Citation

Convertino VA, Cardin S, Cap AP, Crowder AT, Stackle ME, Talley MJ, Lurie KG. J. Trauma Acute Care Surg. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000003286

PMID

unavailable

Abstract

Traumatic brain injury (TBI) is associated with increased morbidity and mortality in civilian trauma and battlefield settings. TBI has been classified across a continuum of dysfunctions, with as much as 80% to 90% of cases diagnosed as mild to moderate in combat casualties. In this review, a framework is presented that focuses on the potential benefits for acute noninvasive treatment of reduced cerebral perfusion associated with mild TBI by harnessing the natural transfer of negative intrathoracic pressure during inspiration. This process is known as intrathoracic pressure regulation (IPR) therapy which can be applied by having a patient breath against a small inspiratory resistance created by an impedance threshold device. IPR therapy leverages two fundamental principles for improving blood flow to the brain: 1) greater negative intrathoracic pressure enhances venous return, cardiac output and arterial blood pressure, and 2) lowering of intracranial pressure provides less resistance to cerebral blood flow. These two effects work together to produce a greater pressure gradient that results in an improvement in cerebral perfusion pressure. In this way, IPR therapy has the potential to counter hypotension and hypoxia, potentially significant contributing factors to secondary brain injury, particularly in conditions of polytrauma that include severe hemorrhage. By implementing IPR therapy in patients with mild to moderate TBI, a potential exists to provide early neuroprotection at the point-of-injury, and a bridge to more definitive care, particularly in settings of prolonged delays in evacuation such as those anticipated in future multi-domain operations.

Language: en