IPPB

IPPB

1. JAMIA MILLIA ISLAMIA center for physiotherapy and rehabilitation sciences PHYSIOTHERAPY IN CARDIOPULMNARY CONDITIONS (BPT 402) Topic: INTERMITTENT POSITIVE PRESSURE BREATHING Submitted to: Dr. Jamal ALI Moiz Submitted by: Ankush BPT 4 th YEAR Roll No. 17BPT0o5

2. What is ippb ? Intermittent positive pressure breathing (IPPB) is an assisted breathing technique used to provide short term or intermittent mechanical ventilation via mouthpiece or mask for the purpose of augmenting lung expansion and delivering aerosol medication. IPPB is usually not a therapy of choice in treating lung collapse as there are other techniques that are less expensive, easy to administer and less tasking . IPPB is inspiration using a non-invasive ventilator such as the Bird and B ennett with a pressure boost. The Bird Mark 7 ventilator is a pressure cycled device convenient to use for providing IPPB as an adjunct to physiotherapy in the spontaneously breathing patient. IPPB may be applied to intubated as well as non intubated patients.

3. IPPB can be used to: Increase the volume inspiration Support weak inspiratory muscles. Assist in clearing sputum from the lungs. Ease the inspiration of large volume of air Assist in the delivery of aerosol medication ( nebulisers ). Improve the levels of oxygen and carbon dioxide in the blood Re education of paralyzed respiratory muscles.

4. Indication for IPPB: T o improve lung expansion in the presence of atelectasis when other forms of therapy (incentive spirometry, Chest Physiotherapy Technique, Deep Breathing Exercises, positive airway pressure adjuncts) have been unsuccessful. T o 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. Patient who have an acute flare-up of their breathing problem and are too weak to have an effective cough T o relieve bronchospasm as in case of acute asthma by delivering bronchodilators to the patient. In case of respiratory failure, as in patients who develops an acute exacerbation of chronic bronchitis with sputum retention and hypercapnia.

5. ASSESSMENT OF NEED for IPPB : Presence of clinically significant atelectasis. Reduced pulmonary function as evidenced by reductions in timed volumes and vital capacity ( e.g , FEV1 < 65% predicted, FVC < 70% predicted, or VC < 10 mL/kg), precluding an effective cough. Neuromuscular disorders or kyphoscoliosis with associated decreases in lung volumes and capacities. Fatigue or muscle weakness with impending respiratory failure. Presence of acute severe bronchospasm or exacerbated COPD that fails to respond to other therapy. IPPB may be indicated in patients who are at risk for the development of atelectasis and are unable or unwilling to deep breathe without assistance.

6. Procedures for IBBP using Bird mark Ventilator: Explain procedure to patient. Attach circuit corrugated tubing, expiratory valve line, and nebulizer tubing to IPPB machine. Pressure test the circuit and machine to e nsure proper function; open up nebulizer control, set inspiratory pressure level, and cycle the machine manually. Block the mouthpiece with sterile gauze or the sterile circuit package. The machine should cycle off when the preset inspiratory pressure is reached. Aseptically prepare medication as prescribed and insert in the IPPB nebulizer.

7. Purse lips around mouthpiece so air do not leak, keeping the tongue back. Breathe through the mouth only. Mask may be used if patient is unable to cooperate with mouthpiece. Inspire slowly and deeply , and pause briefly at end of inspiration and then exhale. After patient is comfortable with this technique, treatment can begin. Set sensitivity control to cycle on with patient’s inspiratory effort (usually kept minimal). Adjust inspiratory pressure to 10 – 15 cmH2O, simultaneously, assessing adequate volume by chest expansion and auscultation.

8. Adjust nebulizer controls to have medication nebulized adequately. Monitor patient throughout duration of treatment. When treatment is complete, detach circuit from IPPB machine, discard any excess solution from nebulizer, and place circuit in plastic bag at bedside for use with next treatment.

9. Fig:1, Bird mark 7 ventilator, © 2021 Wood Library-Museum of Anesthesiology (WLM),

10. Frequency for use of ippb : Critical care: Every 1 to 6 hours for IPPB as tolerated. IPPB order should be re-evaluated at least every 24 hours based on assessments during individual treatments. Acute/home care patients : Common strategies for IPPB vary from b.i.d. to q.i.d . Frequency should be determined by assessing patient response to therapy. For acute care patients , order should be re-evaluated based on patient response to therapy at least every 72 hours or with any change of patient status. Home care patients should be reevaluated/reinstructed periodically and with any change of status.

11. Contraindications for IPPB: Increased intracranial pressure. Hiccups Hemodynamic instability. Recent facial, oral, or skull surgery. Tracheoesophageal fistula. Recent oesophageal surgery. Active haemoptysis. Nausea. Active, untreated tuberculosis or other respiratory communicable disease.. Radiographic evidence of bleb.

12. LIMITATIONS OF PROCEDURE OR DEVICE : All of the mechanical effects of IPPB are short-lived, only lasting for an hour after treatment. Based on the available literature, MDI or compressor-driven nebulizers should be considered the devices of choice for aerosol therapy to COPD and stable asthma patients, not IPPB. Delivery of a therapeutic medication dose via IPPB may require as much as a tenfold increase in medication amount when compared to MDIs. Efficacy of device for ventilation and aerosol delivery is technique-dependent ( e.g , coordination, breathing pattern, selection of appropriate inspiratory flow, peak pressure, inspiratory hold).

13. Efficacy is dependent on the design of the device ( e.g , flow, volume, and pressure capability as well as aerosol output and particle size). IPPB is equipment- and labor-intensive as a method of delivery of aerosol. Limited portability, lack of instruction, and/or lack of 50-psi gas source may affect patient compliance.

14. Intermittent positive pressure breathing in the cardiac surgery setting- review BY Polastri et al.,2016: It was concluded that IPPB is used postoperatively in the cardiac surgery setting as a suitable therapeutic treatment to increase arterial partial pressure of oxygen values in subjects with pulmonary complications after cardiac surgical procedures. Major advantages of the IPPB treatment were related to reversing hypoxemia and lowering respiratory workload .

15. Summary: IPPB is an assistive breathing technique, used as an adjunct to chest physiotherapy. Can be used with invasive and non invasive ventilator, and with patient with or without spontaneous breathing. The Bird mark 7 and Bennett are most popularly used devices for IPPB. IPPB is usually not a therapy of choice as better techniques are available than this, and it has more chances of causing barotrauma to lungs.

16. References: AARC Clinical Practice Guideline Intermittent Positive Pressure Breathing—2003 Revision & Update. Massimiliano Polastri et al., 2016 Intermittent positive pressure breathing in the cardiac surgery setting: A review International Journal of Therapy and Rehabilitation, December 2016, Vol 23, No 12. Cash textbook of physiotherapy in cardiopulmonary conditions.

17. Thankyou!! any query?