Intermittent positive pressure breathing

Introduction

Intermittent positive pressure breathing (IPPB) is a technique used to provide short term or intermittent mechanical ventilation via mouthpiece or mask for the purpose of augmenting lung expansion and delivering aerosol medication. IPPB is usually not a therapy of choice in treating lung collapse as there are other techniques that are less expensive, easy to administer and less tasking; It usually implored when other therapies failed or patient is no co-opporating. 

IPPB is inspiration using a non-invasive ventilator such as the Bird with a pressure boost. The patient stimulates inspiration, with positive pressure support, and followed by airway pressure returning to atmospheric pressure with passive expiration.The Bird Mark 7 ventilator is a pressure cycled device convenient to use for providing IPPB as an adjunct to physiotherapy in the spontaneously breathing patient. IPPB may be applied to intubated as well as nonintubated patients. 

Benefits of IPPB

IPPB has been shown to

1. Increase the volume of  inspiration(Sukumalchantra et al 1965)
2. Support weak inspiratory muscles.In completely relaxed subject the work of breathing during inspiration approaches zero (Ayres et al 19630 with IPPB.
3. Assist in clearing sputum from the lungs. The two prior benefits aids in bronchial secretions clearance when more simple airway clearance techniques alone are not maximally effective. (Pavia et al 1988)
4. Ease the inspiration of large volume of air
5. Assist in the delivery of aerosol medication (nebulisers). The reduction in the work of breathing can be used with effect in the acute severe exhausted asthmatic, but there is no evidence that the effect of bronchodilators delivered by IPPB is greater than from a nebulizer alone (Webber et al 1974).
6. Improve the levels of oxygen and carbon dioxide in your blood

Indication for IPPB

1. The need to improve lung expansion in the presence of atelectasis when other forms of therapy have been unsuccessful (incentive spirometry, CPT, positive airway pressure adjuncts).
2. Inability of the patient to clear secretions adequately because of pathology that severely limits the ability to ventilate or cough effectively and failure to respond to other modes of treatment.
3. Patient who have an acute flare-up of their breathing problem and are too weak to have an effective cough
4. The need to deliver aerosol medication to the patient