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Pressure by design: How to improve the consistency of pressure garments in the clinical environment and implement a simple method for gathering evidence to establish efficacy
Institution:1. Sheffield Children’s Hospital, Ryegate Therapy Block, Tapton Crescent Road, Sheffield, S10 5DD, UK;2. School of Textiles and Design, Heriot-Watt University, Netherdale, Galashiels, TD1 3HE, UK;1. AP-HP, GH St-Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, DMU PARABOL, FHU PROMICE, Paris, France;2. Université de Paris, France;3. UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), France;4. F-CRIN INICRCT Network, Nancy, France;5. AP-HP, GH Saint-Louis-Lariboisière, Department of Infectious Disease, Paris, France;6. AP-HP, GH Saint-Louis-Lariboisière, Department of Plastic Surgery and Burn Unit, Paris, France;7. AP-HP, GH Saint-Louis-Lariboisière, Department of Virology, Paris, France;8. Department of Anesthesia and Perioperative Care, University of California, 500 Parnassus Avenue MUE416, Box 0648, San Francisco, CA 94143, USA;1. Department of Surgery, Texas Tech University Health Science Center, Lubbock, Texas, USA;2. Texas Tech University, Lubbock, Texas, USA;1. 903rd Hospital of People Liberation Army (PLA), Hangzhou, Zhejiang, China;2. The First Affiliated Hospital of Naval Medical University, Yangpu, Shanghai, China;1. Department of Clinical Research, Shriners Hospitals for Children – Boston, Boston, MA, United States;2. Boston University School of Medicine, Boston, MA, United States;3. Harvard Medical School, Boston, MA, United States;4. Division of Plastic, Reconstructive, and Laser Surgery, Shriners Hospitals for Children – Boston, Boston, MA, United States;5. Department of Surgery, St. Agnes Hospital, Baltimore, MD, United States;6. Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, MA, United States
Abstract:Pressure garments are used to treat scars after major trauma including burns. However, the ideal pressure for treatment is not known. Pressures exerted are not routinely measured and garments exert a wide range of pressures. Therefore, current treatment and its efficacy are variable.Pressure Garment Design Tools were introduced in 2012 but their application in hospitals has not been reported. A Garment Dimension and Pressure Calculator was used to audit pressures delivered by 8 pressure garments made for children using the hospital department’s standard reduction factor. The tool was easy to use and showed that pressures exerted by standard garments ranged from 15 to 54 mmHg with highest pressures exerted on wrists.Results of our pilot study indicated that the Garment Dimension and Pressure Calculator was slightly quicker to use than our normal manual process for calculating garment dimensions and enabled easy auditing of past treatment. The Pressure Garment Design Tool was easy to use and calculated garments that exerted the mean target pressures of 15 mmHg and 25 mmHg, improving consistency.Pressures exerted by garments were difficult and time consuming to measure with the Picopress sensor. Pressure was not distributed evenly around the limbs and measurements were inaccurate on the smallest limbs.
Keywords:Pressure garment  Compression  Laplace Law  Reduction factor  Pressure garment design tool  garment dimension and pressure calculator
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