Transcript Intermittent Positive Pressure Breathing (IPPB)

Intermittent Positive
Pressure Breathing (IPPB)
RET 2275L
Respiratory Therapy Theory Lab 2
Module 3.0
IPPB
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Definition
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The application of inspiratory positive pressure
to a spontaneously breathing patient as an
intermittent or short-term therapeutic modality
IPPB
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Definition
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The delivery of a slow deep sustained
inspiration by a mechanical device providing
controlled positive pressure breath during
inspiration
IPPB
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Indications (AARC)
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The need to improve lung expansion
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Treatment of atelectasis not responsive to other
therapies, (e.g., IS and CPT)
Inability to clear secretions adequately
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Limited ventilation
Ineffective cough
IPPB
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Indications (AARC)
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Short-term nonivasive ventilatory support for
hypercapnic patients
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Alternative to intubation and continuous
ventilatory support
IPPB
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Indications (AARC)
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The need to deliver aerosol medication
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When MDI or nebulizer has been unsuccessful
Patients with ventilatory muscle weakness or
fatigue
IPPB
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Contraindications (AARC)
Tension pneumothorax
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ICP > 15 mm Hg
Hemodynamic instability
Recent facial, oral or skull surgery
IPPB
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Contraindications (AARC)
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Tracheoesophageal fistula
Recent esophageal surgery
Active hemoptysis
Nausea
Air swallowing
IPPB
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Contraindications (AARC)
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Active, untreated TB
Radiographic evidence of bleb
Singulus (hiccups)
IPPB
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Hazards (AARC)
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Increase airway resistance (Raw)
Barotrauma, pneumothorax
Nosocomial infection
Hyperventilation (hypocapnia)
Hemoptysis
IPPB
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Hazards (AARC)
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Hyperoxia when O2 is the gas source
Gastric distention
Secretion impaction (inadequate humidity)
Psychological dependence
Impedance of venous return
IPPB
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Hazards (AARC)
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Exacerbation of hypoxemia
Hypoventilation
Increased V/Q mismatch
Air trapping, auto peep, overdistended alveoli
IPPB
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Potential Outcomes
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Improved IC or VC
Increased FEV1 or peak flow
Enhanced cough or secretion clearance
Improved Chest radiograph
Improved breath sounds
IPPB
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Potential Outcomes
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Improved oxygenation
Favorable patient subjective response
IPPB
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Baseline Assessment
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Vital signs
Patient’s appearance and sensorium
Breathing pattern
Breath sounds
IPPB
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Implementation
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Infection control
Equipment preparation
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Pressure check machine/circuit
Patient orientation
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Why MD ordered therapy
What treatment does
How it feels
Expected results
IPPB
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Implementation
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Application
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Mouthpiece / nose clip (initially)
Mouthseal
Mask
Trach adaptor
IPPB
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Implementation
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Machine settings
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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
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Implementation
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When treating atelectasis
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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
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Implementation
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When treating atelectasis
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IPPB is only useful in the treatment of atelectasis
if the volumes delivered exceeds those volumes
achieved by the patient’s spontaneous efforts
IPPB
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Discontinuation and Follow-Up
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Treatments typically last 15-20 minutes
Repeat patient assessment
Identify untoward effects
Evaluate progress
Document
IPPB
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Next Week?
La Maquina !
IPPB – Bird Series
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Mark 7 Series
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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
IPPB – Bird Series
Center Body
Ambient Chamber
Gas Source Inlet
Pressure Chamber
Mainstream Hose
Connection
Hand Timer
Pressure Manometer
Nebulizer / Exhalation
Valve Connection
Holder
IPPB – Bird Circuit
Exhalation Valve
Drive Line
Reservoir
Tube
Nebulizer/Exhalation
Valve Drive Line
Mouthpiece
Exhalation
Valve
Main Flow Tube
Nebulizer
Manifold
IPPB – Bird Circuit
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Inhalation
IPPB – Bird Circuit
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Exhalation
IPPB: Puritan Bennett PR Series
PR-1
PR-2
IPPB: Puritan Bennett PR Series
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PR-1 and PR-2
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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
System Pressure
Manometer
Control Pressure
Manometer
Sensitivity
Hook
Rate
Filter
Pressure
Gas Source Inlet
Air Dilution
Bennett
Valve
Main Flow
Connection
Continuous
Nebulization
Expiratory Valve
Connection
Inspiratory
Nebulization
Nebulizer
Connection
Handout
IPPB PR - 1 Controls / Parts
IPPB PR - 2 Controls / Parts
System Pressure
Manometer
Control Pressure
Manometer
Expiratory
Timer
Terminal
Flow
Sensitivity
Hook
Rate
Pressure
Filter
Air Dilution
Negative
Pressure
Bennett
Valve
Main Flow
Connection
Continuous
Nebulization
Peak Flow
Gas Source Inlet
Negative
Inspiratory
Pressure
Connection Nebulization
Expiratory Valve
Connection
Nebulizer
Connection
Handout
IPPB PR - 2 Controls / Parts
IPPB: Puritan Bennett AP Series
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Electrically
Powered
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Pressure
limited
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Only patient
triggered
AP- 4
AP - 5
IPPB: Puritan Bennett Circuit