Intermittent Positive Pressure Breathing (IPPB)

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 • 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 15-20 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. 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 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-1PR-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