title: Pressures and timing of intermittent pneumatic compression devices for efficient tissue fluid and lymph flow in limbs with lymphedema.
abstract: Pneumatic compression of tissues with lymph stasis is, aside from the manual massage, a commonly used therapeutic modality in limb lymphedema. A number of pneumatic devices have been constructed. There is lack of reports of comparative studies determining inflation pressure levels, inflation/deflation cycle times, and total pumping times.
  
  
  OBJECTIVE
  We tried to answer the question how high compression pressure and how long compression timing should be applied to the limb soft tissues to reach tissue fluid (TF) head pressure above 30 mmHg, necessary to initiate proximal flow.
  
  
  METHODS
  TF pressures were measured subcutaneously during intermittent pneumatic compression in the lymphedematous limbs stage II to IV. Pressures of 50, 80, and 120 mmHg and timing 5, 20, and 50 sec were applied.
  
  
  RESULTS
  a) the TF head pressures were lower than those in inflated chambers, b) inflation time of 5 and 20 sec was not long enough to generate TF head pressures above 30 mmHg, even if the compression pressures were as high as 120 mmHg, c) the 50 sec timing allowed to reach head pressures above 30 mmHg; however, they remained always lower than in the compression chamber, d) TF head pressures differed at various levels of the limb depending on the soft tissue mass, e) deflation of the inflated whole sleeve for 5 and 20 sec was followed by high end pressures, whereas that of 50 sec brought about pressure drop to 0, facilitating refilling with TF of the distal parts of the massaged limb.
  
  
  CONCLUSIONS
  Our observations point to the necessity of applying high pressures and compression times over 50 sec, to generate effective TF pressures and provide enough time for creating TF flow. Short inflation times generate TF pressures as in one-chamber devices that preclude its effectiveness compared to the multi-chamber devices.
authors.affiliation: 1 Medical Research Centre, Polish Academy of Sciences, Department of Surgery and Epigenetics, Central Clinical Hospital , Warsaw, Poland .
authors.forename: Marzanna
authors.initials: M
authors.lastname: Zaleska
authors.forename: Waldemar L
authors.initials: WL
authors.lastname: Olszewski
authors.forename: Pradeep
authors.initials: P
authors.lastname: Jain
authors.forename: Sashi
authors.initials: S
authors.lastname: Gogia
authors.forename: Arun
authors.initials: A
authors.lastname: Rekha
authors.forename: Samsita
authors.initials: S
authors.lastname: Mishra
authors.forename: Marek
authors.initials: M
authors.lastname: Durlik
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices; D007866:Leg / Q000473:pathology*; D008209:Lymphedema / Q000473:pathology / Q000628:therapy*; D008297:Male; D026301:Manipulation, Osteopathic; D008405:Massage / Q000379:methods; D008875:Middle Aged; D011312:Pressure; D012212:Rheology; D013997:Time Factors; D016896:Treatment Outcome