Intermittent Positive Pressure Breathing (IPPB) Illustration

What is Intermittent Positive Pressure Breathing (IPPB)?

by | Updated: May 16, 2024

Intermittent positive pressure breathing (IPPB) is a type of noninvasive ventilation (NIV) that delivers positive pressure during inspiration and then returns to atmospheric pressure during expiration.

IPPB was designed to help patients take deeper breaths, stimulate a cough, and treat or prevent atelectasis. This article will cover the basics of IPPB and how it works, so keep reading if you want to learn more.

What is Intermittent Positive Pressure Breathing (IPPB)?

IPPB is a patient-triggered, pressure-cycled form of noninvasive positive pressure ventilation that can assist with lung expansion. It works by delivering pressure-supported breaths from the machine to the patient’s lungs through a mouthpiece.

The pressure helps to expand the lungs, making it easier for the body to take in oxygen and expel carbon dioxide. This improves gas exchange, increases lung compliance, and reduces a patient’s work of breathing.

IPPB is helpful in treating and preventing atelectasis, which refers to a collapse in the alveoli of the lungs. It is often recommended for postoperative patients who are unconscious or too sedated to perform incentive spirometry.

Indications for IPPB

As previously mentioned, IPPB is a type of lung expansion therapy used to treat or prevent atelectasis. It is often recommended for postoperative patients who are unconscious or too sedated to perform incentive spirometry.

Some other indications for IPPB include:

  • Improve cough effectiveness
  • Decrease work of breathing
  • Mobilize secretions
  • Administer a bronchodilator treatment
  • Treat pulmonary edema

The potential outcomes of IPPB therapy include improved breath sounds, increased oxygenation, improved vital capacity, improved chest x-ray, and a stronger cough.

Contraindications for IPPB

IPPB therapy is not recommended in patients with any of the following:

Furthermore, IPPB is not recommended for postoperative patients who are conscious, alert, and able to perform sustained maximal inspirations. In this case, incentive spirometry is the preferred method of treatment.

What is Atelectasis?

Atelectasis is a collapse of the alveoli, which are the tiny air sacs in the lungs. It could be a total collapse of an entire lung or a partial collapse in one or more lobes.

During inspiration, air moves freely through the airways to the alveoli. This is where the gas exchange of oxygen and carbon dioxide occurs. If the alveoli collapse, gas exchange is impaired, which can lead to hypoxemia, hypercapnia, and other respiratory complications.

IPPB uses positive pressure to help treat and prevent atelectasis by expanding the lungs and opening collapsed alveoli.

IPPB Settings

IPPB settings are used to control the amount of support that is delivered. This include:

  1. Sensitivity
  2. Flow Rate
  3. Pressure
  4. Air Mix

Adjusting IPPB Settings

  • To give a larger tidal volume, increase the pressure setting.
  • To give a smaller tidal volume, decrease the pressure setting
  • To give a faster breath, you must decrease the inspiratory time (i.e., increase the flow)
  • To give a slower breath, you must increase the inspiratory time (i.e., decrease the flow)

Note: A common error that occurs with an IPPB is when the machine doesn’t cycle off. When this happens, it likely indicates that a leak is present. This means that the pressure limit will not be reached, and that is why the machine will not cycle off.

To fix the leak, you must check the circuit and tighten up any loose connections.

Furthermore, it’s common for leaks to occur near the mouthpiece when a patient is not making a tight seal with their lips. In this case, you should recommend using a mouth seal (e.g., Bennett seal) to correct the leak.

IPPB Procedure

  1. Check the doctor’s order.
  2. Gather and assemble all equipment, including the IPPB unit, gas source, circuit, and mouthpiece.
  3. Explain the procedure to the patient.
  4. Perform a pre-treatment assessment, including auscultation and vital signs.
  5. Input the initial settings, including sensitivity, flow rate, and peak pressure.
  6. Add medication to the nebulizer (if indicated).
  7. Ensure the machine cycles off at the preset pressure limit by occluding the mouthpiece.
  8. Instruct the patient to make a tight seal with their lips around the mouthpiece and perform an inhalation. The patient should only breathe through their mouth.
  9. Instruct the patient to relax as the machine fills their lungs with air until the pressure limit is reach. Pause briefly at the end of inhalation after the machine cycles off. Then the patient can exhale slowly.
  10. Make adjustments to the settings depending on the patients needs. Strive to reach an inspiratory time of 1–2 seconds with an I:E ratio of 1:3.
  11. Monitor the patient and carry out the treatment for up to 15 minutes.
  12. When treatment is complete, disconnect the circuit from the machine and discard solution that remains in the nebulizer. Store the patient’s circuit at bedside for future treatments.

IPPB vs. Incentive Spirometry

Incentive spirometry is another form of lung expansion therapy that is used to help prevent atelectasis. It does not use positive pressure but rather relies on the patient’s own effort to take a sustained maximal inspiration (SMI).

Note: Incentive spirometry is typically preferred over an IPPB machine in patients who are capable of performing the therapy with the proper technique.

It is also preferred when there is an increased risk of barotrauma or pneumothorax.

However, in cases where patients are too weak or sedated to perform incentive spirometry, IPPB is a better choice. IPPB can also provide more consistent deep breaths than incentive spirometry.

Final Thoughts

Intermittent positive pressure breathing (IPPB) is a type of lung expansion therapy that is effective in treating and preventing atelectasis. It works by delivering positive pressure to expand the lungs and open collapsed alveoli.

IPPB is capable of providing full ventilatory support; however, that is not its intended medical purpose.

It is more commonly used as an adjunct therapy to encourage deep breathing, enhance a patient’s cough effort, manage pulmonary edema, and prevent impending ventilatory failure.

However, incentive spirometry is an affordable and more convenient alternative for patients who are conscious and able in the clinical setting.

John Landry, BS, RRT

Written by:

John Landry, BS, RRT

John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.

References

  • Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020.
  • Clinical Application of Mechanical Ventilation. 4th ed., Cengage Learning, 2013.
  • Pilbeam’s Mechanical Ventilation: Physiological and Clinical Applications. 6th ed., Mosby, 2015.
  • Mosby’s Respiratory Care Equipment. 10th ed., Mosby, 2017.
  • Rau’s Respiratory Care Pharmacology. 10th ed., Mosby, 2019.
  • Wilkins’ Clinical Assessment in Respiratory Care. 8th ed., Mosby, 2017.
  • Clinical Manifestations and Assessment of Respiratory Disease. 8th ed., Mosby, 2019.

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