the new inflatable external lower leg compression improves stroke volume and peripheral perfusion...

The new inflatable external lower leg compression improves stroke volume and

peripheral perfusion during central hypovolemia in healthy volunteers

M. Helmi, A. Lima, D. Gommers, J. Bakker, J. van Bommel.

Shock

HypotensionTissue hypoperfusionEnd-organ damage

Shock

To reverse hemodynamic alterations

Fluid overloading

Fluid resuscitation

External leg compression

Reverse hypotensionNo risk of fluid overloading

Use in intensive care ??

Hemodynamic effectHemodynamic effectExternal leg compression

Venous

Emptying

Venous return Venous pressure

Soft tissue blood flow Tissue oxygenation

Arterial

Arteriovenous gradient

Stroke volume Cardiac output

Mean arterial pressure Heart rate

What is the potential effect of ELC around the legs during mild hypovolemia on systemic hemodynamic and peripheral perfusion parameters?

Question

?? ?

Prevent central hypovolemia when applied before HUT

The application of a new inflatable ELC around the upper and lower legs is able to:

Hypothesis

Restore central hypovolemia when applied after HUT.

!!

• 20 healthy volunteers:– Free of cardiovascular or neurological disease– Not taking any medication

Subjects

External leg compression

• Around upper and lower legs

• Inflation pressure can be set at levels of 0, 20, 40 and a maximum of 50 cmH2O

The head up tilt

One maneuver

Measurements• Global hemodynamic with Finometer®

• Perfusion index (PI) with Masimo®

• Tissue oxygen saturation (StO2) with InSpectra®

Each intervention was done in three minutes

To find the ideal ELC compression pressure (the inflation pressure related to the best SV and HR values).

SUP

Pre-Study

HUT HUT50 HUT40 HUT20

Supine HUT0 HUT50 HUT40 HUT20

• SV, mL 86±16 62±14 70±19 67±19 65±18• HR, bpm 71±13 85±12 77±10 79±9 82±11

Results pre-study

Each intervention was done in three minutes

Study protocol

Control model

SUP

HUT SUP’

Prevention model

SUP50 HUT50 SUP50’

Prevent hemodynamic alteration.-Mechanical ventilation-Hemodialysis

Restore model

SUP HUT50 HUT’

Restore hemodynamic alteration.(Circulatory shock)

HUT

*: P < .05 against previous time point.

Global HemodynamicsControl model Prevention model

*

*-27%

**-17%

*

*+19%

* *+9%

*: P < .05 against previous time point.

*

**

Restore model

+24%

-9%

*: P < .05 against previous time point.

Control model Prevention model

*

*

*

*

*

**

*

Peripheral perfusion

-79% -65%

-9% -4%

*: P < .05 against previous time point.

*

**

Restore model

+117%*

+30%

It may be used to prevent or to restore hemodynamic alterations in critically ill patients.

ELC was shown to be able to prevent and restore hemodynamic alterations during HUT.

ELC produced an auto transfusion effect in normovolemic subjects in a 60o HUT at 50 cm H2O compression pressure.

Conclusion

Thank you!!!