Intrathoracic Pressure Regulation Improves 24-Hour Survival in a Pediatric Porcine Model of Hemorrhagic Shock

Hemorrhagic shock is a common cause of mortality and morbidity in the pediatric population. Intrathoracic pressure regulation (IPR) lowers intrathoracic pressure thereby decreasing intracranial pressure and increasing venous return, cardiac output, and cerebral perfusion without the need for immediate fluid resuscitation. We hypothesized that IPR would improve hemodynamics and 24-hour survival in a pediatric porcine model of hemorrhagic shock. Twenty piglets were subjected to a 50% total blood volume hemorrhage over 15 minutes and then randomized to treatment with either IPR or no treatment. After 60 minutes, survivors were auto-transfused, weaned from the ventilator and assessed and autopsied at 24 hours. Mean arterial pressures (MAP), cardiac index (CI), and arterial blood gases were recorded. MAP (mmHg) was significantly higher in the IPR group (60.8 ± 3.7) vs. controls (41.2 ± 4.6, p