• N Segal, D Yannopoulos, J Truchot, S Laribi, and P Plaisance.
• Service des urgences, hôpital Lariboisière, S2, rue Ambroise-Paré, 75010 Paris, France. Electronic address: nicolas.segal@lrb.aphp.fr.
• Ann Fr Anesth Reanim. 2013 Sep 1;32(9):572-9.

ObjectiveIn this article, we review the effects of the respiratory pump to improve vital organ perfusion by the use of an inspiratory threshold device.Data SourcesMedline and MeSH database.Study SelectionAll papers with a level of proof of I to III have been used.Data ExtractionThe analysis of the papers has focused on the physiological modifications induced by intrathoracic pressure regulation.Data SynthesisPrimary 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.ConclusionThe 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.Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

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