Improving vital organs perfusion by the respiratory pump: Physiology and clinical use

N. Segal, D. Yannopoulos, J. Truchot, S. Laribi, P. Plaisance, V. A. Convertino

Research output: Contribution to journalShort surveypeer-review

3 Scopus citations


Objective: In this article, we review the effects of the respiratory pump to improve vital organ perfusion by the use of an inspiratory threshold device. Data sources: Medline and MeSH database. Study selection: All papers with a level of proof of I to III have been used. Data extraction: The analysis of the papers has focused on the physiological modifications induced by intrathoracic pressure regulation. Data synthesis: Primary function of breathing is to provide gas exchange. Studies of the mechanisms involved in animals and humans provide the physiological underpinnings for "the other side of breathing": to increase circulation to the heart and brain. We describe studies that focus on the fundamental relationship between the generation of negative intrathoracic pressure during inspiration through a low-level of resistance created by an impedance threshold device and the physiologic effects of a respiratory pump. A decrease in intrathoracic pressure during inspiration through a fixed resistance resulting in an intrathoracic pressure of -7 cmH2O has multiple physiological benefits including: enhanced venous return, cardiac stroke volume and aortic blood pressure; lower intracranial pressure; resetting of the cardiac baroreflex; elevated cerebral blood flow oscillations and increased tissue blood flow/pressure gradient. Conclusion: The clinical and animal studies support the use of the intrathoracic pump to treat different clinical conditions: hemorrhagic shock, orthostatic hypotension, septic shock, and cardiac arrest.

Original languageEnglish (US)
Pages (from-to)572-579
Number of pages8
JournalAnnales Francaises d'Anesthesie et de Reanimation
Issue number9
StatePublished - Sep 2013

Bibliographical note

Copyright 2013 Elsevier B.V., All rights reserved.


  • Cardiac arrest
  • Cardiovascular collapse
  • Hemorrhagic shock
  • Impedance threshold device
  • Intrathoracic pressure
  • Resuscitation


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