Pneumatic leg compression as military anti-shock trousers during resuscitation in acute circulatory failure patients in medical and surgical intensive care unit.

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ภาณุ บุญต่อเติม

Abstract

Background: Military anti-shock trousers (MAST) was used for augment venous return (VR) in tactical combat casualty care. Basically, it improves hemodynamic by increased mean systemic pressure (Pms) cause increase in MAP and suggested in septic shock patients when pharmacologic venous thromboembolism is contraindicated. No study of hemodynamics effect and clinical outcome compared with flat position in patients with shock during resuscitation.


Methods: Randomized, single blind, prospective cohort and comparison study on experimental design. 60 patients with shock were included in this analysis. 30 patients were performed MAST by use of pneumatic leg compression pressure 40 mmHg during and until finish resuscitation compared with the flat position and measured for hemodynamic variables immediately after finish resuscitation . Primary outcome was difference in hemodynamic variables. Secondary outcome were survival at hospital admission and mean days in ICU stay.


Results: There was no difference in baseline characteristics in hemodynamic variables. MAST was significantly less mean days in ICU than flat position [4±1.29 vs. 6±1.11, p < 0.001]. MAST significantly increased all hemodynamic variables after resuscitation. Compared to the flat position, MAST significantly increased CO [3.29 (2.64, 3.93) vs. 0.34 (0.26,0.42) L/min, p = <0.001], SV [9.87 (8.68, 11.05) vs. 1.91 (1.15, 2.67) L, p<0.001], MAP [7.9 (5.8, 10) vs. 1.67 (0.82, 2.52) mmHg, p<0.001], SVR [26.87 (21.13, 32.6) vs. 11.13 (8.99, 13.27) dyn.s/cm5, p<0.001], FTc [43.23 (37.15, 49.32) vs. 10.93 (7.96, 13.9), p<0.001], SD [2 (1.76, 2.24) vs. 0.7 (0.57, 0.83), p<0.001] and PV [11.07 (9.41, 12.73) vs. 5.57 (4.27, 6.87), p<0.001].


Conclusion: In patients with acute circulatory failure, MAST significantly increased all hemodynamic variables during resuscitation. Compared to Flat position, MAST increased more CO, SV, SBP, DBP, MAP, SVR, FTc, SD and PV. MAST significantly was less mean days in ICU and did not improve survival at hospital admission.

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