The Complete Guide to Intermittent Compression Devices for 2023

Introduction

The intermittent pneumatic compression (IPC) devices provide compression per the predetermined treatment mode using an inflated sleeve that wraps around the body or limbs. The stagnation of venous blood and lymphatic fluid is successfully driven back to regular circulation throughout the process of inflation, expansion, squeezing, and deflation.

Veins return oxygen-poor blood to the heart, and arteries take oxygen-rich blood from the heart and distribute it in the body. If any clots form in veins and arteries, it disturbs the circulation and leads to various diseases, i.e., deep vein thrombosis(DVT), stasis, and venous ulcers. IPC devices keep the blood and lymphatic circulation smooth and help prevent these conditions.

The sleeves inflate and deflate every 20 to 60 seconds. This inflating and deflating action helps in circulation and the experience resembles massage. The compression aids blood flow from the body to the heart. When sleeves relax, oxygen-rich blood travels to the body through arteries.

The sleeves also assist the body in releasing chemicals that help avoid clots. These devices are used in hospitals and homes equally as a part of recovery from surgery and in preventing clots formation in various conditions. It can be worn easily while sleeping or sitting in a chair.

Types of IPC Device

There are three types of IPC devices

Single-chamber IPC devices do not use a pressure gradient; instead, they use a single cuff to deliver pressure to the upper extremities.

Multichambered IPC devices have four to thirty-six chambers, with greater pressure in the distal chambers and lower pressure in the proximal chambers, resulting in a pressure gradient.

Advanced compression systems may have just one to two and a half chambers active at any one moment, simulating the distal-to-proximal direction. 

IPC Pumps (control units)

A control unit is required to manage the inflation and deflation process required for IPC. 

Manufacturers have different options, typically the controller will control between 1 and 4 recovery modes, and may include –  Peristaltic, Sequential, Pulse & warmup modes. Treatment Timer Options tend to range from 5 to 99 minutes and pressure Range 30 – 240 mmHg. Each mode and pressure range will have different applications. Click here for examples. 

Cuff Types and Configurations 

The most commonly used cuffs for medical and athlete applications are leg cuffs and arm cuffs to move the blood volume from the distal to the proximal. Other commonly used cuffs include Torso, full-length pants, and shorts (hip and glute focus). 

Cuffs have different chamber (air cell) number options, ranging from four to thirty six, depending on the application. More cuffs are generally better, within reason, with six being a sweet spot in terms of benefits, functionality, convenience and intermittent pneumatic compression device cost. Cuff design is essential; cuffs that overlap are better by design than those that don’t overlap as they promote a continuous movement of the blood without the risk of blood pooling that the seams in non-overlapping cuffs may cause. 

Measurements of interface pressure reveal that IPC cuffs that perform circumferential compression distribute force more evenly over the limb circumference than those that don’t. Circumferential cuffs provide a more consistent compression, and the calf deforms less than noncircumferential cuffs, which tend to compress the calf into a “flatter” shape.

Some manufacturers can support two people sharing a machine simultaneously; this application is helpful for teams, clubs, and families. For examples of cuffs and uses, click here

Precautions:

Cuffs should always start at the distal (furthermost point) and move the blood to the proximal (center of the body). In this regard, cuffs that only address the midpoint of the limb (for example calf only cuffs) or cuffs that have a gap between sections should be avoided due to the risk of blood pooling as the wrong cuff can damage the tiny valves in veins

Blood pooling, also known as venous pooling, is a condition in which blood collects in the lower extremities. Venous or blood pooling happens when the tiny valves in the veins get damaged and stop working correctly. According to research, the retrograde flow of the blood can lead to varicose veins and leg ulcers.

Working Principle of IPC Devices

Intermittent pneumatic compression is a therapeutic method that uses an air pump and inflatable, gloves, boots, or auxiliary sleeves in medical equipment to enhance venous circulation in the limbs of patients with edema, deep vein thrombosis (DVT), and pulmonary embolism (PE).

Veins are compressed and emptied during the inflation phase and then refilled during the deflation phase.

Pneumatic systems work like hydraulic systems but use air instead of liquids. They transfer and regulate energy by using compressed air. Most pneumatic systems need a consistent flow of compressed air to operate, which an air compressor supplies. The receiver is a high-pressure tank where the atmospheric air is stored. This compressed air is sent to the calves and sleeves through a system of tubes and valves.

Intermittent pneumatic compression device mainly improves blood circulation through mechanical and biochemical effects; these two effects work mutually.

Mechanical effects of IPC on body

Before diving into mechanical effects, it’s compulsory to know some terms:

Shear stress is the force generated per unit area when a tangential force of the flowing blood acts on a surface of the endothelium of blood vessels.

Shear strain is the change in shape or displacement of material created from shear stress.

Endothelium: The internal lining of the heart and blood vessels is called the endothelium. This lining comprises endothelial cells, which release regulatory molecules that control the contraction and relaxation of the vessels.

Hemodynamics is the study of blood flow or blood dynamics.

The interaction between hemodynamics and endothelium is vital in mammals’ evolution, survival development, and morbidity. Shear stress is present where flow occurs. 

IPC devices apply shear stress and strain through compression on the endothelium. This compression results in the release of prostaglandins, nitro vasodilators, lipoxygenases, hyperpolarizing factors, growth factors, and other similar molecules. These elements influence how blood pressure, thickness, and circulation are controlled.

Consistent external compression to the body part induces a progressive, continuous flow of blood into the lumen of the deep veins. The sudden pressure gradients at the compression site move the blood and cause lumen collapse, which results in venous emptying and prevents stasis and clot formation.

Biochemical effects of IPC on body

As a consequence of mechanical compression (stress and strain), biochemical effects are activated. 

When IPC devices are placed in the body, the fast compression creates a pulsatile flow forward, eventually resulting in blood draining at the compression site. The venous endothelial cells are subjected to a compressive strain due to the dilation caused by an influx of blood volume(shear stress). Strain and shear are mechanical stresses that contribute to IPC’s antithrombotic, fibrinolytic, and vasodilatory properties. All of these methods are discussed below.

  • Fibrinolytic Mechanism

IPC increases fibrinolytic activity by increasing tPA. Plasminogen is a plasma glycoprotein that degrades fibrin and solubilizes blood clots in its active form. Plasminogen needs a tissue plasminogen activator (tPA) to get converted into its active form(plasmin).  The administration of cyclic strain increases immunoreactive tPA generation. More tPA causes more plasmin formation, and as a result, fewer clots formation occurs. 

  • Antithrombic Pathway factors

A tissue factor pathway inhibitor is essential in initiating blood coagulation in the extrinsic coagulation system. IPC activates the antithrombotic mechanism by increasing tissue factor pathway inhibitor and associated decrease in factor VIIa levels. These are most likely variables that contribute to IPC’s capacity to prevent venous thrombosis. 

  • Inhibition of Platelets Aggregation

Another method through which IPC function is its effect on platelet aggregation. 

At the location of the injured vessels, platelets gather and create a mesh that closes the wound. The round platelets become spiny, release proteins and other compounds that trap more platelets and clotting proteins in the expanding plug that develops into a blood clot. Inhibition of platelet accumulation can help prevent clot formation. Prostacyclin, an autacoid secreted by endothelial cells, is the most effective endogenous inhibitor of platelet aggregation.

Prostacyclin synthesis capability increased after subjecting cultivated endothelium cells to the cyclic strain of 24% at cycles of 10s elongation followed by 10s relaxation.

 

  • Vasodilation through Nitric Oxide 

IPC increases perfusion in arterial occlusive artery disease. Nitric oxide is a vascular relaxant molecule released by endothelial cells as a result of compression. Nitric oxide inhibits smooth muscle contractions, platelet aggregation, platelet and monocyte adhesion to endothelial surfaces, and smooth muscle cell proliferation. Inhibition of these factors leads to vasodilation. 

Applications of Intermittent Pneumatic Compression (IPC) devices

Intermittent Pneumatic Compression (IPC) is a recognized method that improves blood and lymph circulation. It significantly promotes venous return, strengthens arterial perfusion, eliminates edema, and simultaneously helps improve extremity ischemia and increase the degree of oxygenation.

According to research, massage is the most efficient means of reducing tiredness, while compression, massage, and chilling are the most effective methods of relieving pain. A recent poll of professional soccer players indicated that 57% of the clubs questioned used intermittent pneumatic compression. IPC improves fluid tissue exchange and enhances blood circulation, allowing for quicker regeneration. 

Restoration of sensory functions after stroke 

Ten cycles of 3 minutes with a peak of 40 mmHg with an intermittent pneumatic compression device help restore sensory functions in stroke patients.

Improvement of circulation in arterial occlusive disease

Applying IPC(foot+calf) for 3 to 5 months (>2.5 hours/day) improves patients’ walking abilities and ankle pressure indices, resulting in a significant improvement in quality of life.

According to Delis (2005), foot and calf IPC significantly improves acute arterial limb inflow in intermittent claudication. Increased arteriovenous pressure and a significant decrease in peripheral resistance to flow due to a temporary cessation of peripheral sympathetic autoregulation and the release of nitric oxide are responsible for the beneficial effects of venous expulsion with IPC on leg venous pressure. 

Treatment of dependent pregnancy edema

A lower body swelling brought on by gravity is called dependent pregnancy edema. Gravity causes fluid to pool in feet, legs, or hands as it drags fluid downward toward the earth. This problem is treated with an IPC device.

In a research, 42 healthy pregnant women were subjected to an external pneumatic intermittent compression (EPIC) device for 30 minutes. The volume of the calf, lower leg, and foot frustum decreased significantly using EPIC. Hence it was concluded that EPIC is a successful treatment for dependent pregnancy edema.

Management of postmastectomy lymphedema

Postmastectomy lymphedema is a condition that may arise after breast cancer surgery. It can develop months or years after surgery. It is a chronic (ongoing) disorder with no known treatment. IPC can manage it.

The research was conducted on 21 women with breast cancer-related lymphedema to see the results of IPC. Twenty IPC sessions (45 minutes per day at 60 mm Hg, five times per week) were given to the women. According to the results, pneumatic compression is an excellent treatment for postmastectomy upper limb edema. 

Healing of leg ulcer and edema in immobilized/paralyzed patients

In wheelchair-bound or immobile patients, edema is developed by increased fluid extravasation, while leg ulcers are caused by a failure of the venous and lymphatic pumps. IPC is a very effective yet underutilized therapy technique; it generates pressure waves on the leg by inflating and deflating the air-filled garments, which restores the skin’s damaged microcirculation.

Elimination of swelling and pain in healthy people

Sometimes healthy people also feel heaviness, discomfort, and edema after standing or sitting for a long time. Intermittent pneumatic compression (IPC) is a simple technique for preventing chronic venous insufficiencies

The research was conducted on 20 healthy volunteers who usually stand on duty and complain of leg discomfort and edema. This study showed IPC is an effective treatment in lowering leg discomfort, edema, and pain without producing side effects. 

Treatment of Lymphedema 

Lymphedema is the swelling of tissues or organs in specific body sections caused by a lymphatic drainage disease (difficulty or absence of lymphatic channels), which causes lymph (tissue fluid) to remain in the tissues and not flow via the lymphatic circulation.

IPC uses air pressure to pressurize the affected limb from the distal end to the proximal end, and inflate, expand, and deflate sequentially through the sleeves back and forth, which can push the stasis of lymph fluid back into the blood circulation, which is directional and progressive and has the cumulative “squeeze out” effect. The cumulative “squeeze out” effect meets the physiological requirements. On the other hand, IPC can use pressure to remove some metabolites and inflammatory pain-causing substances that cause pain through blood circulation and lymphatic circulation to achieve the purpose of eliminating edema

IPC is a safe and economical treatment, but this method has been unreasonably ignored. There are many effective ways to prove that this treatment has an excellent effect on many patients with such lymphedema. 

Faster healing of venous ulcers 

Venous leg ulcers are open, frequently painful skin sores that may take up to a month to cure. They often appear on the inner of the leg, slightly above the ankle. Swollen ankles (edema), discoloration, and darkening of the skin surrounding the ulcer are all symptoms of a venous leg ulcer. The most prevalent cause of lower limb ulceration is chronic venous insufficiency.

IPC modifies the underlying pathophysiology through stress and strain, creating an environment conducive to venous ulcer healing. Greater venous return, reduced leg edema, higher endogenous fibrinolysis, decreased intravascular coagulation, and better arterial (skin) perfusion all contribute to wound healing. According to the American College of Chest Physicians, compression treatment demonstrates increased ulcer healing rates in patients who were resistant to healing for six months. 

Management of posttraumatic fracture complications

The effects of intermittent pneumatic compression (IPC) treatment were studied on posttraumatic ankle joint mobility and edema in patients with lower leg fractures. According to the findings of this research, IPC therapy helps rehabilitate posttraumatic disorders.

Toxins Elimination 

IPC circumferentially compresses the lower limbs, applying pressure to the subcutaneous tissues and muscle groups. As a result of compression, the interstitial pressure in the extracellular space increases. When the interstitial pressure surpasses the hydrostatic pressure within the vessels, third-spaced fluids are forced back into circulation. This process effectively lowers the lower limb’s cross-sectional area and the tensile stress on the cutaneous tissues, especially in those with edematous lower limbs. Reduced surface tension improves transcutaneous oxygenation and metabolic toxin clearance.

Venous thromboembolism (VTE)

Venous thromboembolism (VTE), or blood clots in the veins, is a dangerous though avoidable medical disorder that may cause disability and death.

Deep vein thrombosis (DVT) and pulmonary embolism are examples of venous thromboembolism (VTE). After acute coronary syndrome and stroke, VTE is the third most frequent cardiovascular condition. DVT and PE affect people of all ages, from youth to the elderly. 

DVT symptoms include swelling, soreness, discomfort, and increased skin temperature at the DVT site. APE symptoms include trouble breathing and chest discomfort, particularly during breathing. Venous thromboembolism might potentially be asymptomatic.

  • Prevention of DVT & pulmonary embolism following surgery

There are three methods to minimize the risk of VTE after major surgery. You can practice them after asking your doctor. 

Walk: Moving as much as possible (even if just a few steps) is essential to avoid DVTs.

IPC devices: Use compression whether you are in bed or on a chair. An IPC is a wraparound sleeve that, when activated, squeezes the leg to maintain blood flow. 

Blood thinning agent: Take blood-thinning medicine prescribed by the doctor without missing any doses. Blood thinner dosages missed have been linked to VTE episodes; hence it is critical to take it.

  • Prevention of DVT & thrombosis in healthy individuals

If your time is spent in front of a mobile screen and laptop and you live a sedentary life, you are at increased risk of DVT or thrombosis.

It can be prevented by taking the following measures.

Exercise daily: There are many beneficial physical activities, such as walking, swimming, and riding a bicycle. 

Healthy diet: A low-fat, high-fiber diet rich in vegetables and fruits, together with regular exercise, will help you maintain a healthy weight.

Quit smoking: Put an end to your smoking habit. Help is available through nicotine patches, gums, sprays, prescription drugs, and support groups.

Use compression device: Intermittent pneumatic compression devices are proven to prevent blood disorders.

Get yourself routinely checked: Blood pressure readings should be taken monthly or more often if recommended by your doctor. If they prescribe medicine, be sure to take it as directed. 

Uses of Intermittent Pneumatic Compression Devices for Athletes

1. Warm-up – 10 minutes on compression boots has been shown to increase muscle oxygen to the same point that would typically take 30-40 minutes of exercise (jogging or cycling, for example). This is an excellent warm-up hack at a low metabolic cost to the athlete. 

2. Recovery – using compression boots accelerates recovery via the mechanical and biomechanical effects mentioned above. They can be used multiple times a day with no tissue damage. The increased blood flow can also enhance recovery techniques such as percussion guns, foam rolling, and stretching.

3. Rehab – accidents, and injuries happen from time to time. Blood flow is key to faster healing and recovery by removing the swelling and spreading up the delivery of the healing process. Ice gel packs can also be added inside the cuffs if trauma is present to control internal bleeding and relieve pain. 

4. Travel – Many athletes train for months and years before a key event such as a world championship or Olympics only to step on a prevent long-haul flight and have the lower SPO levels of a pressurized aircraft cabin create edema or swelling at a time when the athlete needs it the least. Using compression boots for 15 to 20 minutes of each flight hour can significantly mitigate the effects of edema and the risk of DVT.

 

Improved Sleep 

Most people feel sleepy or fall asleep when using compression. When this was studied by a brain scientist, a decrease in delta, theta, and alpha wave activity was noticed, leading to faster central nervous system recovery, reduction in brain fatigue, stamina optimization, better focus, less distraction, and better sleep quality, and better sleep quality brain health—on this basis, using compression boots for a power nap or before bedtime can improve sleep quality. 

The image above illustrates the calming of the delta, theta and alpha brain waves after 30 mins of treatment (represented by the darker colours on the right)

Summary

IPC has for many decades, been a proven treatment modality for athlete recovery, healthy aging and the management of chronic pain and long term illness. 

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Author: Michael Lyons