1. Intermittent Positive Pressure Breathing (IPPB)
RET 2275L
Respiratory Therapy Theory Lab 2
Module 3.0

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

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

4. 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

5. IPPB Indications (AARC)
Short-term nonivasive ventilatory support for hypercapnic patients
Alternative to intubation and continuous ventilatory support

6. IPPB Indications (AARC) The need to deliver aerosol medication
When MDI or nebulizer has been unsuccessful
Patients with ventilatory muscle weakness or fatigue

7. IPPB Contraindications (AARC) Tension pneumothorax ICP > 15 mm Hg
________________________________________
ICP > 15 mm Hg
Hemodynamic instability
Recent facial, oral or skull surgery

8. IPPB Contraindications (AARC) Tracheoesophageal fistula
Recent esophageal surgery
Active hemoptysis
Nausea
Air swallowing

9. IPPB Contraindications (AARC) Active, untreated TB
Radiographic evidence of bleb
Singulus (hiccups)

10. IPPB Hazards (AARC) Increase airway resistance (Raw)
Barotrauma, pneumothorax
Nosocomial infection
Hyperventilation (hypocapnia)
Hemoptysis

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

12. IPPB Hazards (AARC) Exacerbation of hypoxemia Hypoventilation
Increased V/Q mismatch
Air trapping, auto peep, overdistended alveoli

13. IPPB Potential Outcomes Improved IC or VC Increased FEV1 or peak flow
Enhanced cough or secretion clearance
Improved Chest radiograph
Improved breath sounds

14. IPPB Potential Outcomes Improved oxygenation
Favorable patient subjective response

15. IPPB Baseline Assessment Vital signs
Patient’s appearance and sensorium
Breathing pattern
Breath sounds

16. IPPB Implementation Infection control Equipment preparation
Pressure check machine/circuit
Patient orientation
Why MD ordered therapy
What treatment does
How it feels
Expected results

17. IPPB Implementation Application Mouthpiece / nose clip (initially)
Mouthseal
Mask
Trach adaptor

18. 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

19. 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

20. 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

21. IPPB Discontinuation and Follow-Up
Treatments typically last minutes
Repeat patient assessment
Identify untoward effects
Evaluate progress
Document

22. IPPB
Next Week?

23. La Maquina !

24. 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

25. IPPB – Bird Series Inspiratory Flow Rate Sensitivity Control
Pressure Control
Air Dilution
Expiratory Timer

26. Mainstream Hose Connection
IPPB – Bird Series
Center Body
Gas Source Inlet
Ambient Chamber
Pressure Chamber
Mainstream Hose Connection
Hand Timer
Nebulizer / Exhalation Valve Connection
Pressure Manometer

27. IPPB – Bird Circuit Holder Nebulizer/Exhalation Valve Drive Line
Reservoir Tube
Mouthpiece
Exhalation Valve
Main Flow Tube
Nebulizer
Manifold

28. IPPB – Bird Circuit
Inhalation

29. IPPB – Bird Circuit
Exhalation

30. IPPB: Puritan Bennett PR Series
PR PR-2

31. 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

32. IPPB: Puritan Bennett PR Series

33. IPPB PR - 1 Controls / Parts
Control Pressure Manometer
System Pressure Manometer
Sensitivity
Hook
Rate
Pressure
Gas Source Inlet
Filter
Air Dilution
Inspiratory Nebulization
Bennett Valve
Continuous Nebulization
Main Flow Connection
Expiratory Valve Connection
Nebulizer Connection

34. IPPB PR - 1 Controls / Parts
Handout

35. IPPB PR - 2 Controls / Parts
Control Pressure Manometer
System Pressure Manometer
Terminal Flow
Sensitivity
Expiratory Timer
Hook
Rate
Pressure
Gas Source Inlet
Filter
Air Dilution
Negative Pressure
Negative Pressure Connection
Inspiratory Nebulization
Bennett Valve
Continuous Nebulization
Main Flow Connection
Expiratory Valve Connection
Nebulizer Connection
Peak Flow

36. IPPB PR - 2 Controls / Parts
Handout

37. IPPB: Puritan Bennett AP Series
Electrically Powered
Pressure limited
Only patient triggered
AP- 4
AP - 5

38. IPPB: Puritan Bennett Circuit