Intermittent Positive Pressure Breathing (IPPB)

RET 2275L

Respiratory Therapy Theory Lab 2

Module 3.0

IPPB

Definition

The application of inspiratory positive pressure to a spontaneously breathing patient as an intermittent or short-term therapeutic modality

IPPB

Definition

The delivery of a slow deep sustained inspiration by a mechanical device providing controlled positive pressure breath during inspiration

IPPB

Indications (AARC)

The need to improve lung expansion Treatment of atelectasis not responsive to other

therapies, (e.g., IS and CPT) Inability to clear secretions adequately

Limited ventilation Ineffective cough

IPPB

Indications (AARC)

Short-term nonivasive ventilatory support for hypercapnic patients Alternative to intubation and continuous

ventilatory support

IPPB

Indications (AARC)

The need to deliver aerosol medication When MDI or nebulizer has been unsuccessful Patients with ventilatory muscle weakness or

fatigue

IPPB

Contraindications (AARC)

Tension pneumothorax

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ICP > 15 mm Hg Hemodynamic instability Recent facial, oral or skull surgery

IPPB

Contraindications (AARC)

Tracheoesophageal fistula Recent esophageal surgery Active hemoptysis Nausea Air swallowing

IPPB

Contraindications (AARC)

Active, untreated TB Radiographic evidence of bleb Singulus (hiccups)

IPPB

Hazards (AARC)

Increase airway resistance (Raw) Barotrauma, pneumothorax Nosocomial infection Hyperventilation (hypocapnia) Hemoptysis

IPPB

Hazards (AARC)

Hyperoxia when O2 is the gas source Gastric distention Secretion impaction (inadequate humidity) Psychological dependence Impedance of venous return

IPPB

Hazards (AARC)

Exacerbation of hypoxemia Hypoventilation Increased V/Q mismatch Air trapping, auto peep, overdistended alveoli

IPPB

Potential Outcomes

Improved IC or VC Increased FEV1 or peak flow Enhanced cough or secretion clearance Improved Chest radiograph Improved breath sounds

IPPB

Potential Outcomes

Improved oxygenation Favorable patient subjective response

IPPB

Baseline Assessment

Vital signs Patient’s appearance and sensorium Breathing pattern Breath sounds

IPPB

Implementation

Infection control Equipment preparation

Pressure check machine/circuit Patient orientation

Why MD ordered therapy What treatment does How it feels Expected results

IPPB

Implementation

Application Mouthpiece / nose clip (initially) Mouthseal Mask Trach adaptor

IPPB

Implementation

Machine settings Sensitivity of 1 – 2 cm H2O Initial pressure between 10 – 15 cm H20 Breathing pattern of 6 breaths/min I:E ration of 1:3 to 1:4 Flow and pressure will need subsequent

adjustment to patient’s needs and goal

IPPB

Implementation

When treating atelectasis Therapy should be volume-oriented Tidal volumes (VT) must be measured VT goals must be set VT goal of 10 – 15 mL/kg of body weight Pressure can be increased to reach VT goal if

tolerated by patient

IPPB

Implementation

When treating atelectasis IPPB is only useful in the treatment of atelectasis

if the volumes delivered exceeds those volumes achieved by the patient’s spontaneous efforts

IPPB

Discontinuation and Follow-Up

Treatments typically last 15-20 minutes Repeat patient assessment Identify untoward effects Evaluate progress Document

IPPB

Next Week?

La Maquina !

IPPB – Bird Series

Mark 7 Series

Pneumatically driven Can be time, pressure, or manually TRIGGERED Pressure CYCLED Can be used to provide short-term ventilatory

support Primarily used for IPPB therapy

IPPB – Bird Series

Sensitivity Control

Expiratory TimerAir Dilution

Inspiratory Flow Rate

Pressure Control

IPPB – Bird Series

Hand Timer

Pressure Manometer

Pressure Chamber

Mainstream Hose Connection

Ambient Chamber

Center Body Gas Source Inlet

Nebulizer / Exhalation Valve Connection

IPPB – Bird Circuit

Main Flow Tube

Nebulizer/Exhalation Valve Drive Line

Exhalation Valve Drive Line

Manifold

Nebulizer

Exhalation Valve

Holder

Reservoir Tube

Mouthpiece

IPPB – Bird Circuit

Inhalation

IPPB – Bird Circuit

Exhalation

IPPB: Puritan Bennett PR Series

PR-1 PR-2

IPPB: Puritan Bennett PR Series

PR-1 and PR-2 Pneumatically driven Can be time, pressure, or manually TRIGGERED Flow CYCLED, pressure limited Can be used to provide short-term ventilatory

support Primarily used for IPPB therapy

IPPB: Puritan Bennett PR Series

IPPB PR - 1 Controls / Parts

RatePressure

Sensitivity

Air Dilution

Continuous Nebulization

Inspiratory Nebulization

Gas Source InletFilter

Main Flow Connection

Nebulizer Connection

Expiratory Valve Connection

Bennett Valve

Hook

System Pressure Manometer

Control Pressure Manometer

IPPB PR - 1 Controls / Parts

Handout

IPPB PR - 2 Controls / Parts

RatePressure

Sensitivity

Air Dilution

Continuous Nebulization

Inspiratory Nebulization

Gas Source InletFilter

Main Flow Connection

Nebulizer Connection

Expiratory Valve Connection

Bennett Valve

Hook

System Pressure Manometer

Control Pressure Manometer

Expiratory Timer

Terminal Flow

Negative Pressure

Peak Flow

Negative Pressure Connection

IPPB PR - 2 Controls / Parts

Handout

IPPB: Puritan Bennett AP Series

Electrically Powered

Pressure limited

Only patient triggered

AP- 4

AP - 5

IPPB: Puritan Bennett Circuit