Feature ArticleHigh compression leg bandaging prevents seated postural hypotension among elderly hospitalized patients
Introduction
Postural hypotension (PH) is a clinically important disorder that predicts increased morbidity and mortality.1, 2, 3, 4, 5, 6 PH can be classified into two pathophysiological forms: neurogenic (structural) and non-neurogenic (functional).3, 5, 6 Neurogenic PH is chronic and results from autonomic failure due to multiple system atrophy, Parkinson's disease, pure autonomic failure, and neuropathies.3, 5, 6 Non-neurogenic PH is often acute and may be caused by volume depletion, venous pooling, medications, hypertension, heart failure, and other disorders.3, 5, 6
PH is a very common and often symptomatic disorder in elderly hospitalized patients.7, 8, 9, 10 In this population, the prevalence of PH can be as high as 65−75%.7, 8, 9, 10 Among acutely ill elderly inpatients, the prevalence of PH is particularly high due to an additive effect of multiple predisposing factors for non-neurogenic PH.8, 9, 10, 11 Such patients are often weak, connected to medical devices, and at a high risk for symptomatic standing PH during their ambulation following bed rest.9, 10, 12 Therefore, evaluating standing PH in hospitalized older patients may be difficult and potentially dangerous, and sitting before standing is recommended.9, 10, 12 In this patient population, rates of seated PH (16−56%) are generally lower than those of standing PH (22−75%).10, 12 However, among older patients in internal medicine wards, PH (rates are 49−56%) and related symptoms (rates are 25−81%) are common on sitting at the initial phase of ambulation.12, 13, 14, 15 Thus, measures for preventing seated PH should be undertaken.10, 12
The application of various lower body compression devices is recommended for managing chronic PH.3, 5, 6 However, the evidence supporting this recommendation is limited, because the benefit of compression therapy was evaluated in short-term studies with small sample sizes.6,16, 17, 18, 19 Moreover, little is known about the preventive effect of compressive garments on previously unknown PH. In a single available investigation, 61 acutely ill inpatients, older than 65 years, who had been bedridden for at least 36 h, were evaluated for seated PH in a bandaged and unbandaged state within two consecutive days.14 In the evaluations performed with lower limb compression bandaging, PH did not appear less often, although seating-induced dizziness, palpitations, and heart rate acceleration were largely prevented.14 The results of that study may have been affected by its crossover design, the relatively small sample size, and the use of a bandage that achieved only moderate compression. Thus, the benefit of leg compression bandaging on the prevention of PH at an initial PHase of ambulation of hospitalized patients warrants further investigation.
The aim of the present study was to examine the hypothesis that elderly inpatients without history of PH, who were exposed to wearing leg compression bandages on first sitting mobilization, would be less likely to develop PH than matched patients who did not wear the bandaging.
Section snippets
Study population and design
Fig. 1 presents the study population and design. This single-center comparative study was conducted in the Department of Internal Medicine “F”. This is one of six Departments of Internal Medicine in Assaf Harofeh Medical Center, a tertiary care university hospital located at Zerifin, Israel. The study population comprised elderly patients admitted for a variety of acute medical disorders who were either bandaged (intervention group) or unbandaged (comparison group).
The intervention group (n
Baseline characteristics (Table 3)
In the entire cohort, the mean age was 81.7 ± 7 years (range 70−98 years), 63% were women, and the mean bed rest duration was 79.9 ± 73 h (median value 62 h and range 12−450 h). The most common reasons for admission were infection, decompensated heart failure, and acute coronary syndrome.
Demographic characteristics, duration of bed rest, and the main reasons for admission were comparable between the intervention and comparison groups. Coronary artery disease and heart failure were more
Discussion
This interventional pragmatic clinical study confirmed our hypothesis. We demonstrated the benefit of high compression leg bandaging in the prevention of seated PH during an initial phase of ambulation, among elderly internal medicine inpatients at high risk for developing PH. The use of lower limb compression bandages reduced the risk of PH occurrence by 47%. The number of patients needed to be bandaged to prevent one case of PH is calculated as 4.2. To the best of our knowledge, this study of
Conclusions
This is the first report in the literature that demonstrated that the application of high compression leg bandaging reduces the risk of occurrence of seated PH in elderly inpatients, during the initial phase of their ambulation. Compression leg bandaging is inexpensive and safe, and may be easily applied by health care providers to hospitalized patients. Among inpatients at a high risk for development of PH, the use of this technique is recommended as a non-pharmacologic intervention.
Funding
Compression bandages SurePress™ were provided free of charge for use in the study by ConvaTec Ltd, United Kingdom. This manufacturer had no role in the study design, the collection, analysis, and interpretation of data, the writing of the manuscript, or the decision to submit the manuscript for publication.
Conflicts of interest
None.
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