title: Peristaltic pneumatic compression of the legs reduces fluid demand and improves hemodynamic stability during surgery: a randomized, prospective study.
abstract: BACKGROUND
  Perioperative fluid restriction might be beneficial in specific clinical settings. In this prospective, randomized and blinded study, we assessed whether peristaltic pneumatic compression of the legs can support restrictive fluid management strategies by reducing intraoperative fluid demand and improving hemodynamic stability.
  
  
  METHODS
  Seventy patients scheduled for minor surgery were randomly assigned to receive either intraoperative peristaltic pneumatic compression or placebo compression. Both groups received fluid therapy according to a goal-directed protocol with a crystalloid base rate of 2 ml · kg⁻¹ · h⁻¹ and bolus infusions of 250 ml crystalloids triggered by hypotension, tachycardia, or high Pleth Variability Index.
  
  
  RESULTS
  Patients treated with peristaltic pneumatic compression received less intravenous fluid: median (interquartile range) 286 (499) versus 921 (900) ml (P < 0.001), resulting in a median difference of 693 ml (95% CI, 495-922 ml) and a median difference of 8.4 ml/kg (95% CI, 5.3-11.5 ml; P < 0.001). After the anesthesia induction phase, median overall infusion rates were 12.2 (14.1) ml · kg⁻¹ · h⁻¹ in the control group and 1.9 (0.4) ml · kg⁻¹ · h⁻¹ in the pneumatic peristaltic compression group (P < 0.001). Among patients treated with pneumatic peristaltic compression, the median cumulative time of hypotension was shorter (0 [12.5] vs. 22.6 [22.8] min; P = 0.002), fewer hypotensive events were recorded (39 vs. 137; P = 0.001), and median lowest individual systolic pressure was higher (92 [8] vs. 85 [16] mmHg; P = 0.002).
  
  
  CONCLUSIONS
  This study demonstrates that peristaltic pneumatic compression of the legs significantly improves hemodynamic stability and reduces fluid demand during minor surgery.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Germany.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Kiefer
authors.forename: Judith
authors.initials: J
authors.lastname: Theis
authors.forename: Gabriele
authors.initials: G
authors.lastname: Putensen-Himmer
authors.forename: Andreas
authors.initials: A
authors.lastname: Hoeft
authors.forename: Sven
authors.initials: S
authors.lastname: Zenker
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D000077324:Crystalloid Solutions; D004311:Double-Blind Method; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007022:Hypotension / Q000628:therapy; D048228:Intermittent Pneumatic Compression Devices; D007430:Intraoperative Care; D007432:Intraoperative Period; D007552:Isotonic Solutions / Q000008:administration & dosage; D007866:Leg / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D013511:Minor Surgical Procedures; D010952:Plasma Substitutes / Q000008:administration & dosage; D011446:Prospective Studies
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes