Effect of intermittent pneumatic compression with different inflation pressures on the distal microvascular responses of the foot in people with type 2 diabetes mellitus.

Intermittent pneumatic compression (IPC) is commonly used to improve peripheral circulation of the lower extremity. However, its therapeutic dosage for people with type 2 diabetes mellitus (DM) at risk for ulcers is not well established. This study explored the effect of IPC with different inflation pressures on the distal microvascular responses of the foot in people with type 2 DM. Twenty-four subjects with and without DM were recruited. Three IPC protocols with inflation pressures of 60, 90, and 120 mmHg were applied to the foot. The foot skin blood flow (SBF) responses were measured by laser Doppler flowmetry during and after IPC interventions. Results show that all three IPC interventions significantly increased foot SBF of IPC stage in healthy subjects, but only 90 and 120 mmHg IPC significantly improved SBF in diabetic subjects. IPC with 90 and 120 mmHg showed a greater effect than 60 mmHg in both groups, but 120 mmHg IPC was more effective for diabetic subjects. This study demonstrates that 90 and 120 mmHg are effective dosages of IPC for improving blood flow in healthy people, and 120 mmHg IPC may be more suitable for people with type 2 DM.

Relationship Between Interface Pressures and Pneumatic Cuff Inflation Pressure at Different Assessment Sites of the Lower Limb to Aid Soft Exoskeleton Design.

OBJECTIVE: The aim was to develop a means of predicting interface pressure from cuff inflation pressure during circumferential compression at the lower limb, in order to inform the design of soft exoskeletons. BACKGROUND: Excessive mechanical loading of tissues can cause discomfort and soft tissue injury. Most ergonomic studies on exoskeletons are of interface pressure, but soft exoskeletons apply circumferential pressures similar to tourniquet cuffs by way of cuff inflation pressure. This study details the relationship between interface and cuff inflation pressures for pneumatic tourniquet cuffs. METHOD: Pneumatic cuffs of different widths were inflated to target pressures on (A) a rigid cylinder, (B) the dominant thigh and calf, and (C) knee of healthy participants standing still. Interface pressures were measured under the cuffs using a pressure-sensing mat. Average interface pressures were then compared to cuff inflation pressures. The influence of cuff width, cuff inflation pressure, and participants' anthropometric data on pressure transmission was assessed. RESULTS: A strong linear relationship between cuff inflation pressures and interface pressures was observed. Interface pressures were generally higher than cuff inflation pressures. The efficiency of pressure transmission to the lower limb depended on assessment site, adipose tissue thickness, cuff size, cuff inflation pressure, and possibly limb circumference. Regression equations were developed to predict interface pressures at the thigh, calf, and knee. CONCLUSION: Interface pressures under pneumatic cuffs are influenced by the cuff size, cuff inflation pressure, and tissue compressibility. Predicted interface pressure from cuff inflation pressure and vice versa can be used to aid the design of soft exoskeletons.

Comparison between two mathematical methods to estimate arterial occlusion pressure and tourniquet effectiveness in lower limb surgery: a prospective, randomized, double blind, comparative study.

The effectiveness of two different methods for calculating the arterial occlusion pressure (AOP) to set tourniquet inflation pressures were assessed in patients underwent knee arthroscopy. Eighty patients were included in this study. Tourniquet inflation pressure was set by adding 20 mmHg of safety margin above the AOP value which was calculated by either the Tuncali et al. formula or Hong-yun Liu et al. formula. Primary outcome measures were the initial and maximum SBP, initial and maximum tourniquet inflation pressure, the secondary outcomes were the surgeon rating of the bloodlessness of the surgical field and tourniquet associated complications. There was significant difference in the initial tourniquet pressure (mmHg); it was 208 ± 12 and 262 ± 18 for group (A) and (B) respectively; also there was significant difference in the maximum tourniquet pressure (mmHg), it was 229 ± 14 and 283 ± 19 for group (A) and (B) respectively. There was no significant difference in the initial SBP-to- tourniquet inflation time, the initial SBP or the maximum SBP between the groups. Also, there was no significant difference in surgeon rating of the bloodlessness of the surgical field, at the start, middle and end of surgery. Hong-yun Liu et al. mathematical formula was found to be less effective than Tuncali et al. formula to estimate the least effective tourniquet pressure in lower limb surgery and we might consider it invalid to be used in the lower limb.Clinical trials registration number: NCT03706859 (Clinicaltrials.gov) and registration date: January, 2019. https://clinicaltrials.gov/ct2/show/NCT03706859.

Is lower tourniquet pressure during total knee arthroplasty effective? A prospective randomized controlled trial.

BACKGROUND: Higher tourniquet pressures may be associated with an increased risk of complications. We aimed to determine (1) whether a lower tourniquet pressure [systolic blood pressure (SBP) + 120 mmHg] is as effective as conventional tourniquet pressure (SBP + 150 mmHg) in providing a bloodless surgical field and decreasing blood loss, and (2) whether lowering the tourniquet pressure decreases tourniquet-related complications compared to conventional inflation pressure. METHODS: One hundred and sixty knees in 124 patients undergoing total knee arthroplasty (TKA) were randomly allocated to either conventional (n = 80) or lower inflation pressure group (n = 80). The quality of the initial surgical field and occurrence of intraoperative blood oozing, hemoglobin drop, drained volume and calculated blood loss were assessed as efficacy variables. Safety outcome variables included post-operative pain, tourniquet site skin problems (ecchymosis, bullae, skin necrosis), and other tourniquet-related complications such as nerve palsy, venous thromboembolism, and delayed rehabilitation. RESULTS: A comparable bloodless surgical field was successfully provided in both groups (100% vs. 99%, p = 1.000). One case in the conventional pressure group and two cases in the lower pressure group showed intraoperative blood oozing (p = 1.000), which was successfully controlled after an increase of 30 mmHg in the tourniquet inflation pressure. There was no difference in the hemoglobin drop, drained volume, and calculated blood loss. The two groups did not differ in any safety outcomes such as post-operative pain, thigh complications, and other tourniquet related complications. CONCLUSION: This study demonstrates that a tourniquet inflation pressure of 120 mmHg above the SBP is effective method during TKA. TRIAL REGISTRATION: The trial was with ClinicalTrials.gov ( NCT01993758 ) on November 25, 2013.

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.

The effects of types of guidewires and pressure applied during stent implantation in the main vessel on the incidence of damage to coronary guidewires during angioplasty of coronary bifurcation lesions-Wide Beast study.

OBJECTIVES: We evaluated the impact of stent inflation pressure and type of guidewire on "jailed" coronary guidewire damage occurring during bifurcation angioplasty. BACKGROUND: Despite new techniques and treatment options during percutaneous coronary intervention (PCI) we still observe peri- and postoperative complications for to various known and unknown reasons. METHODS: Patients undergoing PCI within the coronary bifurcation were randomly assigned to one of four groups: Pilot 50 or BMW guidewire and pressure ≤12 or >12 atm. After PCI each "jailed" guidewire was evaluated under an optical microscope. The Wide Beast Scale (WBS) was developed for the internal purposes of the study and was used for qualitative assessment. Also, the inflation pressure, the patients' characteristics and the technical parameters of the procedure were recorded. RESULTS: The clinical characteristics were similar in all the groups. There was no statistical significance of the degree of damage, rated on the WBS, for either guidewire group with respect to inflation pressure (P = 0.49). The prevalence of guidewire damage was higher in the BMW versus the Pilot 50 group (98.4% vs 67.4% respectively, P = 0.00001) as was the severity of the damage (grades 3 and 4) in BMW versus Pilot 50 (55.6% vs 13.0% respectively, P = 0.00001). CONCLUSIONS: The inflation pressure during stent implantation had no impact on "jailed" guidewire damage. The difference in the prevalence of serious damage and total damage number was statistically significant for the BMW guidewire compared to the Pilot50. The BMW guidewire was an independent predictor of the degree of damage to the guidewire.

Paclitaxel-Coated Balloons: Investigation of Drug Transfer in Healthy and Atherosclerotic Arteries - First Experimental Results in Rabbits at Low Inflation Pressure.

PURPOSE: Beyond antiproliferative properties, paclitaxel exhibits anti-inflammatory activity, which might be beneficial in the local treatment of nonocclusive coronary artery disease. Paclitaxel release and tissue concentrations after paclitaxel-coated balloon treatment using different pressures have not been investigated so far. The aim of the study was to investigate in an atherosclerotic rabbit model whether drug transfer from paclitaxel-coated balloons into the vessel wall is affected by the presence of atherosclerotic lesions and to which extent it depends on the inflation pressure used. METHODS: Paclitaxel-coated balloons (3.5 µg/mm(2) paclitaxel) were inflated with pressures of 1, 2, or 6 atm (60s) in healthy (n = 39) and atherosclerotic (n = 22) arteries of New Zealand White Rabbits. Paclitaxel content in arterial walls (10 min after interventions) and paclitaxel remaining on balloons after treatment were analyzed using high-performance liquid chromatography. RESULTS: Median paclitaxel tissue concentrations were 829.3 µg/g (IQR 636.5-1487 µg/g) in healthy and 375.7 µg/g (IQR 169.8-771.6 µg/g) in atherosclerotic arteries (p = 0.0002). The paclitaxel tissue concentration was dependent on inflation pressure (1 atm vs. 2 atm vs. 6 atm) in atherosclerotic arteries (p = 0.0106) but not in healthy arteries (p ≥ 0.05). CONCLUSIONS: Atherosclerotic lesions impede the transfer of paclitaxel into arterial walls. Higher inflation pressures resulted in an increased paclitaxel transfer in atherosclerotic but not in healthy arteries. However, it is assumed that the tissue concentrations achieved with an inflation pressure of 2 atm are potentially effective in this model.

A neonatal in-vitro study on the effect of the inflation pressure on end-tidal carbon dioxide levels.

BACKGROUND: Describing the association of the peak inflation pressure (PIP) with end-tidal carbon dioxide (ETCO2) is a prerequisite for the development of closed loop ventilation in neonatal intensive care. We aimed to develop an in-vitro system to study this relationship. METHODS: A ventilator was connected to a test lung, supplied with a stable CO2 concentration from a cylinder. The PIP was altered and the change in ETCO2 per unit of PIP was calculated in three models mimicking respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD) and viral bronchiolitis. RESULTS: The median (IQR) change in ETCO2 per unit of PIP was 0.23(0.13-0.38) kPa/cmH2O, using 138 paired measurements of PIP and ETCO2. The median (IQR) change in ETCO2 per unit of PIP, was higher when starting at an ETCO2 > 6 kPa [0.43(0.33-0.58) kPa/cmH2O] compared to starting at an ETCO2 < 6 kPa [0.14(0.08-0.20) kPa/cmH2O, p < 0.001]. The median (IQR) change in ETCO2 per unit of PIP, was larger in the model of RDS [0.33(0.13-0.51) kPa/cmH2O] compared to the BPD [0.23(0.13-0.33) kPa/cmH2O, p = 0.043] and the bronchiolitis models [0.15(0.10-0.31) kPa/cmH2O, p = 0.017]. CONCLUSIONS: The change in ETCO2 in response to increasing PIP was larger for higher ETCO2 values and in a model simulating neonatal RDS, compared to BPD and bronchiolitis.

Mechanical performances of balloon post-dilation for improving stent expansion in calcified coronary artery: Computational and experimental investigations.

Stent deployment in a calcified coronary artery is often associated with suboptimal outcomes such as stent underexpansion and malapposition. Post-dilation after stent deployment is commonly used for optimal stent implantation. There is no guideline for choosing the post-dilation balloon diameter and inflation pressure. In this work, ex-vivo/in-silico experiments were performed to investigate the efficacy of post-dilation balloon diameter and inflation pressure in improving the stent expansion in a calcified lesion. Post-dilations with three balloon diameters (3 mm, 3.5 mm, and 4 mm) were performed. For each balloon diameter, three inflation pressures (10 atm, 20 atm, and 30 atm) were sequentially applied. In ex-vivo experiments, optical coherence tomography images were acquired during the stenting procedure, i.e., pre- and post-deployment of 3 mm diameter stent, as well as after each post-dilation. The results from in-silico experiments were compared with ex-vivo experiments in terms of lumen area. In addition, stretch ratio analysis was developed to predict the stent-induced lumen area, along with the strain analysis and the in-silico experiments. Results have shown that target lumen area could be achieved with an oversized nominal balloon diameter of +0.5 mm (i.e., 0.5 mm greater than reference lumen diameter) at an inflation pressure of 20 atm. After each post-dilation, fibrotic tissue demonstrated a larger strain, contributing to improved lumen gain. However, minimal changes were observed in calcification. Moreover, a strong correlation (R2 = 0.95) between the stretch ratio of fibrotic tissue and lumen area after each post-dilation was observed. This indicated that the morphology of the fibrotic tissue could be a potential marker to predict the lumen gain. The detailed mechanistic quantifications of a single lesion cannot be generalized to all clinical cases. However, this work could be used to provide a fundamental understanding of the post-dilations, to develop experimental protocols for producing generalized guidelines, and to exploit their potential for optimal pre- and post-stent strategies.

Delivery of Positive End-Expiratory Pressure Using Self-Inflating Bags during Newborn Resuscitation Is Possible Despite Mask Leak.

BACKGROUND: Ventilation is the key intervention to resuscitate non-breathing newborns. Positive end-expiratory pressure (PEEP) may facilitate lung-liquid clearance and help establish functional residual capacity. OBJECTIVES: The aim of this study was to describe how mask leak and ventilation rates affect delivered PEEP and tidal volumes during newborn resuscitations using a self-inflating bag with an integrated PEEP valve. METHODS: This was an observational study including near-term/term newborns who received bag-mask ventilation (BMV) with a new self-inflating bag with a novel 6 mbar PEEP valve, without external gas flow, between October 1, 2016 and June 30, 2018 in rural Tanzania. Helping Babies Breathe-trained midwives performed most of the resuscitations. Pressures and flow were continuously measured and recorded by resuscitation monitors. RESULTS: In total, 198 newborns with a median gestation of 39 weeks (25th, 75th percentiles 37, 40) and birth weight of 3,100 g (2,580, 3,500) were included. The median delivered PEEP and expired (tidal) volume at different levels of mask leak were 6.0 mbar and 11.3 mL/kg at 0-20% mask leak, 5.5 mbar and 9.3 mL/kg at 20-40%, 5.2 mbar and 7.8 mL/kg at 40-60%, 4.6 mbar and 5.0 mL/kg at 60-80%, and 1.0 mbar and 0.6 mL/kg at 80-100% mask leak. A high ventilation rate (>60/min) nearly halved expired volumes compared to <60/min for 0-60% leak. The BMV rate had a negligible effect on peak inflation pressure (PIP) and PEEP. CONCLUSIONS: Mask leak up to 80% did not impair the provision of recommended PEEP or tidal volumes during BMV with a self-inflating bag. High or low ventilation rates did not significantly affect PIP or PEEP. Expired volumes were reduced at ventilation rates >60/min.

The relationship of lumen diameter and neointimal hyperplasia with inflation pressure.

BACKGROUND: The mechanical stretch injury imposed by the intravascular intervention contributes to neointimal hyperplasia. Lessening of this damage without the compromise of luminal dilation could be an alternative way to alleviate restenosis. OBJECTIVE: We aimed to assess the relationship of lumen diameter and neointimal hyperplasia with inflation pressure using color Doppler ultrasound-guided balloon dilation. METHODS: The anteroposterior diameter of the given aortic segment in rabbits was measured by ultrasonography to ensure the similar original diameter. Then they were assigned into three groups with the inflation force at 1, 5, 10 atmosphere pressure (atm), respectively. Balloon dilation and injury of the given aortic segment were performed. Two weeks later, all rabbits were euthanized for histologic evaluation. RESULTS: After operation, the lumen diameter of each group enlarged significantly (P< 0.05) with a similar rate of change. However, neointimal area, circumference and hepatocyte growth factor (HGF) positive cells in group with 1 atm were significantly less than those of the other two (P< 0.05). Maximal neointima thickness increased significantly with the elevation of the inflation pressure (P< 0.05). CONCLUSIONS: Based on sufficient dilation of the balloon, the balloon inflated with the less pressure caused the similar increase in lumen diameter as the higher pressure but the less neointimal hyperplasia and HGF positive cells.

Do Changes in Temperature and Inflation Pressure Affect Rolling Resistance During Road and Track Testing for Fuel Economy of Class 8 Tractor-Trailers?

Data from air cavity thermistors, tire pressure monitoring systems (TPMS), and SAE J1269 rolling resistance tests were analyzed to evaluate the significance of changes in tire pressure on rolling resistance during fuel economy tests of class 8 tractor trailers. Thermistor data show that air cavity temperatures vary, with the main increase happening during the warm-up run, and measurable cooling during the fuel measurement breaks between runs. Inflation pressure also increases by 50 - 70 kPa during the warm-up run, but once the tire has warmed up, the pressure is more stable, rarely varying by more than 20 kPa during a test run. Results of SAE J1269 rolling resistance tests allow estimation of rolling resistance force for any specified load and inflation pressure. Using the test weight of the truck, rolling resistance force was estimated for inflation pressures ranging from 550 to 860 kPa. The relationship between the inflation pressure and rolling resistance was roughly linear. The relationship was then used to estimate changes in fuel consumption due to changes in inflation pressure normalized to the cold inflation pressure. For each change of relative inflation pressure of 5%, rolling resistance would change by about 1%. Using a common return factor of a 1% change in fuel consumption for every 5% change in rolling resistance, a change in relative inflation pressure of 5% would result in a change of fuel consumption of about 0.2%. The precision of the J1321 fuel economy tests was measured to be plus or minus about 1%. This suggests that the warm-up run provided for in the test method stabilizes the tire pressure and rolling resistance, and that interference due to changes in rolling resistance during a test run or between runs is a concern only for tests that measure small changes in fuel consumption. While the results obtained here are used to assess the effect of inflation pressure on the SAE J1321 test and only apply to the particular tires tested, the method of analysis may be useful in the assessment of the effect of over- or underinflated tires on fuel consumption in the wider long-haul trucking fleet.

Characterization of acute ischemia-related physiological responses associated with remote ischemic preconditioning: a randomized controlled, crossover human study.

Remote Ischemic Preconditioning (RIPC) is emerging as a new noninvasive intervention that has the potential to protect a number of organs against ischemia-reperfusion (IR) injury. The standard protocols normally used to deliver RIPC involve a number of cycles of inflation of a blood pressure (BP) cuff on the arm and/or leg to an inflation pressure of 200 mmHg followed by cuff deflation for a short period of time. There is little evidence to support what limb (upper or lower) or cuff inflation pressures are most effective to deliver this intervention without causing undue discomfort/pain in nonanesthetized humans. In this preliminary study, a dose-response assessment was performed using a range of cuff inflation pressures (140, 160, and 180 mmHg) to induce limb ischemia in upper and lower limbs. Physiological changes in the occluded limb and any pain/discomfort associated with RIPC with each cuff inflation pressure were determined. Results showed that ischemia can be induced in the upper limb at much lower cuff inflation pressures compared with the standard 200 mmHg pressure generally used for RIPC, provided the cuff inflation pressure is ~30 mmHg higher than the resting systolic BP. In the lower limb, a higher inflation pressure, (~55 mmHg > resting systolic BP), is required to induce ischemia. Cyclical changes in capillary blood O2, CO2, and lactate levels during the RIPC stimulus were observed. RIPC at higher cuff inflation pressures of 160 and 180 mmHg was better tolerated in the upper limb. In summary, limb ischemia for RIPC can be more easily induced at lower pressures and is much better tolerated in the upper limb in young healthy individuals. However, whether benefits of RIPC can also be derived with protocols delivered to the upper limb using lower cuff inflation pressures and with lesser discomfort compared to the lower limb, remains to be investigated.

Exposição humana à vibrações de corpo inteiro em um trator agrícola com pneus radiais / Human exposure to whole body vibrations on a farm tractor with radial-ply tires

O objetivo deste trabalho foi avaliar as vibrações de corpo inteiro incidentes em um operador de trator agrícola utilizando pneus radiais, com três diferentes pressões de insuflagem em operação de semeadura. O trabalho foi divido em três tratamentos, com quatro repetições cada. Utilizou-se um trator Massey Ferguson 5450 Dyna 4, 4x2 TDA, 75kW, acoplado a uma semeadora da mesma marca, modelo MF 509. Os pneus radiais utilizados foram Michelin VF 480/60 R28 para o eixo dianteiro e VF 600/60 R38 para o traseiro, nas pressões de 41, 69 e 96kPa. O equipamento para aquisição dos dados foi o Type 4447 da Brüel & Kjær, mesma marca do software para análise, o 4447 Vibration Explorer. Todos os tratamentos apresentaram resultados que ficaram na faixa de extremamente desconfortável, segundo os limites considerados pela Norma ISO 2631. A análise estatística não identificou diferença significativa quando a pressão de insuflagem do pneu foi alterada. O eixo X, horizontal frontal, apresentou os maiores valores de vibração incidentes no operador. Concluiu-se que, para uma jornada de 8 horas de trabalho, o operador está exposto acima do nível limite de conforto estabelecido pela norma utilizada.

The aim of this study was to evaluate the whole body vibrations incidents in a tractor operator using radial ply tires, with three different inflation pressures in operation of seeding. The study was divided into three treatments with four replicates each. Was used a tractor Massey Ferguson 5450, TDA 4x2, 75kW, connected to a planter of the same brand, model 509. Radial ply tires were used VF Michelin 480/60 R28 for the front axle and VF 600/60 R38 for the rear, at pressures of 41, 69 and 96kPa. The equipment for data acquisition was the 4447 Type of Brüel & Kjær, same brand of software for analysis, the 4447 Vibration Explorer. All treatments showed results that were in the range extremely uncomfortable, according to the limits considered by International standard 2631. Statistical analysis identified no significant difference when the inflation pressure of the tire was changed. The X, horizontal forward axis was the one with the highest incidents of vibration to the operator. It was concluded that for an 8-hour workday work, the operator is exposed above the level of comfort limit established by the 2631 International Standard.