Intermittent positive pressure breathing explained

Intermittent positive pressure breathing
Synonym:	Intermittent Positive Pressure Ventilation
Specialty:	pulmonology

Intermittent positive pressure breathing (IPPB) is a respiratory therapy treatment for people who are hypoventilating. While not a preferred method due to cost,^[1] IPPB is used to expand the lungs, deliver aerosol medications, and in some circumstances ventilate the patient.^[2] __TOC__

Indications

IPPB may be indicated for patients who are at risk for developing atelectasis and who are unable or unwilling to breathe deeply without assistance.^[3] In patients with severe lung hyperinflation, IPPB may decrease dyspnea and discomfort during nebulized therapy.^[4]

Contraindications

Most contraindications are relative, such as nausea, hemodynamic instability,^[5] tracheal fistula, singulation and hemoptysis.^[6] Untreated tension pneumothorax is an absolute contraindication.^[7]

IMPLEMENTATION

When treating atelectasis -

1. Therapy should be volume-oriented

2. Tidal volumes(VT) must be measured

3. VT goals must be set

4. VT goal of 10-15mL/kg ofbody weight

5. Pressure can be increased to reach VT goal if tolerated by patient.

When treating atelectasis, IPPB is only useful in the treatment of atelectasis if the volume delivered exceeds those volumes achieved by the patient's spontaneous efforts.

Notes and References

1. Thomas JA, McIntosh JM . Are incentive spirometry, intermittent positive pressure breathing, and deep breathing exercises effective in the prevention of postoperative pulmonary complications after upper abdominal surgery? A systematic overview and meta-analysis . Phys Ther . 1994 . 74 . 1 . 3–16 . 8265725 . 10.1093/ptj/74.1.3 .
2. Handelsman H . Health Technology Assessment Reports . Intermittent positive pressure breathing (IPPB) therapy . 1991 . 1 . 1–9 . 1810351 .
3. Book: Shelledy DC, Mikles SP . Patient assessment and respiratory care plan development. . Mishoe SC, Welch MA Jr . Critical thinking in respiratory care . New York . McGraw-Hill . 2001 . 978-0-07-134474-6.
4. Janssens JP, de Muralt B, Titelion V . Management of dyspnea in severe chronic obstructive pulmonary disease . J Pain Symptom Manage . 2000 . 19 . 5 . 378–92 . 10.1016/S0885-3924(00)00129-9. 10869878 . free .
5. Schilling JP, Kasik JE . Intermittent positive pressure breathing: a continuing controversy . J Iowa Med Soc . 1980 . 70 . 3 . 99–100, 102–103 .
6. Shapiro BA, Peterson J, Carne RD . Complications of mechanical aids to intermittent lung inflation . Respir Care . 1982 . 27 . 4 . 467–70 .
7. Book: Scanlan CL, Wilkins RL, Stoller JK . Egan's fundamentals of respiratory care . 7th . St. Louis . Mosby . 1999 . 777–782 .