High compression leg bandaging prevents seated postural hypotension among elderly hospitalized patients

Compression therapy and heart failure: a scoping review of the existing evidence

The completion of a scoping review within the area of compression therapy and heart failure offers an insight into the present literature in this area, alongside offering the ability to connect this existing knowledge to chronic oedema/lymphoedema when both conditions co-exist. The evidence obtained included national agreed guidelines, consensus documents and existing primary/secondary research. The review identified existing evidence that suggests that the application of compression therapy in those with heart failure may be appropriate, but is dependent upon staging and stability. However, this needs to be contextualised against other co-morbidities, such as lymphoedema, which may impact upon the exact compression therapy and level applied. Further research within the area of heart failure in combination with chronic oedema/lymphoedema would expand the existing evidence base. This is set against a need for further consensus guidance to bridge the gap that exists within the literature.

Effect of using elastic-pressure socks in spinal surgery patients on orthostatic hypotension in the first mobilization

BACKGROUND

Orthostatic hypotension (OH) is a common early postoperative finding in patients who undergo major surgery, and it might delay early mobilization, which is the main building block of modern perioperative care programs. The aim of this study was to determine the effect of using thigh-length elastic pressure socks in patients who undergo spinal surgery in development of OH at first mobilization after surgery.

METHODS

The study was a randomized-controlled intervention study. A total of 70 patients who underwent spinal surgery were included in the study. The patients were allocated randomly to the intervention group (n = 35) who used thigh-length elastic pressure socks and the control group (n = 35) which received no intervention other than routine nursing care.

RESULTS

It was found in the study that 2.9% of the patients in the intervention group developed OH during the first mobilization after the surgery, and 48.6% of the patients in the control group developed OH at first mobilization. The patients in the intervention group were found to have the risk ratio (RR): 0.06 times less probability of developing OH than the patients in the control group (95% confidence interval [CI]:0.01-0.42). The OH symptoms were lower in the patients in the intervention group.

CONCLUSION

It was found as a result of the study that using thigh-length elastic pressure socks in spinal surgery patients reduced OH development and symptoms at first mobilization after the surgery.

Compression therapy for leg oedema in patients with heart failure

The presence of chronic heart failure (CHF) results in a significant risk of leg oedema. Medical compression (MC) treatment is one of the basic methods of leg oedema elimination in patients with chronic venous disease and lymphedema, but it is not routinely considered in subjects with CHF‐related swelling. In the study, an overview of the current knowledge related to the benefits and risk of using MC in the supportive treatment of leg oedema in CHF patients is presented. The available studies dedicated the comprehensive management of leg swelling using MC in CHF patients published in the English language literature till December 2019 were evaluated in term of the treatment efficacy and safety. In studies performed on CHF populations, manual lymphatic drainage, MC stocking, multilayer bandaged, as well as intermittent pneumatic compression or electric calf stimulations were used. The current evidence is based on non‐randomized studies, small study cohorts, as well as very heterogenous populations. The use of the intermittent pneumatic compression in CHF patients significantly increases the right auricular pressure and mean pulmonary artery pressures as well as decreases systemic vascular resistance in most patients without the clinical worsening. The transient and rapid increase in the human atrial natriuretic peptide, after an application of the MC stocking in New York Heart Association (NYHA) class II patients was observed without clinical exacerbation. An application of the multilayer bandages in NYHA classes III and IV patients lead a significant increase in the right arterial pressure and lead to transient deterioration of the right and the left ventricular functions. In the manual lymphatic drainage study, aside from expected leg circumference reduction, no clinical worsening was observed. In a pilot study performed in a small cohort of CHF patients, electrical calf stimulation use resulted in a reduction in the lean mass of the legs without cardiac function worsening. The use of local leg compression can be considered stable CHF patients without decompensated heart function for both CHF‐related oedema treatment and for treatment of the concomitant diseases leading to leg swelling occurrence. The use of MC in more severe classes of CHF (NYHA III and IV) should be the subject of future clinical studies to select the safest and most efficient compression method as well as to select the patients who benefit most from this kind of treatment.