03: IPPB Flashcards
Define IPPB
Intermittent positive pressure breathing
Goals of IPPB
#1 short term vent support Lung expansion Deliver aerosol (pt w muscle fatigue)
Indications for IPPB
#1 true: increase ventilation in pt unable to take deep breath Unsuccessful IS Prevent/treat atelectasis Inability to move secretions/cough Alternate to mechanical ventilation Decrease dyspnea
Absolute contraindication of IPPB
Untreated tension pneumothorax
Relative contraindications for IPPB
Increased ICP Face surgery Tracheoesophogeal fistula Nausea TB Hemoptysis Hemodynamic instability Blebs (increases barotrauma)
IPPB tx hazards
#1: increased Raw and WOB Barotrauma Hyperventilation Hyperoxia O2 induced hypoventilation Decreased venous return Increased alveolar dead space Impacted secretions Increase VQ mismatch
How to minimize decreased venous return
Decrease pressure to increase ventilation
Adverse reactions to IPPB
Pneumothorax
Pulmonary edema
Patients benefitting from IPPB
Atelectasis
Neuromuscular diseases
Abnormal chest circumference -> decreased LV
IPPB effect on WOB
Decrease
IPPB effect on ventilation
Decreased dyspnea (increasing Vt) Increased oxygenation (1:2)
IPPB blood gas measurements during tx
Increased V/Q
Increased PaO2
Decreased PaCO2
N/increased pH
IPPB effect on cardiovascular function
Improved HR
Decreased venous return
IPPB order should include
Tx to be delivered
Frequency
Duration
Medication
What to monitor during IPPB therapy
Machine performance (sensitivity, peak pressure, inspiratory time, FiO2) Delivered Vt Pt response (appearance/sensorium/LOC) VS Other: skin color, sputum, ICP, CXR
Bird Mark 7 operational principles
Pneumatic Pt triggered (pressure cycled)
What is pressure cycled
Inspiration ends when pressure preset limit has been reached
Initial setting for Bird Mark 7
10-15 cmH2O
Bird Mark 7 controls
Pressure (cycle/stop) Sensitivity (trigger) Flow Air dilution Expiratory timer
Bird mark procedure
Set driving pressure (PIP) Pt triggers machine (decreasing line pressure( Gas moves to aw Preset PIP reached (gas shuts off) Inspiratory phase cycled off
Bird mark 7 trouble shoot: breath/machine wont cycle on
High pressure line -> gas source
Turn on flow
Check sensitivity -> set to autocycle -> then turn back a little
Tight seal, nose clips, etc
Bird Mark 7 troubleshoot: dizzy/finger tingle/light headedness
Pt breathing too deep: relax
Hyperventilation: slow RR
Bird Mark 7 troubleshoot: no cycle off
Check flow rate (might be too slow) Check for leaks Tight seal Check mushroom valve Nebline/cup Mainline For leaks
Birdmark troubleshoot: inhalation >1-1.5 sec
Flow too slow
Check for: small leaks, manometer pressure, air mix
Air mix 100%? Loss of air entrainment, increase flow
Bird mark troubleshoot: breath starts too easily
Sensitivity too low
Machine triggers by itself? Autocycle
Bird mark troubleshoot: no steady rise in manometer on inspiration
Pt over breathing flow
Increased set flow
What to document post IPPB
Pre/post VS
Dosage and diluent
Untoward responses
Duration
Assist mode
Only pt can trigger
Assist/control mode
Set # of bpm, but pt can trigger additional
Control mode
Triggers only at pre-set frequency
Exhalation valve
Gas only to pt on inspiration, cycles off
Passive exhalation via same circuit
Flow rate
How fast pressure limit reached
Increased flow = decreased inspiratory time
Decreased flow = increased inspiratory time
1-1.5 sec
Pressure limit
Change in LC
Decreased Lung compliance = decreased tidal volume
Increased LC = increased Vt
Too much pressure leads to
Increased alveolar dead space, barotrauma, and decreased venous return
Percent oxygen able to be delivered w bird mark
40% or 100%
Minimum delivered Vt
1/3 predicted inspiratory capacity
IC calculation
50 ml/kg of ideal body weight
Ideal body wt calculation
Males: 50 + 2.3(ht (in) - 60)
Females: 45.5 + 2.3(ht - 60)
Increased Mean Alveolar Pressure means there is a
Greater potential for decreased venous return
Factors affecting delivered FiO2
Pt LC
Set flow rate
Pressure limit
Venturi gate function
Volume cycled
Delivers certain volume then stops
Flow capability of bird mark
80 lpm in air mix
50 lpm in 100% O2
Pressure chamber
Pt filter (R on machine)
Ambient chamber
Filter (L on machine)
Optimal breathing technique (rate, I:E, insp. Hold)
6-8 bpm
1:2
3-5 seconds
Length of inspiration in pressure cycled ventilator
Determined by pre-set pressure and pt compliance?
Sensitivity control determines
Negative pressure needed to trigger inspiration
Pressure control determines
Change in lung compliance with positive pressure ventilation
Pt most prone to barotrauma
Pt with emphysematous blebs
Flow rate determines
How fast pressure limit can be reached
What entrains air in bird
Ambient chamber
Alveolar dead space causes
Decreased capillary bf return
If the sensitivity is too low the machine will
Autotrigger
Pressure manometer measures
How much pressure going to pt
How to identify leak in pressure/volume cycled ventilator
Won’t cycle off
Assess effectiveness of IPPB
Increased PEF rate Vt 1/3 predicted vol Improved cough/secretion clearance Reduced dyspnea Improved oxygenation
