IPPB Intermittent Positive Pressure Breathing Flashcards by Steve Gabbs

-IIndications (Desirable Physiological Effects of IPPB) (Part 1)

-Prevent or correct atelectasis in Pt unable to take a deep breath

-Prevent or decrease pulmonary edema

-Decrease the work of breathing ( decrease accessory muscle use in COPD pt.)

-Mechanical bronchodilation

-Distribute aerosols more evEnly in airways for better deposition of medication

-Removal of airway secretions/ mobilize secretions

-Manipulation of the Inspiratory-expiratory pattern

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-IIndications (Desirable Physiological Effects of IPPB) (Part 2)

-Improve alveolar collateral ventilation

-Improve and promote the cough mechanism

-Can be used for short term ventilation. Not for long term use. CAnt monitor Pt. No humidification so PT will dry out

-Used to give alcohol treatment (VODKA TREATMENT). Used with pulmonary edema

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-IIndications (Desirable Physiological Effects of IPPB) (Part 3)

-Presence of conditions predisposing to the development of pulmonary atelectasis (Upper abdominal surgery, thoracic surgery, surgery in POT with COPD)

-Presence of restrictive lung defect associated with quadriplegia and or dysfunctional diaphragm

-Lung expansion therapy

-PTs with visual acuity (ex Blindness ir unable to make out numbers on incentive spirometer

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Contraindications

-Unskilled practitioners and users

-Massive pulmonary hemorrhage

-Untreated pneumothorax

-Dirty equipment

-Active Tuberculosis

-PTs who cannot be instructed or supervised to ensure appropriate use of device

-Pts cooperation is absent or PT is unable to understand or demonstrate proper used of the device


-Is contraindication in PT unable to deep breath effectively (e.g. with VC less than about 10ml/kg ot IC less than about one third of predicted)

-The presence of an open tracheal stoma is not a contraindication but requires adaptation of the spirometer

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Hazards of IPPB

-Hyperventilation

	-Dizziness

	-Tingling of the fingers (from excessive elimination of CO2) have Pt slow down respirations (hyperventilation)

-Impeding venous return

	-Results in decreased cardiac output

	-Increased intracranial pressure (keep pressure low)

-Gastric distention

-Pneumothorax

-excessive oxygenation and increased air trapping in COPD Pts

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Hazards of IPPB (Part 2)

-Exacerbation of bronchospasm

-Hypoxia due to break in mask 02 therapy

-Inappropriate as sole treatment for major lung collapse or consolidation

-Barotrauma (emphysematous lung)

-Fatigue

-Discomfort secondary to inadequate pain control

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Bird Mark 7

-Classification

-Positive pressure

	-Pneumatically powered

	-Time Triggered

	-PT triggered

	-Pressure cycled

	-Assist, control, and assisted control modes

	-Flow adjustable

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Bird Mark 7

Flow Rate Control

-The number on the control knob are for reference

-Turning the knob to a higher number causes a greater flow into the mainstream breathing circuit and nebulizer (decreases I time)

-The opposite occurs in the flow vontoil is turned to a lower number (increased I time)

-I/E ratio is adjustable with this control. Increasing flow will lengthen the E time. Decreasing flow will shorten the E time

-Peak flow: 0-80 liters per min (air max) Peak flow: 0-50 liters per min (air mix off)

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Bird Mark 7

Air Mix

-Air mix off

-This is the 100% source gas setting

	-Flow rates are reduced because room air is not entrained

	-Must increase flow setting when changing to 100% source gas setting, in order to meet PT demand

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Bird Mark 7

Air Mix

-Air mix on

-This setting will give a variable oxygen concentration between 40-80%. The FIO2 decreases due to room air entraining in. May have to adjust peak flow.

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Bird Mark 7

Expiratory Time control for Apnea (rate control)

–Used to time cycle the vent for PT with apnea or very low RR.

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Bird Mark 7

Pressure

-Adjustable control to limit ventilating pressure. Regulated by the distance between the magnet and the plate

-Volume is changed by adjusting the pressure limit

-Maximum pressure limit near 60 cm H2O

-Leaks in the circuit will prevent normal cycling to exhalation

-Obstruction/ Coughing would prematurely end inspiration

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Bird Mark 7

Pressure (contin)

-When initially setting the pressure set between 10-15 cm H2O. adjust until you hear bilateral breath sounds in the bases.

-Venti comp Bag is used to determine exhaled Tidal Volume

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Sensitivity (Patient Effort Control)

-Adjustable control for cycling the vent into inspiration

-The control is adjustable to allow the vent to cycle at approximately -2.0 cm H2O

-Self cycling will occur if the respirator is set too sensitive.

-Higher numbers on this control indicate increased Pt effort (decreased sensitivity) Lower numbers indicate decreased PT effort (increased sensitivity)

-If sensitivity is too sensitive, then the machine will cycle on and off by itself. Thus causing breath stacking. Very dangerous

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Bennett PR-II Respirator

-Classification

-Positive pressure

	-Pneumatically Powered

	-Time Cycles

	-PT Cycled

	-Pressure Limited

	-Flow Limited

	-Time Limited

	-Flow Adjustable

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Bennett AP-4 and AP-5 Vent Primarily used in HOmecare

-Classification

-Positive Pressure

	-Electrically Powered

	-Compressor Powered

	-Compressor Driven

	-PT cycled (Assist mode only)

	-Flow Limited

	-Pressure Limited

	-Appropriate for IPPB therapy in a home setting

Control Changes that Effect the FIO2 (when Air mix is on and vent is powered by 100% O2)

-Increase pressure will increase FIO2

-Decrease Flow (Increase INspiratory Time) Will increase the FIO2

-Air mix off will increase the FIO2 to 100%

-Use of the nebulizer will increase the FIO2 on PR -2

-Use of terminal flow (Compensates for leaks) on PR 2 will increase the FIO2 (terminal flow is used to compensate for leak. Works best if leaks are less than 50 mills per KG.)

-Sensitivity has no effect on FIO2

Troubleshooting

-Loss in pressure

-Leak

	-Not enough flow

Troubleshooting

-Excessive Pressure

-Obstruction

	-To much flow

Troubleshoot

-Fail to cycle into inspiration

-Adjust sensitivity

	-Tight seal around mouthpiece

Troubleshooting

-Fail to cycle off

-Leak

		-Mouthpiece/ mask seal

		-Cuff leaking

		-Fenestrated Trach tube open

		-Loose equipment connection

Troubleshooting

-Pressure Doesn’t rise normally (needle reads low or negative)

-Not enough flow

Control Changes that will change the volume

-Increasing the pressure will increase volume

-Decreasing the flow will increase the volume (Increase I time)

-Increasing the flow will increase turbulence and decrease volume

-Air mix and sensitivity have no effect on volume

Control changes that will affect the I:E Ratio

-Increased pressure (increased tidal volume) will increase the inspiratory time and therefore change the I:E Ratio

-Increased flow will decrease the inspiratory time and change the I:E Ratio

-Increased rate will decrease expiratory time and change I:E Ratio

-The opposite for these is also true, and there are no other controls that affect the I:E Ratio

Changes in delivered volume with changing Compliance and Airway resistance

-Lung status change Volume change Decreased compliance Decrease Increase compliance increase Increased airway resistance Decrease Decreased Airway resistance Increase Decreased Compliance, increase resistance Decrease Increased compliance, decreased AWR Increase

Outcomes (Part 1)

-Absence of or improvement in sign of atelectasis -Decreased RR -Resolution of fever -Normal pulse rate -Absence of crackles or presence of ot improvement in previously absent or diminished breath sounds -Normal chest radiograph -Improved PaO2 and decreased PaCO2

Outcomes Part 2

-Increased VC and Peak expiratory flows -Return of GRC or VC to preoperative values, in absence of lung resection -Improved inspiratory muscle performance (Attainment of preoperative flow and volume levels inv=creased forced vital capacity

Set Up Part 1

-Start out with initial setting for pressure and sens -Pressure 10 to 15 cmH2O -Sens -1 to -2 0-2 is preferred -WHen adjusting pressure, you have reached enough pressure once you hear air movement in the bases -The adjusted flow so the PT can exhale fully and be comfortable with the treatment. Adjust while connected to the PT

Set Up part 2

-Remember that flow controls I:E ratio usually set at 1:3 and 1:4 for COPD pt -If you have any small leaks around the mouthpiece or mask, then adjust terminal flow to compensate for the leak (will on compensate for 50 ml of volume ) -If PT go apnenic then adjust your expiratory time ( or Rate control) so it becomes a mechanical ventilated breath

-If PT starts to de sat,

then turn the air mix and turn it off= 100% oxygen. However you will have less flow= I:E ratio. -If you are giving a treatment, you increase the inspiration neb dial until you see mist

-Nebulizer

A.) Two controls for nebulization, inspiratory and expiratory B.) OPerates on 100% source gas. (Normally 100% O2) C.) May pop off or hiss during treatment, recommended decreasing flow to nebulizer.

-Rate

A.) Adjustment of this control causes automatic cycling (Assist-control mode) B.) The I/E ratio is set at 1 to 1.5 C.) Available rate is 0-70 bpm