Test 1 Ch. 43 Eagans Intermittent Positive Pressure Breathing (IPPB) Flashcards
What are the 3 types of Atelectasis?
- Gas Absorption
- Lobar
- Compression
Gas absorption atelectasis can occur when mucus plugs block _________________ to selected regions of lungs, which causes ______ mismatch
ventilation;
V/q
Lobar atelectaisis happens when ________________ is compromised in a……..
ventilation;
larger airway or bronchus
Compression atelectasis occurs when the
transthoracic pressure exceeds the transalveolar pressure (PAL)
Factors Associated w/ Atelectasis (5)
- Obesity
- Neuromuscular disorders
- heavy sedation
- surgery near the diaphragm
- restrictive chest wall abnormalities
Clinical signs of Atelectasis (5)
- Tachypnea
- Fine, late-inspiratory crackles
- Increased density and signs of volume on chest xray
- Bronchial breath sounds
- Tachycardia
What is the main indication for hyperinflation therapy?
To prevent or treat atlectasis
What are some indications of NPPV? (3)
- Increased WOB
- DNI pts
- Acute exacerbation of COPD
IPPB is positive pressure on inspiration; the pt is getting positive pressure into
their lungs to inflate them
IPPB can be…. (3)
- pt, time, pressure or manually triggered
- pressure cycled
- pneumatically powered
IPPB is considered a _______ ____________ tool b/c ___________ pressure is given to the airway during _______________
lung expansion;
positive;
inspiration
IPPB tx last about (range)
15- 20 minutes
IS is ____% pt effort
100%
IPPB can be modified to adjust the….
pressure that the pt is getting
Pts do not have to be cooperative while doing IPPB, as long as a pt can
take a deep breath it can be done
Contraindications for IPPB
- Hemothorax
- Pneumothorax (b/c will cause a tension pneumothorax)
- Tension Pneumothorax
- Active hemoptysis
- ICP>15 mm Hg
- Tracheoesophageal fistula
- Hemodynamic instability
- Recent facial, oral, or skull surgery
- Nausea
- Singultus (hiccups)
- Surgery near eosphogeal
Pressure builds up until it shifts the mediastinum, once that is shifted, it then causes cardiac instability. What is this describing?
Tension Pneumothorax
Hazards and Complications of IPPB (5)
- Hypoventilation and respiratory alkalosis
- Discomfort secondary to inadequate pain control
- Pulmonary barotrauma
- Exacerbation or bronchospasm
- Fatigue
Potential outcomes of IPPB (6)
- Decrease or elimination
- Improved breath sounds
- Normal or improved chest x-ray
- Increased SpO2
- Increased VC
- Improved inspiratory muscle performance and cough
What is the best position for IPPB
Semi-Fowlers
What are some equipment needed for IPPB
- mouthpiece
- circuit
- Tracheal adapter (can be added to ETT/TT)
Prior to initiating IPPB what most be done first?
A baseline assessment
Monitoring IPPB:
Machine performance (4)
Patient response (8)
Machine Performance
- Sensitivity
- Peak pressure
- Flow setting
- FiO2
Patient Response
- Breathing rate and expired volume
- Peak flow or FEV1/FVC%
- Mental function
- Skin color
- BP
- SPO2
- ICP
- Chest x-ray
Initial settings for IPPB (ranges)
Sensitivity
Pressure
RR
I:E
- Sensitivity: -1 to -2
- Pressure: 10 to 15 cm H2O
- RR: 6 to 8 breaths/min (low rate to provide full expansion of lungs)
- I:E ratio: 1:3 to 1:4
