Intermittent positive pressure breathing

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

Contraindications

Most contraindications are relative, such as nausea, hemodynamic instability, tracheal fistula, singulation and hemoptysis. Untreated tension pneumothorax is an absolute contraindication.

When treating atelectasis:

1. Therapy should be volume-oriented
2. Tidal volumes must be measured
3. VT goals must be set (e.g. VT goal of 10-15mL/kg of body weight).
4. Pressure can be increased to reach VT goal if tolerated by patient.

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

References

References

1. (1994). "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.
2. Handelsman H. (1991). "Intermittent positive pressure breathing (IPPB) therapy". Health Technology Assessment Reports.
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5. (2001). "Critical thinking in respiratory care". McGraw-Hill.
6. (2000). "Management of dyspnea in severe chronic obstructive pulmonary disease". J Pain Symptom Manage.
7. (1980). "Intermittent positive pressure breathing: a continuing controversy". J Iowa Med Soc.
8. (1982). "Complications of mechanical aids to intermittent lung inflation". Respir Care.
9. (1999). "Egan's fundamentals of respiratory care". Mosby.