INTERMITTENT POSITIVE PRESSURE BREATHING (IPPB)

IPPB remains a technique used to provide shortterm or intermittent mechanical ventilation for the purpose of augmenting lung expansion, delivering aerosol medication, or assisting ventilation.

IPPB can include pressure- and time-limited, as well as pressure, time, and flow-cycled ventilation. IPPB may be delivered to artificial airways and nonintubated patients.

INDICATIONS

1.)The presence of clinically significant pulmonary atelectasis when other forms of therapy have been unsuccessful (incentive spirometry, chest physiotherapy, deep breathing exercises, positive airway pressure) or the patient cannot cooperate.

2.)Inability to clear secretions adequately because of pathology that severely limits the ability to ventilate or cough effectively and failure to respond to other modes of treatment.

3.)The need for short-term ventilatory support for patients who are hypoventilating as an alternative to tracheal intubation and continuous mechanical ventilation.

4.)IPPB may be used to deliver aerosol medications to patients with fatigue as a result of ventilatory muscle weakness (eg, failure to wean from mechanical ventilation, neuromuscular disease, kyphoscoliosis, spinal injury) or chronic conditions in which intermittent ventilatory support is indicated (eg, ventilatory support for home care patients and the more recent use of nasal IPPV for respiratory insufficiency).

5.)In patients with severe hyperinflation, IPPB may decrease dyspnea and discomfort during nebulized therapy.

CONTRAINDICATIONS:

There are several clinical situations in which IPPB should not be used. With the exception of untreated tension pneumothorax, most of these contraindications are relative:

1 Tension pneumothorax (untreated)
2 Intracranial pressure (ICP) > 15 mm Hg
3 Hemodynamic instability
4 Recent facial, oral, or skull surgery
5 Tracheoesophageal fistula
6 Recent esophageal surgery
7 Active hemoptysis
8 Nausea
9 Air swallowing
10 Active untreated tuberculosis
11 Radiographic evidence of bleb
12 Singulation (hiccups)

HAZARDS/COMPLICATIONS:

1 Increased airway resistance and work of breathing
2 Barotrauma, pneumothorax
3 Nosocomial infection
4 Hypocarbia
5 Hemoptysis
6 Hyperoxia when oxygen is the gas source
7 Gastric distention
8 Impaction of secretions (associated with inadequately humidified gas mixture)
9 Psychological dependence
10 Impedance of venous return
11 Exacerbation of hypoxemia
12 Hypoventilation or hyperventilation
13 Increased mismatch of ventilation and perfusion
14 Air trapping, auto-PEEP, overdistended alveoli