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Intermittent Positive Pressure Breathing (IPPB) (3.02)

Intermittent Positive Pressure Breathing (IPPB) (3.02) - Policies, Clinical, UWHC Clinical, Department Specific, Respiratory Care Services, Volume Expansion

3.02


3.02 Intermittent Positive Pressure Breathing – IPPB
Category: UWHC Clinical Policy
Policy Number: 3.02
Effective Date: April 1, 2016
Version: Revision
Section: Respiratory Care Services

I. PURPOSE:

IPPB is a technique used to provide short-term or intermittent mechanical ventilation for the purpose of
augmenting lung expansion.

II. CONTRAINDICATIONS:

IPPB may be hazardous for the patient with hypovolemia, bullous emphysema, untreated pneumothorax,
hemoptysis, reactive airway disease, intracranial pressure greater than 15mm Hg, hemodynamic instability,
recent face, oral, or skull surgery and recent esophageal surgery.

III. POLICY:

A. All patients will be assessed by the Respiratory Care Practitioner (RCP)
B. Therapy will be provided in accordance with a provider’s order.

IV. EQUIPMENT:

A. IPPB device.
B. Mouthpiece, Bennett seal, nose clip, mask, or ETT adapter.
C. Hand held spirometer.

V. PROCEDURE:

A. Review and acknowledge provider’s order.
B. Review patient’s chart.
C. Obtain the appropriate equipment.
D. Introduce yourself to the patient and/or family. Explain the reason for the procedure.
E. The IPPB machine should be set up with an oxygen gas source, with the air mix pulled out, , unless
otherwise indicated.
F. Measure the patient’s Vital Capacity (VC) pre treatment.
G. Instruct patient on proper breathing technique. Upon inhalation, the machine will cycle
on. The patient should relax throughout inspiration until the pressure limit is reached.
When the machine cycles off, the patient should complete exhalation through the
mouthpiece so the exhaled volume can be measured.
H. Nose clips may be needed to prevent a nasal leak.
I. Pressures of 15-40cm H2O are utilized to deliver desired volume. If excessive pressures
are needed to deliver adequate volumes, the patient's provider should be contacted and
treatment re-evaluated.
J. Monitor vital signs and breath sounds before, during and after the procedure. If a
significant change in vital signs and/or breath sounds occurs, stop treatment.

K. Measure the patient’s exhaled IPPB volume with handheld spirometer. The IPPB flow should be
increased until the patient’s VC during the treatment is doubled from the pretreatment VC
measurement.
L. The RCP will attempt to localize therapy by the following method: If the patient has a definite lung

that has been identified as being affected, it may be beneficial to position the patient on his/her side opposite
the affected lung so that the gas flow may be diverted to the appropriate lung.
M. Each patient is to be taught to cough, or if needed, naso-tracheally suctioned, unless
contraindicated. Any patients with an ineffective cough, especially spinal cord injury patients, should
be instructed on the use of the Cough Assist machine as per P&P #3.16, or by cough assist, as per P&P #3.13.
N. Use of a mask or Bennett seal may be needed for patients with neuromuscular disease who are unable
to obtain a seal around the mouthpiece.
O. Providing the treatment to the patient with an artificial airway.
1. This type of patient will require slight modification of equipment in that a 15mm
artificial airway adapter will be placed directly to the artificial airway.
2. Cuff should be inflated so as to prevent volume loss and possible aspiration of
oral secretions.
3. This patient may need tracheal suctioning during and after treatment.

VI. REFERENCES:

A. Clinical Practice Guidelines: Intermittent Positive Pressure Breathing
B. Respiratory Care Services P&P:
1. 2:27 Aerosolized Medication Treatment
2. 3:13 Abdominal Thrust & Bicostal (Costophrenic) Cough Assist
3. 3.16 Cough Assist Machine (also called In-exufflator).
4. 3:24 Spontaneous Ventilator Parameters.
5. 3:42 Suctioning







Approved by Director and Medical Director of Respiratory Care:

Original copy of this Policy & Procedure is available in the Respiratory Care Office [E5/489].