SVCC Respiratory Care

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IPPB
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IPPB Introduction

• Intermittent Positive Pressure Breathing
• Def. as the therapeutic application of
  inspiratory positive pressure to the airway

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Physiologic Effects of IPPB

• Increase in MAP - Def. as the average
  pressure applied to the lungs over a defined
  period - potential for decreased venous
  return
• Decreased work of breathing
• Manipulation of IE ratio
• Increased Vt

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Physiologic Effects (contd)

• Mechanical bronchodilation
• Collateral ventilation

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Clinical Goals of IPPB

• To improve and promote the cough mechanism
• Improve distribution of ventilation
• To deliver medication

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Indications for IPPB

• Acute or chronic hypoventilation
• Atelectasis
• Decreased cough
• Increased airway resistance
• Increased WOB
• Accumulated secretions
• Pulmonary congestion
• Cardinal indication is the inability to inspire
  adequately

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Contraindications for IPPB

• Tension pneumothorax without chest tube
• Pulmonary hemorrhage
• Active Tb
• Hyperventilation
• Increased ICP
• Decreased C.O.
• Uncooperative patient
• More economical methods

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Hazards of IPPB

• Excessive ventilation
• - decreased PaCO2 may lead to dizziness,
  loss of consciousness
• Excessive oxygenation
• Decreased cariac output
• Increased I.C.P.
• Pneumothorax
• Hemoptysis - usually due to improved cough

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Considerations for an effective IPPB Tx.

• Usually volume-oriented
• - use 10 ml/kg of ideal body weight
• Machine must be sensitive to respond to pts
  insp. effort (-2 cmH2O)
• Tight seal must be maintained between the pt. and
  the apparatus
• Suitable control pressure and flow should be
  delivered
• Patient must relax, let machine do work

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Considerations (contd)

• Nebulizer must function properly
• Vital signs before, during, after
• Monitor pt. and make necessary adjustments (pulse
  increases 20 from baseline, stop tx.)

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Basic Components of IPPB Machines

• Gas pressure source - 45 - 55 psi
• Main control valve
• Breathing circuit
• Automatic cycling control

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Bird Mark 7

• Is a pneumatically powered, assist/controller,
  and is pressure cycled
• Incorporates magnetism vs. gas pressure

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Bennett PR 2

• Is pneumatically powered, pressure limited at low
  terminal flow, time limited, patient cycled, and
  time cycled
• Has controls for adjusting sensitivity, peak
  flow, independent insp. and exp. nebulizer
  controls, terminal flow for minor leak
  compensation, and an automatic rate with adj. IE
  ratios
• Can deliver 100 or air-diluted source gas