INTERMITTENT POSITIVE

PRESSURE BREATHING

BY DR. HIMANSHU PATEL

M.P.T. (CARDIO)
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 not
co oporating. 
CONT….

• 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
2.Support weak inspiratory muscles. In completely relaxed subject the 
work of breathing during inspiration is reduced immensely 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.
CONT….

1.Ease the inspiration of large volume of air

2.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.
3.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(incentive spirometry, Chest Physiotherapy Technique, Deep Breathing Exercises, 
positive airway pressure adjuncts) have been unsuccessful.
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
PROCEDURES FOR IBBP USING BIRD MARK
VENTILATOR
• Explain procedure to patient.
• Attach circuit corrugated tubing, expiratory valve line, and nebulizer tubing to IPPB
machine. Pressure test the circuit and machine to insure proper function; open up
nebulizer control, set inspiratory pressure level, and cycle the machine manually.
• Block the mouthpiece with sterile gauze or the sterile circuit package. The machine
should cycle off when the preset inspiratory pressure is reached.
• Aseptically prepare medication as prescribed and insert in the IPPB nebulizer.
CONT….

• Instruct patient to:

•  Purse lips around mouthpiece so air do not leak, keeping the tongue back.
• b. Breathe through the mouth only. Mask may be used if patient is unable to
cooperate
• with mouthpiece.
• c. Inspire slowly and deeply not letting air “puff” cheeks out. Pause briefly at
end of inspiration then exhale.
CONT….

• After patient is comfortable with this technique, treatment can begin.

• Set sensitivity to cycle on with patient’s inspiratory effort.
• Adjust inspiratory pressure to 10 – 15 cmH2O, assessing adequate volume by
chest expansion and auscultation.
• Adjust nebulizer controls to have medication nebulized adequately.
• Monitor patient throughout duration of treatment.
CONT….

• When treatment is complete, detach circuit from IPPB machine, discard any
excess solution from nebulizer, and place circuit in plastic bag at bedside for
use with next treatment.
• Age appropriate considerations include assessing the patient’s ability to
cooperate with a mouthpiece. An appropriate fitting mask may be used if
necessary in geriatrics.
CONTRAINDICATIONS FOR IPPB
1.Increased intracranial pressure.
2.Hiccups
3.Hemodynamic instability.
4.Recent facial, oral, or skull surgery.
5.Tracheoesophageal fistula.
6.Recent esophageal surgery.
7.Active haemoptysis.
8.Nausea.
9.Active, untreated tuberculosis or other respiratory communicable disease..
10.Radiographic evidence of bleb.
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