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      Application of intermittent negative pressure on the lower extremity and its effect on macro‐ and microcirculation in the foot of healthy volunteers

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          Abstract

          Intermittent negative pressure ( INP) applied to the lower leg and foot may increase peripheral circulation. However, it is not clear how different patterns of INP affect macro‐ and microcirculation in the foot. The aim of this study was therefore to determine the effect of different patterns of negative pressure on foot perfusion in healthy volunteers. We hypothesized that short periods with INP would elicit an increase in foot perfusion compared to no negative pressure. In 23 healthy volunteers, we continuously recorded blood flow velocity in a distal foot artery, skin blood flow, heart rate, and blood pressure during application of different patterns of negative pressure (−40 mmHg) to the lower leg. Each participant had their right leg inside an airtight chamber connected to an INP generator. After a baseline period at atmospheric pressure, we applied four different 120 sec sequences with either constant negative pressure or different INP patterns, in a randomized order. The results showed corresponding fluctuations in blood flow velocity and skin blood flow throughout the INP sequences. Blood flow velocity reached a maximum at 4 sec after the onset of negative pressure (average 44% increase above baseline, < 0.001). Skin blood flow and skin temperature increased during all INP sequences ( < 0.001). During constant negative pressure, average blood flow velocity, skin blood flow, and skin temperature decreased ( < 0.001). In conclusion, we observed increased foot perfusion in healthy volunteers after the application of INP on the lower limb.

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          Most cited references23

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          An association between vasomotion and oxygen extraction.

          Vasomotion is defined as a spontaneous local oscillation in vascular tone whose function is unclear but may have a beneficial effect on tissue oxygenation. Optical reflectance spectroscopy and laser Doppler fluximetry provide unique insights into the possible mechanisms of vasomotion in the cutaneous microcirculation through the simultaneous measurement of changes in concentration of oxyhemoglobin ([HbO(2)]), deoxyhemoglobin ([Hb]), and mean blood saturation (S(mb)O(2)) along with blood volume and flux. The effect of vasomotion at frequencies 29.3°C (X(2) = 6.19, P 29.5 kg/m(2)) of 18.8 s was statistically significant (Mann Whitney, P < 0.004). The S(mb)O(2) fluctuated spontaneously in this saw tooth manner by an average of 9.0% (range 4.0-16.2%) from mean S(mb)O(2) values ranging from 30 to 52%. These observations support the hypothesis that red blood cells may act as sensors of local tissue hypoxia, through the oxygenation status of the hemoglobin, and initiate improved local perfusion to the tissue through hypoxic vasodilation.
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            Evidence of flowmotion induced changes in local tissue oxygenation.

            The effect of cyclic blood flow velocity on local tissue oxygenation was studied by means of a mathematical simulation in the situation where red blood cells (RBC) act as discrete oxygen sources. Cyclic time varying fluctuations of capillary blood (flowmotion) are due to arteriolar vasomotion. This effect was introduced into the model as an oscillating RBC velocity with equal periods of high and low velocity regulated by a square wave function. Changes in RBC velocity coupled with a constant time-average capillary hematocrit lead to periods of high and low flux. Input parameters were flowmotion frequency and amplitude, capillary hematocrit, and mean RBC velocity. All results were related to baseline states where the velocity and hematocrit are steady. Our principle finding is that flowmotion alters the tissue oxygenation, whereby: 1) high amplitudes of flowmotion cause a modest increase in axial delivery of oxygen but with a decreased average tissue pO2; 2) decreasing flowmotion frequencies lead to increased radial penetration of oxygen; 3) the lower frequencies of flowmotion cause an increase in the volume of tissue that achieves at least a pO2 level of 5 mmHg. Isovolemic hemodilution was simulated and found to substantially increase the volume of oxygenated tissue as a function of flowmotion. These findings indicate that pO2 transients caused by flowmotion oxygenate tissue domains which under steady-state conditions would remain anoxic.
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              A systematic review of intermittent pneumatic compression for critical limb ischaemia.

              Intermittent pneumatic compression (IPC) is designed to aid wound healing and limb salvage for patients with critical limb ischaemia who are not candidates for revascularisation. We conducted a systematic review of the literature to identify and critically appraise the evidence supporting its use in this population. A search was conducted in Embase, MEDLINE and clinical trial registries up to the end of March 2013. No date or language restrictions were applied. Quality assessment was performed by two people independently. Quality was assessed using the Cochrane risk of bias tool and the NICE case-series assessment tool. Two controlled before-and-after (CBA) studies and six case series were identified. One retrospective CBA study involving compression of the calf reported improved limb salvage and wound healing (OR 7.00, 95% CI 1.82 to 26.89, p<0.01). One prospective CBA study involving sequential compression of the foot and calf reported statistically significant improvements in claudication distances and SF-36 quality of life scores. No difference in all-cause mortality was found. Complications included pain associated with compression, as well as skin abrasion and contact rash as a result of the cuff rubbing against the skin. All studies had a high risk of bias. In conclusion, the limited available results suggest that IPC may be associated with improved limb salvage, wound healing and pain management. However, in the absence of additional well-designed analytical studies examining the effect of IPC in critical limb ischaemia, this treatment remains unproven.
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                Author and article information

                Contributors
                o.h.sundby@medisin.uio.no
                Journal
                Physiol Rep
                Physiol Rep
                10.1002/(ISSN)2051-817X
                PHY2
                physreports
                Physiological Reports
                John Wiley and Sons Inc. (Hoboken )
                2051-817X
                14 September 2016
                September 2016
                : 4
                : 17 ( doiID: 10.1111/phy2.2016.4.issue-17 )
                : e12911
                Affiliations
                [ 1 ] Section of Vascular Investigations Division of Cardiovascular and Pulmonary Diseases Department of Vascular SurgeryOslo University Hospital OsloNorway
                [ 2 ] Faculty of Medicine Institute of Clinical MedicineUniversity of Oslo OsloNorway
                [ 3 ]Otivio AS Gaustadalléen 21 Oslo 0349Norway
                [ 4 ] Department of AnesthesiologyOslo University Hospital OsloNorway
                [ 5 ] Department of Vascular SurgeryOslo University Hospital OsloNorway
                [ 6 ] Oslo Center for Biostatistics and EpidemiologyResearch Support Services Oslo University Hospital OsloNorway
                Author notes
                [*] [* ] Correspondence

                Øyvind H. Sundby, Section of Vascular Investigations, Division of Cardiovascular and Pulmonary Diseases, Department of Vascular Surgery, Oslo University Hospital Oslo University Hospital, Aker Pb 4959 Nydalen 0424 Oslo, Norway.

                Tel: + 47 22 89 48 90

                Fax: + 47 22 89 42 90

                Email: o.h.sundby@ 123456medisin.uio.no

                Article
                PHY212911
                10.14814/phy2.12911
                5027346
                27630148
                19cc2cf8-bb86-43d9-90a8-6fda134cf366
                © 2016 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 July 2016
                : 28 July 2016
                : 22 July 2016
                Page count
                Figures: 5, Tables: 1, Pages: 11, Words: 6132
                Funding
                Funded by: Norwegian Research Council
                Award ID: 241589
                Funded by: University of Oslo
                Categories
                Blood Pressure
                Circulation
                Microcirculation
                Original Research
                Original Research
                Custom metadata
                2.0
                phy212911
                September 2016
                Converter:WILEY_ML3GV2_TO_NLMPMC version:4.9.4 mode:remove_FC converted:19.09.2016

                arterial blood flow velocity,dorsal pedis artery,intermittent negative pressure,laser doppler fluxmetry,skin blood flow

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