Pressures and Timing of Intermittent Pneumatic Compression Devices for Efficient Tissue Fluid and Lymph Flow in Limbs with Lymphedema

Pneumatic compression of tissues with lymph stasis is, aside from the manual massage, a commonly used therapeutic modality in limb lymphedema. A number of pneumatic devices have been constructed. There is lack of reports of comparative studies determining inflation pressure levels, inflation/deflation cycle times, and total pumping times. Aim: We tried to answer the question how high compression pressure and how long compression timing should be applied to the limb soft tissues to reach tissue fluid (TF) head pressure above 30mmHg, necessary to initiate proximal flow. Methods: TF pressures were measured subcutaneously during intermittent pneumatic compression in the lymphedematous limbs stage II to IV. Pressures of 50, 80, and 120mmHg and timing 5, 20, and 50sec were applied. Results: a) the TF head pressures were lower than those in inflated chambers, b) inflation time of 5 and 20sec was not long enough to generate TF head pressures above 30mmHg, even if the compression pressures were as high as 120mmHg, c) the 50sec timing allowed to reach head pressures above 30mmHg; however, they remained always lower than in the compression chamber, d) TF head pressures differed at various levels of the limb depending on the soft tissue mass, e) deflation of the inflated whole sleeve for 5 and 20sec was followed by high end pressures, whereas that of 50sec brought about pressure drop to 0, facilitating refilling with TF of the distal parts of the massaged limb. Conclusions: Our observations point to the necessity of applying high pressures and compression times over 50sec, to generate effective TF pressures and provide enough time for creating TF flow. Short inflation times generate TF pressures as in one-chamber devices that preclude its effectiveness compared to the multi-chamber devices.