ARTP03 Positive Airwat Pressure Therapy

Question 1

What are lung expansion therapy devices used for?

Answer 1

Used to prevent or treat atelectasis

Question 2

What are the effects of atelectasis?

Answer 2

Pulmonary shunting
Hypoxemia and hypercapnia
Respiratory failure, if untreated

Question 3

Contributing factors of atelectasis

Answer 3

Retained secretions
Rapid shallow breathing
Pain associated with surgery or trauma
Chronic obstructive and restrictive pulmonary disease
Immobilization
Increased intraabdominal pressure

Question 4

IPPB

Answer 4

Intermittent positive pressure breathing

Question 5

Purposes of IPPB

Answer 5

Short term ventilatory support
Lung expansion therapy
Delivery of aerosol medication

Question 6

A few things to remember about IPPB

Answer 6

Delivers a “bigger than normal breath”

Set to a pressure, machine will shut off once that pressure is met.

The higher the pressure the higher the volume of the breath

Question 7

What is the only true indication for IPPB therapy?

Answer 7

Improvement in ventilation in a patient unable to take a deep breath

Question 8

Other indications for IPPB

Answer 8

Improved lung expansion in pt. w/ atelectasis

Inability to clear secretions in patients who cant cough effectively

Reduction in dyspnea

Can be used as an alternative to mechanical ventilation but only short term

Question 9

Absolute contraindication for IPPB

Answer 9

Untreated tension pneumothorax

Question 10

Contraindications for IPPB

Answer 10

Elevated intracranial pressure (> 15 torr)
Recent facial, oral or skull surgery
Tracheoesophageal fistula 
Recent esophogeal surgery
Nausea
Active or untreated TB
Active hemoptysis
Hemodynamic instability 
Blebs on x ray

Question 11

Hazards or IPPB

Answer 11

Increase airway resistance and WOB
Barotrauma, pneumothorax
Hypocapnia
O2 induced hypoventilation aka “knocking out hypoxic drive”
Decreased venous return
Increased V/Q mismatch
Air trapping 
Impaction of secretions
Nosocomial infection (hospital acquired infection)
Hemoptysis

Question 12

What major hazard can be caused by IPPB

Answer 12

Pneumothorax

Question 13

What can be solved with IPPB

Answer 13

Pulmonary edema

Question 14

What FiO2 is needed when trearing pulmonary edema?

Answer 14

100% FiO2

Question 15

Who needs IPPB?

Answer 15

Atelectasis
Reduced lung volume
Neuromuscular disease or abnormal chest configuration

Comatose patients
People unable to take deep breaths

Question 16

How to tell if IPPB helps

Answer 16

Increase in peak expiratory flow rate
Improved effectiveness of cough and clearance of secretions
Improved BS
minimim tidal volumes should be 1/3 predicted inspiratory capacity

Question 17

What does parasthesia mean?

Answer 17

Numbness and tingling in fingers

Question 18

Calculating IC for men and women

Answer 18

Men: 50+ (2.3[height (inches)-60])

Women: 45.5 (2.3[height (inches)-60)

Question 19

Decrease in lung compliance does what to volume?

Answer 19

Decrease in tidal volume

Question 20

Increase in ling compliance does what to volume?

Answer 20

Increase in volume

Question 21

Increased flow does what to Inspiratory time

Answer 21

Shortens Inspiratory time

Question 22

Decreased flow does what to inspiratory time?

Question 23

What should be included in A doctors order?

Answer 23

Treatment to be delivered
Medication
Frequency
Pressure or volume
Duration

Question 24

Ideal I:E ratio

Answer 24

1:2

Question 25

Physiological effects of blood gas

Answer 25

(PaO2 up
PaCO2 down
pH increase or normal)

Increase V/Q ratio
Collateral ventilation

Question 26

How is IPPB powered

Answer 26

Pneumatically powered
Patient triggered and pressure cycled

RT sets pressure limit, flow, sensitivity

Question 27

What happens once pressure limit met?

Answer 27

Cycles to exhalation