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The following is a summary of “Effect of manual decongestive therapy on cardiac preload in critically ill patients: a randomized controlled trial,” published in the March 2025 issue of Annals of Intensive Care by Posch et al. 

Capillary leakage in critical illness disrupts fluid balance, leading to hypovolemia, edema, and related complications.  

Researchers conducted a retrospective study to evaluate whether manual decongestive therapy (MDT) followed by elastic bandaging increased cardiac preload and reduced interstitial edema in individuals with critical illness.  

They randomized 34 individuals with critical illness requiring advanced hemodynamic monitoring with thermodilution-calibrated pulse contour analysis between November 2021 and May 2023 to receive either standard care or MDT followed by elastic bandaging for 24 hours. The global end-diastolic volume index (GEDI), a marker of cardiac preload, was recorded at 15, 30, and 60 minutes, as well as 24 hours after MDT. Wrist and ankle circumferences were measured to assess local interstitial edema.  

The results showed a significant increase in the change in (Δ GEDI) in the intervention group at 15 minutes [median 48 (IQR 82) to median −19 (IQR 39)], 60 minutes [median 75 (IQR 106.5) to median −11 (IQR 80)], and 24 hours [median 107 (IQR 153) to median −16 (IQR 114)] compared to the control group. After 24 hours, the control group showed a significant increase in ankle [median 23.5 (IQR 5) cm to median 24 (IQR 6) cm, P < 0.0001] and wrist [median 18 (IQR 2) cm to median 19 (IQR 2) cm, P < 0.0001] circumferences. In contrast, the intervention group demonstrated a significant reduction in ankle [median 24.5 (IQR 5) cm to median 24 (IQR 4.5) cm, P < 0.0001] and wrist [median 20 (IQR 3.8) cm to median 18 (IQR 3.5) cm, P < 0.0001] circumferences after 24 hours.  

Investigators concluded that MDT effectively increases cardiac preload and reduces interstitial fluid overload and edema in patients with critical illness. 

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-025-01453-z