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 ICP > 15 mm Hg ________________________________________ 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 Inspiratory Flow Rate Sensitivity Control Pressure Control Air Dilution Expiratory Timer

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

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

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 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

IPPB PR - 1 Controls / Parts Handout

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

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