Comparing hemodynamic effects with three different measurement devices, of two methods of external leg compression versus passive leg raising in patients after cardiac surgery

Helmi Helmi, RBP de Wilde, JRC (Jos) Jansen, BF Geerts, MIM Versteegh, PCM van den Berg, Diederik Gommers, Johan Groeneveld

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External leg compression (ELC) may increase cardiac output (CO) in fluid-responsive patients like passive leg raising (PLR). We compared the hemodynamic effects of two methods of ELC and PLR measured by thermodilution (COtd), pressure curve analysis Modelflow (TM) (COmf) and ultra-sound HemoSonic (TM) (COhs), to evaluate the method with the greatest hemodynamic effect and the most accurate less invasive method to measure that effect. We compared hemodynamic effects of two different ELC methods (circular, A (n = 16), vs. wide, B (n = 13), bandages inflated to 30 cm H2O for 15 min) with PLR prior to each ELC method, in 29 post-operative cardiac surgical patients. Hemodynamic responses were measured with COtd, COmf and COhs. PLR A increased COtd from 6.1 +/- A 1.7 to 6.3 +/- A 1.8 L center dot min(-1) (P = 0.016), and increased COhs from 4.9 +/- A 1.5 to 5.3 +/- A 1.6 L center dot min(-1) (P = 0.001), but did not increase COmf. ELC A increased COtd from 6.4 +/- A 1.8 to 6.7 +/- A 1.9 L center dot min(-1) (P = 0.001) and COmf from 6.9 +/- A 1.7 to 7.1 +/- A 1.8 L center dot min(-1) (P = 0.021), but did not increase COhs. ELC A increased COtd and COmf as in PLR A. PLR B increased COtd from 5.4 +/- A 1.3 to 5.8 +/- A 1.4 L center dot min(-1) (P < 0.001), and COhs from 5.0 +/- A 1.0 to 5.4 +/- A 1.0 L center dot min(-1) (P = 0.013), but not COmf. ELC B increased COtd from 5.2 +/- A 1.2 to 5.4 +/- A 1.1 L center dot min(-1) (P = 0.003), but less than during PLR B (P = 0.012), while COmf and COhs did not change. Bland-Altman and polar plots showed lower limits of agreement with changes in COtd for COmf than for COhs. The circular leg compression increases CO more than bandage compression, and is able to increase CO as in PLR. The less invasive Modelflow (TM) can detect these changes reasonably well.
Original languageUndefined/Unknown
Pages (from-to)163-170
Number of pages8
JournalJournal of Clinical Monitoring and Computing
Issue number2
Publication statusPublished - 2013

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