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