Abstract
Background: An impedance threshold device (ITD) has been found to enhance circulation during CPR by increasing cardiac preload. Additionally, in the spontaneously breathing patient, the ITD has been found to create a small degree of inspiratory resistance (‐6 cm H2O at flow rate of 20L/min). Hypothesis: We sought to determine the effects of the ITD on awake patients with hypotension presenting to the emergency department. We hypothesized that the ITD would improve blood pressure when compared to standard therapy. The main outcome measure was the systolic blood pressure (SBP) change during 10 minutes of ITD use.Methods: A convenience sample of patients with SBPs <95 mmHg were randomized in double‐blind fashion to active or sham ITDs. Patients were enrolled if they were between the ages of 18 and 70 and their hypotension was felt to be due to non‐traumatic blood loss or dehydration by the treating physician. Patients were excluded if they were experiencing shortness of breath, chest pain, failed the abbreviated mini‐mental status exam, or had predefined cardiac/pulmonary history criteria. After consent and baseline measurements, patients spontaneously breathed through a mouthpiece attached to an active or sham ITD for a 10 minute period during which vital signs and patient status were recorded.Results: 12 patients were enrolled (5 randomized to the active device, 7 to the sham device). Mean baseline SBPs were similar between groups with the active and sham devices having baseline SBPs of 84.5 mmHg (SD 5.45) and 83.67 mmHg (SD 10.02), respectively. The active ITD produced a statistically significant (p = 0.03) increase in SBP of 13.0 mmHg (SD 4.69) compared to the sham ITD, 2.33 mmHg (SD 0.58).Conclusions: In spontaneously breathing hypotensive ED patients, the ITD was well‐tolerated and increased the SBP. If these results are validated with a larger sample, the ITD may be a useful adjunct in the treatment of hypotension due to volume loss in the ED.
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