lo tanto, son necesarios más estudios que evalúen las interferencias de las diversas presiones sobre el proceso de reparación del tejido. También hay carencia de estudios que comprueben la acción de la presión neumática intermitente con asociaciones o no de vendajes elásticos.

Introduction: Venous ulcers are skin lesions, which usually affect the lower third of the legs. The treatment of these wounds is dynamic and depends on the tissue repair process. Clinical and surgical procedures are included among those therapies, and the therapeutic compressive most often used non-surgical method. Inelastic and elastic bandages, elastic stockings and intermittent pneumatic pressure are the most common compressive therapy used. Objective: This study aimed to identify the national and international scientific literature profile describing compression therapy and venous ulcers and classify that profile according to: chronology of publication, country, periodicals that are published review of 'Qualis' - CAPES, distribution of the methodological approach, analysis of the publications content and compare, where possible, the data presented. Method: bibliometric study conducted in the Medline, Lilacs and CINAHL databases using the keywords "Varicose Ulcer / therapy", "Compression Bandages", "Wound Healing" and boleyn word AND between the years 2009-2013. Results: 47 articles were selected, the major part was published in 2012 (n = 12, 25.53 %), the United States (n = 14, 29.78 %) and the United Kingdom (n = 14, 29.78%), in vascular surgery specialized magazines (n = 19, 40.42%), Qualis A2 (n = 13, 27.65 %) and B1 (n = 13, 27.65 %). Much of the methodology used in the selected studies was "clinical studies" type (n = 30, 63.82 %). Only 30 % ( n = 14 ) had as main objective assessment of compressive therapy and intended study compared the effectiveness of elastic bandages, inelastic, elastic stockings , intermittent pneumatic pressure and absence compression therapy for the treatment of venous ulcers. Conclusions: There is a concern, in the scientific community, about the research for effective treatment for venous ulcers. However, the worldwide distribution of publications is uneven. It was evident that compression therapy is ...

Prevention Effects of Graduated Compression Stockings and Intermittent Pneumatic Compression on Deep Vein Thrombosis in SICU Patients: Pilot Study / 기본간호학회지

PURPOSE: The purpose of this pilot study was to investigate the effects of mechanical interventions for deep vein thrombosis (DVT) prophylaxis in surgical intensive care unit (SICU) patients. METHODS: The participants were assigned to the intermittent pneumatic compression (IPC) and graduated compression stocking (GCS) intervention. Patients who met the criteria were selected for comparison from our previous study. Data for 140 patients were included in the final analysis. RESULTS: The mean age was 57.5 (+/-15.7) and 61.4% were men. About forty-seven percent of the participants were 61 years or over. In the second duplex scan, 3, 2 and 1 critically ill patients developed deep vein thrombosis in the control, GCS, and IPC groups, respectively. Incidences of DVT were 6.0%, 5.0%, and 2.0% for the control, GCS, and IPC groups, respectively. This difference was not significant. Relative risks of no intervention were 3.0 and 1.2 compared with IPC and GCS application. There were no significantly different variables among the three groups before the intervention except for diagnosis on admission. CONCLUSION: Although it may difficult to conclude that mechanical prophylaxis effectively prevents DVT among SICU patients because there was no statistical significance in this study, but incidence rates among the three groups differed greatly. The findings reveal that further study should be conducted with larger samples and randomized controlled trial for SICU patients.

IPC devices combined with anticoagulants for the prevention of deep vein thrombosis in TKA and THA patients: A prospective randomized control study / 中华骨科杂志

Objective To investigate the effectiveness of intermittent pneumatic compression (IPC) devices combined with anticoagulants for the prevention of deep vein thrombosis (DVT) after joint replacement surgery.Methods All of 400 patients were involved in this prospective randomized control study with 100 total knee arthroplasty (TKA) patients and 100 total hip arthroplasty (THA) patients in each group.All patients were operated under the general anesthesia.Patients in the control group received 10 mg of rivaroxaban per day beginning 6-8 hours after the surgery.Besides the prescription of rivaroxaban, IPC devices were used just after the anesthesia in the operating theater and lasted for 48 hours in the experimental group.The diagnosis of DVT in the lower extremities was made by color Duplex sonography on the second postoperative day.The incidence rate of DVT and symptomatic pulmonary embolism was recorded.The incidence rates of total DVT, proximal DVT (p-DVT, proximal to the trifurcation of the popliteal vein), distal DVT (d-DVT, in the anterior tibial vein, posterior tibial vein or peroneal vein) and intermuscular DVT were recorded.CT pulmonary angiography was used to confirm the pulmonary embolism if it was suspected.Results The incidence rates of overall, proximal, distal and intermuscular DVT were 9.5％, 0.5％, 0.5％, 8.5％ in the experimental group and 30％, 0.5％, 5.5％, 24％ in the control group respectively.The incidence rates of total DVT, distal DVT and intermuscular DVT were significantly lower in the experimental group.The incidence rate of DVT in TKA patients and THA patients were significantly lower in the experimental group than in the control group respectively.For patients with DVT, enoxaparin was used instead of rivaroxaban, and DVT was found disappeared by color Duplex sonography 10-12 days postoperatively.Conclusion Compared with the use of rivaroxaban alone, IPC devices combined with anticoagulants can significantly reduce the incidence rate of distal DVT and intermuscular DVT in the early postoperative period after joint replacement surgery.

Non-pharmacological Prophylaxis of Venous Thromboembolism in Acutely Ill Medical Patients.

Venous thromboembolism (VTE) represents one of the leading causes of mortality and morbidity in acutely ill medical patients. VTE prophylaxis can be assured by pharmacological strategies and, when contraindicated, by non pharmacological measures, such as early mobilization, graduated compression stockings (GCS), intermittent pneumatic compression (IPC) or inferior vena caval filters. Literature evidence on non pharmacological VTE prophylaxis lacks and guidelines are not standardized for hospitalized ill medical patients. Much recently randomized clinical trials in patients with stroke and other medical diseases, seem to increase doubts and reduce certainties in this context. In this review we provide information about non pharmacological thromboprophylaxis in acutely hospitalized ill medical patients.

Comparison of Clinical and Physiological Efficacies of Different Intermittent Sequential Pneumatic Compression Devices in Preventing Deep Vein Thrombosis: A Prospective Randomized Study

BACKGROUND: There are few comparative studies about the optimal method of pneumatic compression to prevent deep vein thrombosis (DVT). The aim of this prospective randomized study was to compare venous hemodynamic changes and their clinical influences between two graded sequential compression groups (an alternate sequential compression device [ASCD] vs. a simultaneous sequential compression device [SSCD]). METHODS: In total, 34 patients (68 limbs) undergoing knee and spine operations were prospectively randomized into two device groups (ASCD vs. SSCD groups). Duplex ultrasonography examinations were performed on the 4th and 7th postoperative days for the detection of DVT and the evaluation of venous hemodynamics. Continuous data for the two groups were analyzed using a two-tailed, unpaired t-test. Relative frequencies of unpaired samples were compared using Fisher exact test. Mixed effects models that might be viewed as ANCOVA models were also considered. RESULTS: DVT developed in 7 patients (20.6%), all of whom were asymptomatic for isolated calf DVTs. Two of these patients were from the ASCD group (11.8%) and the other five were from the SSCD group (29.4%), but there was no significant difference (p = 0.331). Baseline peak velocity, mean velocity, peak volume flow, and total volume flow were enhanced significantly in both device groups (p < 0.001). However, the degrees of flow and velocity enhancement did not differ significantly between the groups. The accumulated expelled volumes for an hour were in favor of the ASCD group. CONCLUSIONS: Both graded sequential compression devices showed similar results both in clinical and physiological efficacies. Further studies are required to investigate the optimal intermittent pneumatic compression method for enhanced hemodynamic efficacy and better thromboprophylaxis.