Intermittent pneumatic compression [Neurosurgery Wiki]

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====== Intermittent pneumatic compression ======

===== Intermittent pneumatic compression after intracerebral hemorrhage =====


[[Intermittent pneumatic compression after intracerebral hemorrhage]]

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The incidence of [[venous thromboembolism]] (VTE) remains high despite the use of [[low molecular weight heparin]] ([[LMWH]]) and [[compression stocking]] (CS). 

Pranata et al. aimed to evaluate the use of [[IPC]] as [[VTE]] prophylaxis in neurosurgical patients.

They conducted a meta-analysis to assess the use of IPC as VTE prophylaxis in neurosurgical patients from several databases.

There was a total of 7.515 subjects from 5 studies. Reduction in VTE incidence was demonstrated by the IPC group (OR 0.40 [0.31, 0.52], p < 0.001; I2: 44 %). IPC was shown to reduce the incidence of deep venous thrombosis (DVT) (OR 0.43 [0.32, 0.57], p < 0.001; I2: 0 %) compared to the control group. Incidence of pulmonary embolism (PE) was lower (OR 0.42 [0.25, 0.70], p < 0.001; I2: 80 %) in IPC. Upon sensitivity analysis, PE was significantly lower in IPC (OR 0.24 [0.13, 0.45], p < 0.001; I2: 0 %). Subgroup analysis on patients undergoing neurosurgical intervention (operation) and receiving LMWH + CS shows a markedly reduced incidence of VTE (OR 0.37 [0.28, 0.50], p < 0.001; I2: 3 %), DVT (OR 0.39 [0.28, 0.54], p < 0.001; I2: 0 %), and PE (OR 0.22 [0.11, 0.43], p < 0.001; I2: 0 %) in IPC.

Intermittent pneumatic compression was associated with less VTE in neurosurgical patients, especially in those who received neurosurgical interventions, however, the certainty of [[evidence]] remained inadequate for creating a strong [[recommendation]] and further [[randomized controlled trial]]s are needed before drawing a definite conclusion
((Pranata R, Deka H, Yonas E, Vania R, Tondas AE, Lukito AA, July J. The use of 
intermittent pneumatic compression to prevent venous thromboembolism in
neurosurgical patients-A systematic review and meta-analysis. Clin Neurol
Neurosurg. 2020 Jan 23;191:105694. doi: 10.1016/j.clineuro.2020.105694. [Epub
ahead of print] PubMed PMID: 32006929.
)).
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Intermittent [[pneumatic compression]] is a therapeutic technique used in medical devices that include an air pump and inflatable auxiliary sleeves, gloves or boots in a system designed to improve venous circulation in the limbs of patients who suffer edema or the risk of [[deep vein thrombosis]] (DVT) or [[pulmonary embolism]] (PE)
((Chibbaro S, Cebula H, Todeschi J, Fricia M, Vigouroux D, Abid H,
Kourbanhoussen H, Pop R, Nannavecchia B, Gubian A, Prisco L, Ligarotti GKI,
Proust F, Ganau M. Evolution of prophylaxis protocols for venous thromboembolism 
in neurosurgery: results from a prospective comparative study on low-molecular
weight heparin, elastic stockings and intermittent pneumatic compression devices.
World Neurosurg. 2017 Oct 12. pii: S1878-8750(17)31739-4. doi:
10.1016/j.wneu.2017.10.012. [Epub ahead of print] PubMed PMID: 29033376.)).

In the absence of large randomized multicenter trials comparing the use of intermittent pneumatic compression or chemoprophylaxis alone to a combination of both treatments, the current evidence supports the use of a combined approach in high-risk surgical patients
((O'Connell S, Bashar K, Broderick BJ, Sheehan J, Quondamatteo F, Walsh SR,
ÓLaighin G, Quinlan LR. The Use of Intermittent Pneumatic Compression in
Orthopedic and Neurosurgical Postoperative Patients: A Systematic Review and
Meta-analysis. Ann Surg. 2016 May;263(5):888-9. doi:
10.1097/SLA.0000000000001530. Review. PubMed PMID: 26720432.
)).


In use, an inflatable jacket (sleeve, glove or boot) encloses the limb requiring treatment, and pressure lines are connected between the jacket and the air pump. When activated, the pump fills the air chambers of the jacket in order to pressurize the tissues in the limb, thereby forcing fluids, such as blood and lymph, out of the pressurized area. A short time later, the pressure is reduced, allowing increased blood flow back into the limb.

The primary functional aim of the device “is to squeeze blood from the underlying deep veins, which, assuming that the valves are competent, will be displaced proximally.” When the inflatable sleeves deflate, the veins will replenish with blood. The intermittent compressions of the sleeves will ensure the movement of venous blood.

In the European guidelines on perioperative [[venous thromboembolic prophylaxis]] in Neurosurgery, the patients undergoing [[craniotomy]], if intermittent pneumatic compression (IPC) is used, it should be applied before the surgical procedure or on admission ([[Level of Evidence 1C]]). In craniotomy patients at particularly high risk for venous thromboembolism, they suggest considering the initiation of mechanical thromboprophylaxis with IPC preoperatively with addition of [[low molecular weight heparin]] (LMWH) postoperatively when the risk of bleeding is presumed to be decreased (Grade 2C). In patients with [[spontaneous intracranial hemorrhage]], its suggested thromboprophylaxis with IPC (Grade 2C). For patients who have had non-traumatic intracranial haemorrhage, they suggest giving consideration to commencement of LMWH or low-dose unfractionated heparin when the risk of bleeding is presumed to be low (Grade 2C). They suggest continuing thromboprophylaxis until full mobilisation of the patient (Grade 2C). For patients undergoing spinal surgery with no additional risk factors, they suggest no active thromboprophylaxis intervention apart from early mobilisation (Grade 2C). For patients undergoing spinal surgery with additional risk factors, thery recommend starting mechanical thromboprophylaxis with IPC (Grade 1C), and suggest the addition of LMWH postoperatively when the risk of bleeding is presumed to be decreased (Grade 2C)
((Faraoni D, Ferrandis R, Geerts W, Wiles MD; ESA VTE Guidelines Task Force.
European guidelines on perioperative venous thromboembolism prophylaxis:
Neurosurgery. Eur J Anaesthesiol. 2017 Nov 6. doi: 10.1097/EJA.0000000000000710. 
[Epub ahead of print] PubMed PMID: 29112542.
)).

===== Sequential compression devices =====
see [[Sequential compression device]]s (SCD) 

===== Case series =====

[[Intermittent pneumatic compression case series]].

===== References =====