Inspiratory Impedance as a Treatment for Traumatic Brain Injury

Traumatic head and neck injuries account for 16-33% of all war-related injuries and are a leading cause of mortality upon evacuation to a definitive care setting. This application is focused on treating one of the most important determinants of outcome from severe head injury, the degree and duration of elevated intracranial pressure (ICP). The main objective of this proposal is to continue the development of the inspiratory impedance threshold device (ITD); an operationally useful and effective device initially designed to counteract the effects of severe hypotension after the development of hemorrhagic shock, heat shock, and dehydration. New research has discovered that the ITD has a marked effect on reducing ICP. When ICPs are decreased in spontaneously breathing patients during inspiration through an ITD or when using a modified ITD called an intrathoracic pressure regulator (ITPR) in non-breathing patients, the small vacuum created in the thorax enhances venous return to the heart thereby enhancing cardiac output and decreasing ICP. The successful development and deployment of a new device designed to immediately decrease elevated ICP or prevent the onset of elevated ICP following traumatic brain injury is an important advance in treating battlefield casualties, a major cause of death for American soldiers.