Document Detail

Use of respiratory impedance in prehospital care of hypotensive patients associated with hemorrhage and trauma: a case series.
MedLine Citation:
PMID:  22847095     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The respiratory pump can be optimized to enhance circulation in patients with hypotension by having patients spontaneously breathe through a low level of inspiratory resistance. This can be achieved with an impedance threshold device (ITD) designed to provide 7 cm H2O resistance during spontaneous inspiration with minimal resistance during expiration. Little is known about the effects of harnessing this physiological concept to increase blood pressure (BP) in the prehospital setting of care for patients with hypotension caused by blood loss or trauma. In this case series, we report on the feasibility, effectiveness, and safety of rapidly deploying the ITD by first responders to treat hypotension secondary to blood loss and trauma in the urban setting by emergency medical services personnel.
METHODS: Hemodynamic data from hypotensive patients (pretreatment systolic BP [SBP] <100 mm Hg) from 3 U.S. cities where the ITD is deployed were evaluated. The primary end point was maximum change in SBP and diastolic BP (DBP) from before to during ITD use in patients with hypotension secondary to documented blood loss or trauma. Secondary end points were device tolerance, whether the patient felt "better," change in heart rate, O2 saturation, and adverse events.
RESULTS: Of the 255 hypotensive patients treated, there were 26 categorized with blood loss and 13 with trauma. In this 39-patient subgroup, the SBP and DBP (mean ± SD) increased from 79 ± 14 mm Hg and 48 ± 12 mm Hg before ITD placement to 110 ± 17 mm Hg and 66 ± 14 mm Hg after ITD placement (p < 0.001). Breathing through the ITD resulted in no reported adverse events, was well tolerated, and resulted in feeling "better" in more than 85% of the patients.
CONCLUSION: Use of an ITD by emergency medical services personnel on hypotensive spontaneously breathing patients secondary to blood loss and trauma increased SBP and DBP and was feasible, well tolerated, and not associated with adverse effects (e.g., increased bleeding).
Victor A Convertino; Brent Parquette; John Zeihr; Kevin Traynor; Daryn Baia; Mark Baumblatt; Levon Vartanian; Mithun Suresh; Anja Metzger; Robert T Gerhardt; Keith G Lurie; David Lindstrom
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  73     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-07-31     Completed Date:  2012-10-15     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S54-9     Citation Subset:  AIM; IM    
Tactical Combat Casualty Care Research Program, United States Army Institute of Surgical Research, Fort Sam Houston, Texas 78234, USA.
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MeSH Terms
Aged, 80 and over
Blood Pressure
Emergency Medical Services / methods*
Heart Rate
Hemorrhage / complications,  therapy*
Hypotension / etiology,  therapy*
Middle Aged
Respiration, Artificial / instrumentation,  methods*
Wounds and Injuries / complications,  therapy*
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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