Intermittent Positive-Pressure Breathing
Intermittent positive-pressure breathing (IPPB) delivers room air or oxygen into the lungs at a pressure higher than atmospheric pressure. This delivery ceases when pressure in the mouth or in the breathing circuit tube increases to a predetermined airway pressure.
IPPB was formerly the mainstay of pulmonary therapy, with its proponents claiming that the device delivered aerosolized medications deeper into the lungs, decreased the work of breathing, and assisted in the mobilization of secretions. Studies now show that IPPB has no clinical benefit over handheld nebulizers. However, it continues to be used selectively to treat atelectasis not responsive to other procedures, such as incentive spirometry or chest physiotherapy.1
Equipment
IPPB machine with all necessary circuit tubing ▪ mouthpiece or mask ▪ noseclips, if necessary ▪ source of pressurized gas at 50 psi, if necessary ▪ oxygen, if desired ▪ prescribed medication and normal saline solution ▪ 3-mL syringe ▪ sphygmomanometer ▪ stethoscope ▪ specimen cup or facial tissues and waste bag ▪ warm, soapy water ▪ Optional: suction equipment.
Preparation of Equipment
Follow the manufacturer’s instructions to set up the equipment properly. Label all medications, medication containers, and other solutions.
Implementation
Verify the doctor’s orders.
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.5
Explain the procedure to the patient to decrease anxiety and ensure his cooperation.
Tell the patient to sit erect in a chair, if possible, to allow for optimal lung expansion. Otherwise, place him in semi-Fowler’s position.
Take baseline blood pressure and heart rate measurements, especially if a bronchodilator will be administered, and listen to breath sounds for posttreatment comparisons.
Instill the ordered medication or normal saline solution into the nebulizer cup. Turn on the IPPB machine at the appropriate settings as determined by the doctor or respiratory therapist.
Instruct the patient to breathe deeply and slowly through his mouth as if sucking on a straw. Encourage the patient to let the machine do the work.
During treatment, instruct the patient to hold his breath for a few seconds after full inspiration to allow for greater distribution of gas and medication. Then instruct him to exhale normally.
During treatment, take the patient’s blood pressure and heart rate. IPPB treatment increases intrathoracic pressure and may temporarily decrease cardiac output and venous return, resulting in tachycardia, hypotension, or headache. Monitoring also detects reactions to the bronchodilator. If you find a sudden change in blood pressure or increase in heart rate by 20 or more beats per minute, stop the treatment and notify the doctor.
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