IPPB vs. EzPap

Ruby Bueno, Michael Cua, Sherria Miller, Myaa Smith, and Subrina Vohra Lonestar-Kingwood College respiratory Care Program Respiratory Care 2243-22001 Facilitator: Elizabeth Kelley Buzbee, AAS-RRT-NPS, RCP

Abstract

We conducted our study on 10 healthy individuals. The data we gathered included our study participants vital signs, tidal volumes, and peak flows. Each participant first used the IPPB and then the EzPap. Then we compared their peak flows after each use. One of our limitations was that we conducted our research on healthy participants. Each participant did not show that much of a change in percentage. We believe if the study had been conducted on participants with lung disorders there would have been a true comparison.

Hypothesis

IPPB will increase peak flow results when compared to EZPAP treatments in healthy adults.

IPPB

IPPB Background

IPPB is indicated for the need to improve lung expansion. Patients who cannot cooperate to therapy are also candidates for IPPB(AARC,2003). IPPB is also indicated for patients who have the inability to clear secretions due to a certain disease that severely limit themselves to ventilate or cough on their own (AARC,2003). IPPB is also indicated to deliver aerosol medication (AARC,2003). In a healthy person, it can cause barotrauma or pneumothorax, physiological dependence, nosocomial infections, hypocarbia, hypo- or hyper- ventilation, increased mismatch of ventilation or perfusion and gastric distention (AARC, 2003).

EZPAP

EZPAP Background

EZPAP is indicated to treat, prevent and reverse atelectasis. It is also used to mobilize retained secretions, reduce air trapping and is used as an aerosol medication delivery device adjunct.

Methodology

1 . EZPAP

 Positive Airway Pressure Device 1. Ambient Air Inlet 2. Gas Inlet Port 3. Pressure Monitoring Port with Cap  Patient interface – mouthpiece  7 foot O2 tubing to connect gas inlet port to wall flow meter  Intended use: EzPap is indicated for use in conjunction with a medical need for lung expansion therapy and the treatment and prevention of atelectasis. EzPap may be used with nebulizer between patient and device. EzPap is also available with various mask sizes.

Methodology cont.

 Set up: Connect one end of tubing to a 0 -15 lpm flow meter that is connected to 50-60 psi medical air. Connect the patient end of tubing coming from the flow meter to the device’s gas inlet port. Connect the device pressure port to a pressure gauge. This is recommended for initial set-up to become aware of pressures transmitted to the patient. If pressure monitoring is not being done, seal port with attached pressure monitoring port cap. Pressure monitoring port should not be exposed to ambient air while in use. Attach the mouthpiece to rounded end of the device. Serrated end is to be exposed to ambient air at all times. DO NOT OCCLUDE.

 Manufacturer: Smiths Medical ASD Inc 10 Bowman Drive Keene, NH 03431 USA www.smiths-medical.com

Methodology cont.

2. IPPB (BIRD MARK 7)

 Bird Mark 7 - have two connections on the right side of the machine (the pressure side): a large-bore connection for the main breathing hose and one small connection for a single drive line. This line splits at the nebulizer to power both the nebulizer and the exhalation valve. A splitting device fits over the connection on the nebulizer. The drive line connects to this device, and the short piece of tubing connects to  Positive Airway Pressure Device 1. Ambient Chamber 2. Gas source inlet

Methodology cont.

 Pressure Manometer  IPPB Machine is connected to a 50 psig gas source with high-pressure hose.

 Set up: IPPB BIRD 7 machines have a connection for the large-bore tubing, which is usually attached before being packaged, and a connection on the nebulizer for the line splitter. Attach the tubing to the appropriate connections on the respirator, making sure all connections are tight. The connections and tubing are sized so that only the correct tubing will fit on the connector. Attach the tubing to the nebulizer and exhalation valve assembly. Again the tubing and connections are sized to prevent incorrect assembly. The small drive line is attached to the line splitter. The short piece of tubing on the line splitter connects to the exhalation valve. Attach the patient connection to the nebulizer assembly. Most disposable circuits come with a six-inch length of large-bore tubing which provides a reservoir for medication and connects the mouthpiece or other device to the nebulizer.  Manufacturer: Bird Products Corporation 1100 Bird Center Drive Palm Springs, CA, 92262

Methodology cont.

3. PEAK FLOW (Respironics Personal Best Peak Flow Meter)

 A peak flow measures how fast air flows from your lungs. It's a small device that you are able to hold in your hand. It's also portable so it can be used for bedside. The peak flow meter is known to assist in the management of the asthmatic patients. If any changes are needed with their medications, then monitoring the patient's peak flow measurements would not be a useful tool.

 Available in both full range (60 – 810 l/min) and low range (50 – 390 l/min).  Manufacturer: Respironics Houston (RIHS) 3605 Willowbend, Suite 500 Houston, TX 77054

Methodology cont.

Protocol (Experiment) for Methodology  After obtaining informed consent, explaining the procedure to the test subject, performing a physical exam with a complete medical history, and getting approval from the institutional review board, we then conducted our research.

 Subject Selection: 1. No specific age. Adults only 2. Healthy adults of both sexes 3. Subjects were selectively chosen from a small population, rural college and the local community.

4. Subjects were selected on health only. Anyone was able to participate as long as they were healthy adults without any major health restrictions. If the subject had any condition that could complicate their health or the study, he/she was eliminated from the study.

Methodology cont.

 Prevented disconnection of equipment during usage, made sure all tubing and connections were securely attached.

 Projected times: 1. Explained procedures, answered questions and signed consents – 15 minutes 2. Pt filled out questionnaire – 10 minutes 3. Vital signs and peak flows were done – 5 minutes 4. IPPB performed – 10 breath cycles for 1 to 2 minutes 5. There was a 1 minute break 6. Checked Peak flows and documented – 2 minutes 7. There was a 5 minute break between each equipment use 8. EZ Pap performed – 10 breath cycles for 1 to 2 minutes 9. There was a 1 minute break 10. Checked Peak flows and documented – 2 minutes  Aseptic technique was used between each equipment use and in between each patient.

 There were disposable bacterial filters and tubing for the EZ Pap and IPPB machine.

Patient Code Z008 Z009 Z010 Z011 Z001 Z002 Z003 Z004 Z005 Z006 Z007 IPPB Peak Flow Results n/a 300 470 375 475 350 330 475 385 280 340 EzPap n/a 300 470 355 460 400 330 345 410 270 300 Percent (%) Change -3.16

14.29

0 -27.37

6.49

-3.57

-11.76

n/a 0 0 -5.33

Patient Code Z001 Z002 Z003 Z004 Z005 Z006 Z007 Z008 Z009 Z010 Z011 AVERAGE (MEAN) RANGE MEDIAN Expected PF 1st PF Peak Flow 2nd PF 3rd PF 638 448 375 385 565 385 386 n/a 497 622 469 477 375-638 458.5

460 360 320 350 375 275 300 n/a 334 450 340 356.4

275-460 345 475 390 320 290 430 280 325 n/a 320 480 330 364 280-480 327.5

490 400 320 350 430 290 300 n/a 310 470 360 372 290-490 355 IPPB Peak Flow Results EzPap 475 350 330 475 385 280 340 n/a 300 470 375 378 280-475 362.5

460 400 330 345 410 270 300 n/a 300 470 355 364 270-470 350

500 450 400 350 300 250 200 150 100 50 0 0 Patient Code 0 0 475 460 Z001 350 400 330 330 Z002 Z003 475 345 Z004 385 410 Z005 280 270 Z006 340 300 300 300 Z007 0 0 Z008 Z009 470 470 Z010 375 355 Z011

Limitations



Money



Time



Unhealthy patients

Recommendations We would like a research group to mimic our study on patients:



With COPD



With Asthma



After bronchodilator treatments

Conclusion

Based on the results from our research, we found that IPPB improved peak flows more than EzPap. With the patients that we

h

ave chosen, the difference was very minimal.

Glossary

         AARC – American Association of Respiratory Care Acapella – A small PEP device that helps to mobilize secretions by providing positive expiratory pressure (PEP) therapy and airway vibrations.

Alveoli – any of the small thin-walled air-containing compartments of the lung that are typically arranged in saclike clusters into which an alveolar duct terminates and from which respiratory gases are exchanged with the pulmonary capillaries Ambulatory – Refers to the ability to walk.

Asthmatic – A chronic respiratory disease, in which the airways unexpectedly and suddenly narrow Atelectasis – collapse of the expanded lung; defective expansion of the pulmonary alveoli Auscultation – Listening for sounds within the body, especially from the chest, neck, or abdomen. A stethoscope is typically used.

Barotrauma – Injury caused by increased air or water or pressure Bronchodilator – A drug that expands he bronchi by relaxing bronchial muscles.

Glossary cont.

        COPD- (chronic obstructive pulmonary disease) a progressive lung disease process characterized by difficulty breathing, wheezing, and a chronic cough CPT Chest physiotherapy; technique used to mobilize or loose secretions in the lungs and respiratory tract.

Dyspnea-Air hunger resulting in labored breathing or difficult breathing, sometime accompanied by pain EKG (Electrocardiogram) – A record of the electrical activity of the heart consisting of waves called P, Q, R, S, T and sometimes U.

Emesis – Vomiting. It may be of gastric, systemic, or neurological origin.

Exacerbation-Worsening or a “flare up” of COPD Fistula- an abnormal connection between two organs, or between an organ and the outside of the body Gastric-Stomach

Glossary cont.

          Hemoptysis-Blood spitting, the act of coughing up blood Hypercapnia – An increase in the partial pressure of carbon dioxide in the blood, typically to levels greater than 45-50 mmHg.

Hyperoxia-An excess of oxygen in the system Hyperventilation – Excessive ventilation; excessive rate and depth of respirations leading to loss of carbon dioxide from the blood Hypocarbia - Less than normal level of carbon dioxide in the blood. Hypoventilation- deficient ventilation of the lungs that results in reduction in the oxygen content or increase in the carbon dioxide content of the blood or both Hypoxemia-A deficiency in the concentration of dissolved oxygen in arterial blood Infiltrates- Allowing dirt and water to enter into something Infiltrates- Allowing dirt and water to enter into something Intracranial pressure- Pressure of the cerebrospinal fluid in the head with sensor inserted through the skull

Glossary cont.

        Intubation-The insertion of a tube into any hollow organ. Intubation of the trachea provides an open airway and thus is an essential step in advanced life support.

IPPB- Intermittent positive pressure ventilation IS – (incentive spirometry); also referred to as sustained maximal inspiration (SMI), is a component of bronchial hygiene therapy Kyphoscoliosis- Lateral curvature of the spine accompanied by the anterioposterior hump.

MDI- ( metered dose inhaler)small aerosol canister in a plastic container that releases a mist of medication when pressed down from the top. This medication can be breathed into the airways Mechanical ventilation-Artificially inflating and deflating the lungs to force gas exchange in the lungs Nebulizer-An apparatus for producing a fine spray or mist. This may be done by rapidly passing air through a liquid or by vibrating a liquid at a high frequency so that the particles produced are extremely small.

Neuromuscular-Concerning both nerves and muscles

Glossary cont.

        Nosocomial infections-Any infection that first occur during a patient’s stay at a health-care facility, regardless of whether it was detected during or after the stay.

NPPV (non-invasive positive pressure ventilation); refers to delivery of ventilatory support using a mechanical ventilator connected to a mask or mouthpiece instead of an endotracheal tube.

Peak Flow-A peak flow meter is a small, hand-held device used to manage asthma by monitoring airflow through the lungs PEEP Positive end expiratory pressure; term used in mechanical ventilation to denote the amount of pressure above atmospheric pressure present in the airway at the end of the expiratory cycle PEP – Positive Expiratory Pressure Perfusion- An act of perfusing the pumping of a fluid through an organ or tissue Pneumothorax- accumulation of air or gas in the pleural cavity . Pneumatically-Powered by compressed air

Glossary cont.

       Spirometer- A spirometer is an instrument for measuring the volume of air inspired and expired by the lungs.

Sputum – Mucus expelled from the lung by coughing. It may contain a variety of materials from the respiratory tract, including in some instances cellular debris, mucus, blood, pus, caseous material and/or microorganisms.

Stethoscope – An instrument used to transmit o the examiners ears sounds produced in the body. It ordinarily consists of rubber tubing in a Y shape and a bell or diaphragm.

TB (tuberculosis)-A disease caused by the bacterium Mycobacterium tuberculosis that usually causes an infection of the lungs.

Venous- Venous blood is blood returning to the heart in veins.

Ventilation- The movement of air into and out of the lung Wheezing- A wheeze is a continuous, coarse, whistling sound produced in the respiratory airways during breathing Infiltrates- Allowing dirt and water to enter into something

Bibliography

AARC. (2003).AARC clinical practice guideline: intermittent positive pressure breathing-2003 revision and update.

Respiratory Care,

48(5), 540-546.

AARC. (1993). AARC clinical practice guidelines: use of positive airway pressure adjuncts to bronchial hygiene therapy.

Respiratory Care,

38(5), 516-521.

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van der Scahans, Cees P.(2007) Conventional chest physical therapy for obstructive lung disease.

Respiratory Care,

52(9), 1198-1208 Taber, Clarence Wilbur. (2005). Taber’s cyclopedic medical dictionary (Ed. 20). Philadelphia: Davis Co.

THE END