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Use of an inspiratory impedance threshold device on a facemask and endotracheal tube to reduce intrathoracic pressures during the decompression phase of active compression???decompression cardiopulmonary resuscitation

Use of an inspiratory impedance threshold device on a facemask and endotracheal tube to reduce intrathoracic pressures during the decompression phase

Use of an inspiratory impedance threshold device on a facemask and endotracheal tube to reduce intrathoracic pressures during the decompression phase of active compression???decompression cardiopulmonary resuscitation   (Citations: 25)
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Introduction: Use of an inspiratory impedance threshold device (ITD) significantly increases coronary perfusion pressures and survival in patients ventilated with an endotracheal tube (ETT) during active compression-decompression cardiopulmonary re- suscitation. We tested the hypothesis that the ITD could lower intratracheal pressures when attached to either a facemask or ETT. Methods: An active and sham ITD were randomly applied first to a facemask and then to an ETT during active compression- decompression cardiopulmonary resuscitation in 13 out-of-hos- pital cardiac arrest patients in a randomized, double-blinded, prospective clinical trial. The compression-to-bag-valve ventila- tion ratio was 15:2. Airway pressures (surrogate for intrathoracic pressure) were measured with a pressure transducer. A sham and an active ITD were used for 1 min each in a randomized order, first on a facemask and then on an ETT. Statistical analyses were made using Friedman's and Wilcoxon's rank-sum tests. Results: For the primary end point, mean SD maximum negative intrathoracic pressures (mm Hg) during the decompres- sion phase of cardiopulmonary resuscitation were 1.0 0.73 mm Hg with a sham vs. 4.6 3.7 mm Hg with an active ITD on the facemask (p .003) and 1.3 1.3 mm Hg with a sham ITD vs. 7.3 4.5 mm Hg with an active ITD on an ETT (p .0009). Decompression phase airway pressures with the facemask and ETT were not statistically different. Conclusions: Use of an active ITD attached to a facemask or an ETT resulted in a significantly lower negative intratracheal pres- sure during the decompression phase of active compression- decompression cardiopulmonary resuscitation when compared with controls. Airway pressures with an ITD on either a facemask or ETT were similar. The ITD-facemask combination was practical and enables rapid deployment of this life-saving technology. (Crit Care Med 2005; 33:990-994)
Journal: Critical Care Medicine - CRIT CARE MED , vol. 33, no. 5, pp. 990-994, 2005
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