Intermittent Positive Pressure Breathing (IPPB)
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Transcript of Intermittent Positive Pressure Breathing (IPPB)
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Intermittent Positive Pressure Breathing (IPPB)
RET 2275L
Respiratory Therapy Theory Lab 2
Module 3.0
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IPPB
Definition
The application of inspiratory positive pressure to a spontaneously breathing patient as an intermittent or short-term therapeutic modality
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IPPB
Definition
The delivery of a slow deep sustained inspiration by a mechanical device providing controlled positive pressure breath during inspiration
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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
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IPPB
Indications (AARC)
Short-term nonivasive ventilatory support for hypercapnic patients Alternative to intubation and continuous
ventilatory support
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IPPB
Indications (AARC)
The need to deliver aerosol medication When MDI or nebulizer has been unsuccessful Patients with ventilatory muscle weakness or
fatigue
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IPPB
Contraindications (AARC)
Tension pneumothorax
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ICP > 15 mm Hg Hemodynamic instability Recent facial, oral or skull surgery
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IPPB
Contraindications (AARC)
Tracheoesophageal fistula Recent esophageal surgery Active hemoptysis Nausea Air swallowing
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IPPB
Contraindications (AARC)
Active, untreated TB Radiographic evidence of bleb Singulus (hiccups)
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IPPB
Hazards (AARC)
Increase airway resistance (Raw) Barotrauma, pneumothorax Nosocomial infection Hyperventilation (hypocapnia) Hemoptysis
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IPPB
Hazards (AARC)
Hyperoxia when O2 is the gas source Gastric distention Secretion impaction (inadequate humidity) Psychological dependence Impedance of venous return
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IPPB
Hazards (AARC)
Exacerbation of hypoxemia Hypoventilation Increased V/Q mismatch Air trapping, auto peep, overdistended alveoli
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IPPB
Potential Outcomes
Improved IC or VC Increased FEV1 or peak flow Enhanced cough or secretion clearance Improved Chest radiograph Improved breath sounds
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IPPB
Potential Outcomes
Improved oxygenation Favorable patient subjective response
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IPPB
Baseline Assessment
Vital signs Patient’s appearance and sensorium Breathing pattern Breath sounds
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IPPB
Implementation
Infection control Equipment preparation
Pressure check machine/circuit Patient orientation
Why MD ordered therapy What treatment does How it feels Expected results
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IPPB
Implementation
Application Mouthpiece / nose clip (initially) Mouthseal Mask Trach adaptor
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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
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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
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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
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IPPB
Discontinuation and Follow-Up
Treatments typically last 15-20 minutes Repeat patient assessment Identify untoward effects Evaluate progress Document
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IPPB
Next Week?
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La Maquina !
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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
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IPPB – Bird Series
Sensitivity Control
Expiratory TimerAir Dilution
Inspiratory Flow Rate
Pressure Control
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IPPB – Bird Series
Hand Timer
Pressure Manometer
Pressure Chamber
Mainstream Hose Connection
Ambient Chamber
Center Body Gas Source Inlet
Nebulizer / Exhalation Valve Connection
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IPPB – Bird Circuit
Main Flow Tube
Nebulizer/Exhalation Valve Drive Line
Exhalation Valve Drive Line
Manifold
Nebulizer
Exhalation Valve
Holder
Reservoir Tube
Mouthpiece
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IPPB – Bird Circuit
Inhalation
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IPPB – Bird Circuit
Exhalation
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IPPB: Puritan Bennett PR Series
PR-1 PR-2
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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
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IPPB: Puritan Bennett PR Series
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IPPB PR - 1 Controls / Parts
RatePressure
Sensitivity
Air Dilution
Continuous Nebulization
Inspiratory Nebulization
Gas Source InletFilter
Main Flow Connection
Nebulizer Connection
Expiratory Valve Connection
Bennett Valve
Hook
System Pressure Manometer
Control Pressure Manometer
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IPPB PR - 1 Controls / Parts
Handout
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IPPB PR - 2 Controls / Parts
RatePressure
Sensitivity
Air Dilution
Continuous Nebulization
Inspiratory Nebulization
Gas Source InletFilter
Main Flow Connection
Nebulizer Connection
Expiratory Valve Connection
Bennett Valve
Hook
System Pressure Manometer
Control Pressure Manometer
Expiratory Timer
Terminal Flow
Negative Pressure
Peak Flow
Negative Pressure Connection
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IPPB PR - 2 Controls / Parts
Handout
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IPPB: Puritan Bennett AP Series
Electrically Powered
Pressure limited
Only patient triggered
AP- 4
AP - 5
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IPPB: Puritan Bennett Circuit