IPPB Therapy – Flashcards

the therapeutic application of inspiratory positive pressure to the airway of a spontaneously breathing patient

increased work of breathing hypoventilation delivering medication when a nebulizer is not effective enough inadequate cough increased airway resistance atelectasis pulmonary edema to aide in weaning from a mechanical ventilator

untreated pneumothorax (ABSOLUTE CONTRAINDICATION) tuberculosis subcutaneous emphysema hemoptysis (spitting up of blood) closed head injury- increases ICP bullous disease cardiac insufficiency COPD with air trapping uncooperative patients

hemodynamic instability (i.e. MI, hypovolemic shock) increased ICP from neurosurgery or trauma facial, oral, esophageal surgery trachesophageal fistula availablity of a cheaper, simpler therapy (ex: neb, IS, PEP)

excessive ventilation excessive oxygenation decreased cardiac output increased ICP pneumothorax hemoptysis gastric distention nosocomial infection decreased blood pressure

use a 1:2 or a 1:3 I.E. ratio to allow for enough expiratory time *during expiration, no positive pressure is applied, so this allows enough time for the heart to fill with blood*

IPPB may result in better distribution of ventilation, with gas entering poorly ventilated areas like blebs

sudden, sharp pain shortness of breath unilateral chest wall rise increased heart rate increased respiratory rate IPPB reaches pressure limit much sooner than before

excessive oxygenation of O2 sensitive patients; may knock out a patients hypoxic drive. machines are pneumatically powered and driven by oxygen so the RCP may give the patient too high of an FiO2 increased air trapping due to excessive ventilation of partially obstructed areas of lungs possibility of post treatment difficulty breathing due to an increased FRC

increased airway pressures cause an increased intrathoracic pressure, thereby impeding venous return from the brain

due to bronchial venous bleeding secondary to a tumor or blood vessel rupture increased cough effectiveness after a treatment

can occur with a normal treatment, but seen more with mask treatment occurs less with alert patients than those who are not alert

improperly cleaned equipment psychological dependence increased airway resistance from turbulent flow

assemble equipment and check machine for leaks check MD order review chart to check for contraindications wash hands ID patient connect the circuit to IPPB and plug in gas source place meds pt. assessment position pt. in an upright position; allows for better ventilation place mouthpiece in patients mouth and encourage patient to keep lips sealed tight to breathe ONLY though the mouth (use noseclips) instruct patient to sip on mouthpiece to fill the lungs until the machine cycles off. have patient hold his breath for a count of 3 before exhaling

I-pressure: start lower than the desired pressure and gradually increase as treatment continues *increase flow rate as pressure increases to maintain the same I-time*

check vitals halfway through treatment after 10 minutes or when medication is fully nebulized, have patient cough check vitals again encourage patient to cough periodically for the next 30 minutes to 2 hours as the effect of the medication peaks wash hands

a correctly administered IPPB treatment should provide the patient with a tidal volume greater than they would achieve on their own an agressive RT regimen that includes IPPB has been shown to be as effective as a therapeutic bronchoscopy in treating lobar atelectasis try to minimize high pressures, irregular I:E ratiors and excessive flows to avoid patient discomfort and unwanted side effects

should contain the following: objectives of therapy specific frequency duration medication

10-15 cmH20

1:2 or 1:3

varies according to patients needs but keep the lowest flow possible that the patient can tolerate (how fast the breath is given) to avoid hyperventilation

7-10 breaths per minute

2-4 seconds

2 seconds

4-6 seconds

machine delivered tidal volume must exceed the patients spontaneous tidal volume there should be a 25% increase in the patients tidal volume 75% of the patients present vital capacity must also deliver 10-15 mL/kg of body weight

improved breath sounds improved sputum production improved pulse ox improved ABG results improved PFT improved peak flow/slow vital capacity improved CXR favorable subjective responses