Pandy S K, Ozmen B B, Morkuzu S, Xiong Y, Kemp E, Chen W F
Vascular Medicine Unit, Cholet Hospital, Cholet, France.
Lymphology. 2024;57(3):142-156.
Access to trained lymphedema care providers remains limited making patient-driven management solutions essential. One such option, sequential intermittent pneumatic compression (IPC), has gained traction as a supportive tool for lymphedema management. While newer IPC devices and innovative applications are being introduced to the market, questions regarding the safety and efficacy of this technology persist. This underscores the importance of reviewing current literature to understand IPC's evolving role in lymphedema care and to identify existing knowledge gaps. A scoping review of literature was conducted across various databases using PRISMA-ScR guidelines. The eligibility criteria included articles published in English language from database's inception to June 2023, discussing IPC's safety, and/or efficacy, and/or optimal modes and settings for lymphedema management. Review articles and case reports and original studies with unclear outcome measures were excluded. The review identified 49 eligible studies from an initial pool of 614 articles, consisting of 12 randomized controlled trials, 25 cohort studies, and 12 experimental studies. Most studies (44) focused on limb lymphedema, while five examined non-limb regions. Sample sizes varied widely, ranging from 10 to 718 participants, reflecting differences in studies' power. Minor adverse events were reported in six studies, including transient skin irritation, paresthesia, and rare cases of genital edema. Efficacy data indicated that IPC, whether used with or without manual lymphatic drainage (MLD), improved limb volume, quality of life, and reduced infection rates, although results varied according to treatment protocols and limb type. The addition of IPC improved compliance of decongestive therapy and increased patient satisfaction. IPC sessions ranged from 45 to 120 minutes per day, conducted 3 to 7 days per week, with pressures set at 60 to 120 mmHg for lower limbs and 25 to 60 mmHg for upper limbs. Higher pressures were associated with more significant limb volume reduction in the lower limbs. A cost analysis indicated that IPC could potentially lead to healthcare savings by reducing infections and hospital admissions. IPC application also showed promising results in head and neck lymphedema, though results for trunk lymphedema were equivocal. Future research should aim to refine IPC protocols in different regions of the body and ascertain its long-term benefits.
能够获得经过培训的淋巴水肿护理人员仍然有限，因此患者驱动的管理解决方案至关重要。一种这样的选择，即序贯间歇性气动压迫（IPC），作为淋巴水肿管理的一种支持工具已获得关注。虽然更新的IPC设备和创新应用正在推向市场，但关于这项技术的安全性和有效性的问题仍然存在。这凸显了回顾当前文献以了解IPC在淋巴水肿护理中不断演变的作用并识别现有知识空白的重要性。我们按照PRISMA-ScR指南在各种数据库中进行了文献的范围综述。纳入标准包括从数据库建立到2023年6月以英文发表的文章，讨论IPC的安全性、和/或有效性、和/或淋巴水肿管理的最佳模式及设置。综述文章、病例报告以及结局指标不明确的原始研究被排除。该综述从最初的614篇文章中确定了49项符合条件的研究，包括12项随机对照试验、25项队列研究和12项实验研究。大多数研究（44项）关注肢体淋巴水肿，而五项研究考察了非肢体区域。样本量差异很大，从10名到718名参与者不等，反映了研究效能的差异。六项研究报告了轻微不良事件，包括短暂的皮肤刺激、感觉异常以及罕见的生殖器水肿病例。疗效数据表明，IPC无论是否与手动淋巴引流（MLD）联合使用，都能改善肢体体积、生活质量并降低感染率，尽管结果因治疗方案和肢体类型而异。添加IPC提高了消肿治疗的依从性并提高了患者满意度。IPC治疗疗程为每天45至120分钟，每周进行3至7天，下肢压力设定为60至120 mmHg，上肢压力设定为25至60 mmHg。较高的压力与下肢更显著的肢体体积减少相关。成本分析表明，IPC可能通过减少感染和住院次数而节省医疗费用。IPC应用在头颈部淋巴水肿方面也显示出有前景的结果，尽管躯干淋巴水肿的结果尚无定论。未来的研究应旨在完善身体不同部位的IPC方案并确定其长期益处。
