Hemodynamic Effects of Medical Anti-Shock Trousers (MAST Garment)

Gaffney, F. Andrew; Thal, Erwin R.; Taylor, W. F.; Bastian, B.; Weigelt, John A.; Atkins, JM; Blomqvist, C. Gunnar

doi:10.1097/00005373-198111000-00004

Cited by 119 publications

(45 citation statements)

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“…The clinical case reports and the studies support the similar physiologic effects as those in the animal models. 21 In this study also, the increasing IAP did not show significant correlation with the mean blood pressure except in group III (no significant change in the mean blood pressure) as demonstrated by Iberti et al The possible explanation for the discrepancy with respect to the previous studies, could be that, the present study has been conducted in a small sample population. No complex monitoring gadgets were used in the present study.…”

contrasting

confidence: 68%

Clinical study of intra-abdominal pressure in the acute surgical abdomen

Neelam¹,

Kumar

Singh

et al. 2017

Int Surg J

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Background: Intra-abdominal pressure (IAP) is the steady-state pressure concealed within the abdominal cavity. Early recognition of rising abdominal pressure is critically important, because it allows prompt intervention which will prevent Abdominal compartment syndrome (ACS) from developing, leading to a much better prognosis for the patient. This prospective case-control study was aimed at characterisation of this entity in the commonly encountered acute surgical abdomen i.e. perforation peritonitis, intestinal obstruction and the blunt abdominal trauma. The stress was laid upon the detection of the intra-abdominal pressure in the patients and the effect of this entity upon the routinely available clinical and laboratory parameters of organ functions. The organ systems studied were the renal, cardiovascular and the pulmonary systems. The clinical outcome was also analysed.Methods: This is a prospective study conducted in Rajendra Institute of Medical Sciences, Ranchi, Jharkhand over a period of one and half year (January 2014 to June 2015). A total of 120 patients were studied, including 30 as controls. The intra-vesicular pressure was measured in all the subjects, which indirectly gives intraabdominal pressure.Results: Initial intra-abdominal pressure ranged from 0-31 cm of saline with the mean of 13.77±8.46. The mean values of the intra-abdominal pressure in the study groups i.e acute surgical cases were found to be significantly higher, as compared to that of the control group (p<0.01). Highest mortality was observed in the IAP range of >25 cm of saline (33.33%, 4 out of 12).Conclusions: Raised intraabdominal pressure significantly affects outcome and increases mortality.

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confidence: 68%

Clinical study of intra-abdominal pressure in the acute surgical abdomen

Neelam¹,

Kumar

Singh

et al. 2017

Int Surg J

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“…In our study, positive pressure was applied only from the ankles to the upper thighs, whereas the trousers used in other studies exerted a positive pressure not only on the legs but also on the pelvis and the lower abdomen. 27,28 Because the fluid volume in the pelvic and abdominal compartments is substantially greater than that in the legs, the volume displaced during inflation likely was much larger than in our study (unfortunately not measured) and, therefore, more likely to have hemodynamic consequences including an increase in BP. Because of the study's physiologic interventional study design, the potential remains for residual confounding to have accounted for the study findings.…”

mentioning

confidence: 71%

Influence of Lower Body Positive Pressure on Upper Airway Cross-Sectional Area in Drug-Resistant Hypertension

Friedman

Bradley²,

Logan³

2013

Hypertension

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Abstract-We previously showed that in hypertensive patients the amount of fluid displaced from the legs overnight is directly related to the severity of obstructive sleep apnea and that the rostral fluid shift was greater in drug-resistant hypertensive patients. The findings suggested that this fluid redistribution increases upper airway collapsibility, yet more direct evidence is lacking. The present study examines the effects of graded lower body positive pressure on leg fluid volume, upper airway cross-sectional area, and neck circumference in patients with drug-resistant hypertension (n=25) and controlled hypertension (n=15). In both groups, the reduction in mean upper airway cross-sectional area and oropharyngeal junction area, assessed by acoustic pharyngometry, and the increase in neck circumference, determined by mercury strain gauge plethysmography, were related to the amount of fluid displaced from the legs (R 2 =0.41, P<0.0001; R 2 =0.42, P<0.0001; and R 2 =0.47, P<0.0001, respectively). Displacement of leg fluid volume was significantly greater in patients with drug-resistant hypertension than in controlled hypertension (P<0.0001), and as a consequence, the former experienced greater reductions in mean upper airway cross-sectional area and oropharyngeal junction area (P=0.001 and P<0.0001, respectively). The findings support the concept that in hypertensive subjects, rostral fluid displacement may participate in the pathogenesis of obstructive sleep apnea by narrowing the upper airway and making it more susceptible to collapse during sleep. The exaggerated fluid volume displacement from the legs and upper airway response to lower body positive pressure in patients with drug-resistant hypertension provide additional evidence of an important link between drug-resistant hypertension and obstructive sleep apnea. 112.203547/-/DC1Correspondence to Alexander G. Friedman et al Lower Body Positive Pressure in Hypertension 241increases pharyngeal resistance and upper airway collapsibility in healthy subjects. [14][15][16] In this study, we examined the effects of LBPP on the upper airway cross-sectional area of patients with DRH and controlled hypertension (CH). We hypothesized that the degree of upper airway narrowing would be related to the amount of fluid shifted from the legs and the extent of narrowing would be greater in patients with DRH than those with CH. Methods Study DesignThe study was carried in a human physiology laboratory during the daytime. The human subjects review committee of Mount Sinai Hospital, University Health Network, and Toronto Rehabilitation Institute, all in Toronto, approved the study. All subjects provided written informed consent before participation. Study SubjectsPatients with CH and DRH were recruited from the Hypertension Clinic at the Mount Sinai Hospital in Toronto. DRH was defined as uncontrolled hypertension on optimal doses of a diuretic and 2 additional antihypertensive medications or normal blood pressure (BP) on ≥4 drugs and CH as normal BP on ≤3 agents.1 In deter...

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“…34 -36 The application of Pcom to DCMP patients appears to be safe because it has been used to treat patients in a shocked state. 34,35 Moreover, with this device, we were able to determine that even a change in LV-ESWS that is insufficient to trigger a significant rise in LV filling pressure can lead to a significant increase in LVdys and thus cause a "false" classification of LV dyssynchrony status in a given patient. Finally, we are not in a position to propose an optimal timing for LVdys assessment in the prediction of CRT response, and thus additional studies are needed to determine the optimal patient status for assessing LVdys in a foreseeable future.…”

Section: Study Limitationsmentioning

confidence: 99%

Impact of Loading Condition on the 2D Speckle Tracking–Derived Left Ventricular Dyssynchrony Index in Nonischemic Dilated Cardiomyopathy

Park

Chang

Kim

et al. 2010

Circ: Cardiovascular Imaging

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Background-The effects of left ventricular (LV) loading conditions on LV dyssynchrony have not been elucidated. We modified LV loading conditions to reveal their effects on echocardiography-derived LV dyssynchrony index (LVdys) in patients with documented nonischemic dilated cardiomyopathy. Methods and Results-Thirty-seven patients were consecutively enrolled. After baseline measurements, pneumatic compression of the lower extremities (Pcom) was used to increase LV afterload. Subsequently, sublingual nitroglycerin (SL-NG) was administered to modify preload. Conventional echocardiographic parameters, LVdys (by speckle-tracking radial strain analysis) and LV end-systolic wall stress (LV-ESWS), were calculated under each condition. LVdys-6 (defined as the maximal difference in time-to-peak radial strain between 6 myocardial segments) and LV-ESWS increased under Pcom (for LVdys-6, 159Ϯ117 at baseline versus 239Ϯ140 ms under Pcom, PϽ0.05; for LV-ESWS, 191Ϯ63 versus 228Ϯ80 g/m 2 , PϽ0.05) After SL-NG application, both parameters decreased significantly (for LVdys-6, 239Ϯ140 under Pcom versus 147Ϯ103 ms after SL-NG, PϽ0.05; for LV-ESWS, 228Ϯ80 under Pcom versus 189Ϯ67 g/m 2 after SL-NG, PϽ0.05). When the presence of LV dyssynchrony was defined as the absolute difference in time-to-peak radial strain between the anteroseptal and posterior segments (LVdys-2), the results were unchanged. Using 130 ms as a cutoff value, the proportion of patients with LV dyssynchrony changed significantly (29.7% at baseline, 45.9% under Pcom, and 35.1% after SL-NG). When the presence of LV dyssynchrony was defined as standard deviation of the time to peak radial strain for 6 segments (LVdys-SD), the results were same. LVdys and LV-ESWS showed a modest but significant association with each other (rϭ0.47, PϽ0.001 for LVdys-6; rϭ0.41, PϽ0.001 for LVdys-2; rϭ0.46, PϽ0.001 for LVdys-SD). Conclusions-To the best of our knowledge, the present study provides the first evidence of a significant association between LVdys and LV loading status, reflective of a dynamic nature of LVdys. Accordingly, LV loading conditions should be taken into account when echocardiographic LVdys is used for clinical decision-making of selecting candidates for cardiac resynchronization therapy or when it is used as a surrogate marker of prognosis. (Circ Cardiovasc Imaging. 2010;3:272-281.)

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Hemodynamic Effects of Medical Anti-Shock Trousers (MAST Garment)

Cited by 119 publications

References 0 publications

Clinical study of intra-abdominal pressure in the acute surgical abdomen

Clinical study of intra-abdominal pressure in the acute surgical abdomen

Influence of Lower Body Positive Pressure on Upper Airway Cross-Sectional Area in Drug-Resistant Hypertension

Impact of Loading Condition on the 2D Speckle Tracking–Derived Left Ventricular Dyssynchrony Index in Nonischemic Dilated Cardiomyopathy

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