Changes in stroke volume and intrathoracic blood volume induced by a sequential leg compression in critically ill patients
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KeywordsBlood Volume Cardiac Index Central Venous Pressure Hydroxyethyl Hydroxyethyl Starch
The new sequential leg compression device (SCD) (Tyco, Mansfield, MA, USA) pneumatically applies sequential compression to the lower limb, while maintaining a pressure gradient throughout the compression cycle [1, 2]. We hypothesized that the SCD Response System could shift blood volume toward the thoracic compartment comparable with a volume challenge, with an increase in preload index such as the intrathoracic blood volume index (ITBVI) and stroke volume index (SVI). The aim of the study was to evaluate the relationships between changes in SVI (ΔSVI) induced by SCD and ΔSVI induced by rapid fluid loading (RFL) in critically ill patients.
Twenty-seven patients (mean age 60 ± 9.1 years) admitted to the ICU were studied. Each patient received conventional monitoring plus hemodynamic–volumetric monitoring (PiCCO System; Pulsion Medical Systems, Munich, Germany). The heart rate, mean arterial pressure, central venous pressure, cardiac index, ITBVI, and SVI were recorded in the supine position before and after treatment with the SCD Express Compression System®. The same data where collected before and after a RFL performed with 3 ml/kg hydroxyethyl starch 6%. The relationships between ΔSVI induced by SCD and ΔSVI induced by RFL were analyzed by linear regression analysis. Statistical significance was considered to be at P < 0.05.
The SCD Response System could shift blood volume toward the thoracic compartment comparable with RFL better in mechanically ventilated than in spontaneously breathing patients. Larger population studies are needed to confirm these preliminary data.