Application effect of pneumatic tourniquet with individualized pressure setting in orthopaedic surgery of extremities: A meta-analysis.

AIMS: To evaluate the application effect of individualized pressure setting strategy of pneumatic tourniquet in orthopaedic surgery. BACKGROUND: Some individualized setting pressures of pneumatic tourniquet are lower than the standard pressure recommended in the textbook (Nursing of Operating Room, People's Military Publishing House, 2008). DESIGN: Meta-analysis. DATA SOURCES: CL, WOS, PubMed, CNKI, CBM, VIP and Wan-fang DATA. REVIEW METHODS: We searched studies on the application effect of individualized pressure of pneumatic tourniquet from the establishment date of the databases to September 2017. Study quality was assessed using the quality evaluation method recommended in the Cochrane Handbook 5.1.0 (Higgins, 2011). The primary outcome was inflation pressure. RESULTS: We identified nine studies including 1,200 patients. The individualized pressure setting strategy can provide a lower inflation pressure (four studies), improve haemostatic effect (six studies) and reduce the incidence of related complications (eight studies). CONCLUSIONS: An individualized inflation pressure is recommended when using the tourniquet in orthopaedic surgery. And the setting pressure might be a minimum and efficiency one, by accessing the the systolic blood pressure and limb circumferences of the patient. IMPACT: This study addressed that the individualized pressure setting strategy of pneumatic tourniquet can provide a lower inflation pressure and a higher application value in orthopaedic limb surgery. However, greater attention should be focused on how to unify the individualized pressure setting strategy. Meanwhile, the instructions for use from manufacturers need to be updated. Therefore, it is recommended to conduct a large-sample multi-centre high-quality randomized controlled trial in strict accordance with the CONSORT standard.