What is IPPB
the application of inspiratory positive pressure to a spontaneously breathing patient in an intermittent or short term therapeutic modality.
When is IPPB used?
When a patient has atelectasis and incentive spirometry is not working
What pulmonary function data supports the use of IPPB?
- Decreased lung volumes as evidenced by FEV1 less than 65% of predicted
- If the IC is less than 70% of predicted
- If the vital capacity is less than 10 ml/kg
What happens to the alveoli in IPPB?
they increase in size due to positive pressure
What triggers the IPPB?
The patient triggers by inhaling, then pressure and flow move into the patient’s lungs from the device
What is the limit in IPPB?
IPPB is pressure limited
When does expiration start?
when preset pressure limit has been set, the flow stops and patient can exhale
What should the trigger sensitivity be set at?
-2 to -5 cmH2O
How is the flow rate set?
by observation- watch the pressure gauge and talk to the patient
How is the pressure set?
according to the prescribed tidal volume goal based on 10 to 15 ml/kg of ideal body weight but generally should be BELOW 20 cmH2O
Can IPPB be used to deliver aerosolized medicine?
yes
Can IPPB be used with ET tube or tracheostomy?
yes
Can IPPB be used with a mouthpiece?
yes
Can IPPB be used with a mask?
yes
What should you verify before beginning treatment?
physicians orders, review chest x-ray and written report, do a general patient assessment (vitals, chest exam)
What information should you give to the patient before initiating treatment?
why the doctor ordered it, what it does, how it feels, what the expected result should be. You should also demonstrate to patient
In what position should the patient be positioned to receive IPPB?
either high fowlers (sitting up) or semi fowlers
Can you set the respiratory rate for IPPB?
Yes. It should be set at 6 breaths per minute
What should the I:E ratio be when giving IPPB?
1:3 or 1:4
List at list 5 expected IPPB outcomes
- improvement in vital capacity
- increased FEV1
- enhanced cough and secretion clearance
- improved chest x-ray
- improved breath sounds
- improved oxygenation
- favorable patient subjective response
What are contraindications for IPPB?
- tension pneumothorax
- ICP over 15 mmHG
- Hemodynamic instability
- active hemoptysis
- tracheoesophageal fistula
- recent espophagea, facial, skull or oral surgery
- active untreated TB
- xray evidence of blebs
- hiccups (singulus)
- Nausea or air swallowing
What are hazards and complications of IPPB?
- Increased airway resistance
- Pulmonary barotrauma
- nosocomial infection
- hyperoxia (when O2 is used as gas source)
- impaired venous return (resulting in increased ICP)
- gastric distention
- air trapping, autopeep
- psychological dependence
How do you increase the e time?
by increasing the flow
How do you increase the I time?
by decreasing the flow
