IPV Therapy – Flashcards
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chest physical therapy administered to the airways by a pneumatic device called the percussinator.
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IPV (Intrapulmonary percussive ventilation)
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Delivered into the lungs at between 100-300 bpm.
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Rate of Gas
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mouth piece, mask, or inline during mechanical ventilation
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Delivery
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When button is held down, the lungs are percussed mixing o2, co2, and nitrogen with a medicated mist. When released it allows exhalation, cough, or expectorate
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Thumb button
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allows the delivery of medications (vasoconstrictors, bronchodilators, and mucokinetics) to promote bronchial hygiene, reduce edema, and decrease bronchoconstriction.
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Advantages of aerosol
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Racemic Epinephrine (in a 2.25% aqueous concentration, one half cc, is diluted with 20 cc water)
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Medication used
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reduce the adhesive and cohesive forces of retained airway secretions, decreases swelling within the walls of the pulmonary airways and relaxes potential spasm of the terminal bronchioles of the lungs
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Alpha/Beta aerosols
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The greater the mechanical efficacy of secretion mobilization, the less physiological effort the patient has to exert to raise endobronchial secretions.
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Statement of Purpose
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Sputum (DECREASE), Spasm (INCREASE), Swelling (INCREASE), Collapse (DECREASE), Hyperinflation (INCREASE)
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Altering FRC
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Autocephalad Flow. Force is directly proportional to the velocity of the gas. If this airflow velocity is maintained and EXCEEDS THE COHESIVE AND/OR THE ADHESIVE FORCES, the mucus will move in the direction of gas flow.
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Bias Flow Pattern
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delivers the pulsed gas to the phasitron. volume is controlled by adjusting the system pressure (between 25-40 psi) pressure increases, volume increases. Frequency is controlled by the impact control on the IPV-1C between 100-300 pulses per minute.
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Percussionator
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vary from 1:1.5 (higher frequencies) to 1:3 (lower frequencies)
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I:E ratios
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provides a mechanical and pneumatic interface between the percussionator and the patient's airway. During delivery of pulsed gas flow, gas pressure is applied to an orificed diaphragm. As pressure is applied the venturi is moved forward closing the exhalation port.
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Phasitron
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Entrains room air through the entrainment port at a ratio of 1:5 (source gas to ambient air.)
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Venturi
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Aerosol Therapy, Chest physiotherapy, IPPB, mechanical chest thumpers, squeezers, and vibrators, upper airway secretion mobilization, bi level breathing devices, CPAP, postural drainage
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Features of IPV
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Acute: cardiopulmonary shock (fluid mgmt), COPD (Prevent mech vent) smoke inhalation or pulmonary burns, aspiration of irritants, CHF, Asthma, atelectasis, pneumonia, Infants with BPD, Meconium. Chronic: Cystic Fibrosis, Bronchitis, bronchiectasis, neuromuscular disease, fibrotic disease, refractory hypoxemia
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Who will benefit from IPV
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Any COPD pt who continues to smoke, excess alcohol and drugs, malnourished, negative personality, no exercise, no daily activity record, family stress or lassitude. Any patient who is non-compliant
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Who will not benefit from IPV
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prevention/reversal of atelectasis, retained secretions, expected increase in pulmonary secretions secondary to injury or pathophysiology
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Indications
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Absolute: untreated pneumothorax. Relative: bullous emphysema, acute intracranial event, intra-occular surgery, head trauma, repair of tracheoesophageal tear, hemoptysis, hemodynamic instability, nausea, active TB
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Contraindications
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Hyperventilation, pneumothorax, impedance of venous return leading to decreased cardiac output, increased intracranial and/or intraoccular pressure, gastric insufflation, hemoptysis, hypoxemia, air trapping, auto PEEP, overdistention of alveoli
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Hazards
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Suitable for mgmt of pts with cardiopulmonary disease in which secretion mobilization is desirable. An Acute care IPV ventilator
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IPV-1C
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Most complex. Advanced post-surgical model intended for acute care use. Has the most control features giving the practitioner more flexibility.
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IPV-2
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on/off valve on the IPV 2, in the on position it allows the RT to deliver IPV therapy or IPV therapy with continuous positive airway pressure (CPAP). In the off position it delivers aerosolized medication with CPAP
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Master Switch
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May be regulated during percussive ventilation. The control regulates the flow of gas going out of the oscillator cartridge. Has the effect of reducing the percussive amplitude by modulating the output of the oscillator cartidge
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Inspiratory Flow
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Controls the rate of inspiratory pressure rise during pulsed gas delivery. Consists of a needle valve downstream from the oscillator
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Inspiratory Time
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controls the frequency of pulsed gas delivery to the Phasitron (between 100-300 cycles per minute)
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Frequency Control
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A pressure reducing valve that determines the impact velocity of the percussive pulses. Pressures are adjustable between 20-50 psi on the IPV-2. 30 psi is recommended to start Located on the side panel behind hinged door
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Source Pressure
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Allows the RT to vary the output of the nebulizer in the patient circuit. A needle valve controls the flow of gas to the nebulizer
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Nebulizer
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An adjustable regulator used to provide CPAP during oscillatory or demand ventilation. (between 0-30 cm h2o)
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Demand CPAP control
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Located on the front panel to manually trigger the ventilator into the oscillatory mode. Provided in the event the ventilator is used for CPR effors
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Manual Inspiration
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Available on the IPV-1C controls the frequency of the pulsed gas delivery to the Phasitron (100-300 cycles per minute)
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Impact Control
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Connect breathing circuit, install medication in aerosol generator (1 CC NEEDED FOR EVERY MINUTE OF TREATMENT), Rotate percussion control knob with the index under the 12:00 top position, confirm and activate the 35-60 psig source of air or o2, select operating pressure between 20-40 psig 25 to start, check functionality, start tx with breath mist for 1 min.
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Setup
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Use SIMV or CPAP mode. Assist-control/CMV mode is not recommended. Turning the pressure support off is recommended.
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Ventilator
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Aersol given at 15 LPM (1cc/min). Percussion given half of treatment time, increased as tolerated, tight seal not needed with mask but may need to increase delivery pressure, give o2 between 40-50%, start percussive range at 12:00 and rotate. Extra pressure relief valve recommended on trach patient. ON TUBED PATIENT, DEFLATE THE CUFF SLIGHTLY TO PREVENT PULLING OF SECRETIONS BELOW CUFF. Device not gravity dependent
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Important Issues
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Lube connections on weekly basis, disassemble phasitron to clean, may sterilize or wipe down, calibrate yearly, overhaul every 3 years
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Maintenance
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Increased sputum production, improved breath sounds, improved lung and chest wall mechanics (compliance and resistance), resolution of lung infiltrates and atelectasis as shown in xray
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Clinical outcomes
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Positive pressure insp. max, minimal rates, patient and seal dependent, minimal airway support, pressure barotrauma risk, minimal aerosol deposition
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IPPB
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Step inflation pressure splint, percussive rate max-200, patient and seal semidependent, maximal airway support, minimal barotrauma risk, maximum aerosol deposition.
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IPV
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IPV is most effective to reduce airway congestion, increases pulm. perfusion and improves oxygenation by splinting airway, little effect on hemodynamics, mini bursts on insp. and exp. IPV IS AS EFFECTIVE AS CPT, FLUTTER OR CHEST VEST THERAPY IN IMPROVING ACUTE PULM. FUNCTION AND ENHANCING SPUTUM EXPECTORATION, more clinically important improvement in atelectasis than CPT.
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