Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.
King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.
Sci Rep. 2022 May 20;12(1):8519. doi: 10.1038/s41598-022-12336-9.
There are contradictory data regarding the effect of intermittent pneumatic compression (IPC) on the incidence of deep-vein thrombosis (DVT) and heart failure (HF) decompensation in critically ill patients. This study evaluated the effect of adjunctive use of IPC on the rate of incident DVT and ventilation-free days among critically ill patients with HF. In this pre-specified secondary analysis of the PREVENT trial (N = 2003), we compared the effect of adjunctive IPC added to pharmacologic thromboprophylaxis (IPC group), with pharmacologic thromboprophylaxis alone (control group) in critically ill patients with HF. The presence of HF was determined by the treating teams according to local practices. Patients were stratified according to preserved (≥ 40%) versus reduced (< 40%) left ventricular ejection fraction, and by the New York Heart Association (NYHA) classification. The primary outcome was incident proximal lower-limb DVT, determined with twice weekly venous Doppler ultrasonography. As a co-primary outcome, we evaluated ventilation-free days as a surrogate for clinically important HF decompensation. Among 275 patients with HF, 18 (6.5%) patients had prevalent proximal lower-limb DVT (detected on trial day 1 to 3). Of 257 patients with no prevalent DVT, 11/125 (8.8%) patients in the IPC group developed incident proximal lower-limb DVT compared to 6/132 (4.5%) patients in the control group (relative risk, 1.94; 95% confidence interval, 0.74-5.08, p = 0.17). There was no significant difference in ventilator-free days between the IPC and control groups (median 21 days versus 25 days respectively, p = 0.17). The incidence of DVT with IPC versus control was not different across NYHA classes (p value for interaction = 0.18), nor across patients with reduced and preserved ejection fraction (p value for interaction = 0.15). Ventilator-free days with IPC versus control were also not different across NYHA classes nor across patients with reduced or preserved ejection fraction. In conclsuion, the use of adjunctive IPC compared with control was associated with similar rate of incident proximal lower-limb DVT and ventilator-free days in critically ill patients with HF.Trial registration: The PREVENT trial is registered at ClinicalTrials.gov, ID: NCT02040103 (registered on 3 November 2013, https://clinicaltrials.gov/ct2/show/study/NCT02040103 ) and Current controlled trials, ID: ISRCTN44653506 (registered on 30 October 2013).
关于间歇气动压迫（IPC）对危重病患者深静脉血栓形成（DVT）和心力衰竭（HF）失代偿发生率的影响，存在相互矛盾的数据。本研究评估了辅助使用 IPC 对 HF 危重病患者 DVT 发生率和无通气天数的影响。在 PREVENT 试验（N=2003）的预先指定的次要分析中，我们比较了辅助使用 IPC 联合药物预防血栓形成（IPC 组）与单独药物预防血栓形成（对照组）在 HF 危重病患者中的效果。HF 的存在由治疗团队根据当地实践确定。根据左心室射血分数保留（≥40%）与降低（<40%）和纽约心脏协会（NYHA）分类对患者进行分层。主要结局是通过每周两次静脉多普勒超声检查确定的近端下肢 DVT 发生率。作为主要次要结局，我们评估了无通气天数作为临床重要 HF 失代偿的替代指标。在 275 例 HF 患者中，18 例（6.5%）患者有近端下肢 DVT （在试验第 1 至 3 天检测到）。在 257 例无 DVT 的患者中，IPC 组 11/125（8.8%）患者发生了近端下肢 DVT，而对照组 6/132（4.5%）患者发生了近端下肢 DVT（相对风险，1.94；95%置信区间，0.74-5.08，p=0.17）。IPC 组和对照组之间的无通气天数无显著差异（中位数分别为 21 天和 25 天，p=0.17）。IPC 与对照组的 DVT 发生率在 NYHA 分级之间无差异（交互 p 值=0.18），也与射血分数降低和保留的患者之间无差异（交互 p 值=0.15）。IPC 与对照组的无通气天数在 NYHA 分级之间或射血分数降低或保留的患者之间也无差异。结论，与对照组相比，辅助使用 IPC 与 HF 危重病患者近端下肢 DVT 发生率和无通气天数相似。试验注册：PREVENT 试验在 ClinicalTrials.gov 注册，ID：NCT02040103（于 2013 年 11 月 3 日注册，https://clinicaltrials.gov/ct2/show/study/NCT02040103）和当前对照试验，ID：ISRCTN44653506（于 2013 年 10 月 30 日注册）。
