Cardiopulmonary effects of a new inspiratory impedance threshold device in anesthetized hypotensive dogs

Shih, Andre; Vigani, Alessio; Loring, Nichole; Pereira, Fernando G; Szarowicz, Mark D.; Bandt, Carsten

doi:10.1111/j.1467-2995.2009.00524.x

Cited by 10 publications

(21 citation statements)

References 25 publications

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“…Impedance threshold devices (ITDs) have been found to improve short‐term outcomes in people (eg, survival to hospital admit, short‐term survival), but thus far have not proven effect on long‐term outcome measures (eg, neurologic outcome, long‐term survival) . ITDs have been evaluated in dogs with isoflurane‐induced hypotension, and were found to improve SAP (systolic arterial pressure) and cardiac index, however this study found no significant improvement in DAP (diastolic arterial pressure) and MAP (mean arterial pressure) . ITDs have also been evaluated in canine hemorrhagic shock models, and found to increase SAP, MAP, and CO, without increasing DAP .…”

Section: Breathingmentioning

confidence: 93%

Updates in theAmericanHeartAssociation guidelines for cardiopulmonary resuscitation and potential applications to veterinary patients

Maton¹,

Smarick²

2012

J Vet Emergen Crit Care

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Section: Breathingmentioning

confidence: 93%

Updates in theAmericanHeartAssociation guidelines for cardiopulmonary resuscitation and potential applications to veterinary patients

Maton¹,

Smarick²

2012

J Vet Emergen Crit Care

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“…The degree of the rise was, however, variable. In one swine study, Shih et al 10 showed a statistically significant difference in systolic blood pressure in hypotensive subjects breathing with and without a À7 cm H 2 O ITD (67 AE 13 mmHg without ITD vs 80 AE 14 mmHg with ITD; p < 0.05). 10 Voelckel et al 11 in a study of hyperthermic swine, showed an ITD set at À12 cm H 2 O conferred a rise of approximately 25 mmHg in mean arterial pressure (p < 0.001).…”

Section: Animal Evidencementioning

confidence: 97%

“…In one swine study, Shih et al 10 showed a statistically significant difference in systolic blood pressure in hypotensive subjects breathing with and without a À7 cm H 2 O ITD (67 AE 13 mmHg without ITD vs 80 AE 14 mmHg with ITD; p < 0.05). 10 Voelckel et al 11 in a study of hyperthermic swine, showed an ITD set at À12 cm H 2 O conferred a rise of approximately 25 mmHg in mean arterial pressure (p < 0.001). Sigurdsson et al 12 studied exsanguinated swine and showed not only a statistically significant difference in mean arterial pressure in the À10 cm H 2 O ITD group of 23.7 mmHg (p < 0.005) but also a short-term (approximately 310 min) survival benefit.…”

Section: Animal Evidencementioning

confidence: 97%

The use of impedance threshold devices in spontaneously breathing, hypotensive trauma patients

Henning

Smith

2014

Trauma

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Impedance threshold devices are a novel therapeutic option to increase blood pressure in the spontaneously breathing, hypotensive, trauma patient. They have multiple potential mechanisms of action. The most important is their ability to induce a more negative intrathoracic pressure during inspiration. They achieve this by the presence of a series of valves.These valves only open once the patient has generated a more negative intrathoracic pressure than is normally required for inspiration to occur. This negative intrathoracic pressure is thought to increase venous return and therefore cardiac output and subsequently blood pressure. This narrative review examines the evidence pertaining to the use of these devices in spontaneously breathing, hypotensive, trauma patients. While the literature supports the ability of these devices to increase systolic blood pressure in both animal and human models of hypotension, and more recently in patients with true pathological hypotension, potential flaws are discussed, and several key questions that have not been addressed by studies to date are highlighted. Notwithstanding these problems, impedance threshold devices may have a role in hypotensive trauma patients, particularly during the pre-hospital phase of care when available resources limit treatment options. Further work is required to prove both their clinical effectiveness and safety.

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“…Although the use of an ITD has been studied extensively in pig models and people, its application in the veterinary clinical setting has not been similarly evaluated. Currently, the authors are aware of only a single published study by Shih et al, 26 evaluating the cardiopulmonary effects with use of the ITD in dogs. This prospective randomized study reports improved cardiovascular parameters, at the expense of an increased work of breathing, in anesthetized hypotensive dogs 26 .…”

Section: Application To Veterinary Emergency and Critical Care Medicinementioning

confidence: 99%

“…Currently, the authors are aware of only a single published study by Shih et al, 26 evaluating the cardiopulmonary effects with use of the ITD in dogs. This prospective randomized study reports improved cardiovascular parameters, at the expense of an increased work of breathing, in anesthetized hypotensive dogs 26 . Prospective studies evaluating its use in both anesthetic and nonanesthetic CPA are warranted in small animals in both the research and clinical settings.…”

Section: Application To Veterinary Emergency and Critical Care Medicinementioning

confidence: 99%

Application of impedance threshold devices during cardiopulmonary cerebral resuscitation

Seekins

Reiss

2011

J Vet Emergen Crit Care

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Use of an ITD during CPCR in human and animal studies has demonstrated improved vital organ perfusion and faster return of spontaneous circulation. However, the majority of these studies have been carried out in people during out-of-hospital cardiac arrest and ventricular fibrillation cardiopulmonary arrest pig models. Further studies evaluating the use of an ITD during CPCR in the veterinary hospital setting are warranted.

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Cardiopulmonary effects of a new inspiratory impedance threshold device in anesthetized hypotensive dogs

Cited by 10 publications

References 25 publications

Updates in theAmericanHeartAssociation guidelines for cardiopulmonary resuscitation and potential applications to veterinary patients

Updates in theAmericanHeartAssociation guidelines for cardiopulmonary resuscitation and potential applications to veterinary patients

The use of impedance threshold devices in spontaneously breathing, hypotensive trauma patients

Application of impedance threshold devices during cardiopulmonary cerebral resuscitation

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