Automated abdominal compression device for orthostatic hypotension

[Sasha]

It seems to be the week for devices!

Efficacy of Servo-Controlled Splanchnic Venous Compression in the Treatment of Orthostatic Hypotension
A Randomized Comparison With Midodrine

1. Luis E. Okamoto,
2. André Diedrich,
3. Franz J. Baudenbacher,
4. René Harder,
5. Jonathan S. Whitfield,
6. Fahad Iqbal,
7. Alfredo Gamboa,
8. Cyndya A. Shibao,
9. Bonnie K. Black,
10. Satish R. Raj,
11. David Robertson,
12. Italo Biaggioni

+Author Affiliations

1. Italo.biaggioni@vanderbilt.edu

Abstract
Splanchnic venous pooling is a major hemodynamic determinant of orthostatic hypotension, but is not specifically targeted by pressor agents, the mainstay of treatment.

We developed an automated inflatable abdominal binder that provides sustained servo-controlled venous compression (40 mm Hg) and can be activated only on standing.

We tested the efficacy of this device against placebo and compared it to midodrine in 19 autonomic failure patients randomized to receive either placebo, midodrine (2.5–10 mg), or placebo combined with binder on separate days in a single-blind, crossover study.

Systolic blood pressure (SBP) was measured seated and standing before and 1-hour post medication; the binder was inflated immediately before standing.

Only midodrine increased seated SBP (31±5 versus 9±4 placebo and 7±5 binder, P=0.003), whereas orthostatic tolerance (defined as area under the curve of upright SBP [AUCSBP]) improved similarly with binder and midodrine (AUCSBP, 195±35 and 197±41 versus 19±38 mm Hg×minute for placebo; P=0.003).

Orthostatic symptom burden decreased with the binder (from 21.9±3.6 to 16.3±3.1, P=0.032) and midodrine (from 25.6±3.4 to 14.2±3.3,P<0.001), but not with placebo (from 19.6±3.5 to 20.1±3.3, P=0.756).

We also compared the combination of midodrine and binder with midodrine alone.

The combination produced a greater increase in orthostatic tolerance (AUCSBP, 326±65 versus 140±53 mm Hg×minute for midodrine alone; P=0.028, n=21) and decreased orthostatic symptoms (from 21.8±3.2 to 12.9±2.9, P<0.001).

In conclusion, servo-controlled abdominal venous compression with an automated inflatable binder is as effective as midodrine, the standard of care, in the management of orthostatic hypotension.

Combining both therapies produces greater improvement in orthostatic tolerance.

I wonder what the heck this looks/sounds like...

 

[Denise]

@Sasha I have no idea what it looks like. I hope it isn't like what my imagination is trying to tell me...
The authors presented an poster on this in 2013.

• Poster Session II

Abstract 531: Splanchnic Venous Compression With an Automated Binder is as Effective as Midodrine in the Treatment of Orthostatic Hypotension

1. Luis E Okamoto,
2. Andre Diedrich,
3. Franz Baudenbacher,
4. Rene Harder,
5. Jonathan S Whitfield,
6. Alfredo Gamboa,
7. Cyndya Shibao,
8. Bonnie K Black,
9. Satish R Raj,
10. David Robertson,
11. Italo Biaggioni

http://hyper.ahajournals.org/content/62/Suppl_1/A531

This --> links to the abstract @Sasha posted

 

[Sushi]

We developed an automated inflatable abdominal binder that provides sustained servo-controlled venous compression (40 mm Hg) and can be activated only on standing.

I have some doubts about how "cute and comfortable" this would be. I do have low tech abdominal binders that rely on hooks and eyes and zippers. Those are relatively cheap and widely available in ordinary department stores.

 

[ryan31337]

Here's my guess...

 

[panckage]

Does this have better efficacy than wearing a corset?

 

[Sushi]

Does this have better efficacy than wearing a corset?

I think it depends on the corset. They said it had 40 mm Hg compression and this is probably the key.

 

[MEMum]

I think it depends on the corset. They said it had 40 mm Hg compression and this is probably the key.

Sounds like a torture device to me!

 

[Sushi]

Sounds like a torture device to me!

I don't know the compression level of the one I have as it is in the "corset category" and not specifically intended for the type of splanchnic compression we are talking about. But, it is not uncomfortable, though tight. The difficulty is more getting in and out of it and that is just an annoyance.