Intermittent Positive Pressure Breathing Therapy Research Articles

The effects of mechanical insufflation-exsufflation on lung function and complications in cardiac surgery patients: a pilot study

BackgroundPostoperative positive pressure lung expansion is associated with decreased pulmonary complications and improved clinical outcomes. The aim of the present study was to compare the differences in post-operative pulmonary complications and clinical outcomes between two groups of study subjects who underwent cardiac surgery; one included subjects who received mechanical insufflation-exsufflation (MI-E) and the other included subjects who received intermittent positive pressure breathing (IPPB) therapy.MethodsThis retrospective study included 51 subjects, who underwent cardiac surgery in an intensive care unit of a tertiary hospital during the time period from June 2017 to February 2018. After liberation from mechanical ventilation, the subjects received lung expansion therapy by means of two types of positive pressure devices, MI-E (n = 21) or IPPB (n = 30). The pulmonary complications, lung function, and clinical outcomes were compared between the two groups.ResultsSubjects in both groups displayed similar baseline characteristics and underwent similar types of surgical procedures. Compared to subjects who received non-oscillatory therapy, those who received MI-E therapy had higher post-operative force vital capacity (58.4 ± 4.74% vs. 46.0 ± 3.70%, p = 0.042), forced expiratory volume in one second (62.4 ± 5.23% vs. 46.8 ± 3.83%, p = 0.017), and peak flow rate (67.1 ± 5.53 L vs. 55.7 ± 4.44 L p = 0.111). However, the incidence of chest pain was higher in the MI-E group (n = 13, 61.9%) than in the IPPB group (n = 4, 16.7%; odds ratio, 0.123, 95% confidence interval, 0.03–0.45; p = 0.002). The length of hospital and ICU stay, development of atelectasis, pneumonia, and pleural effusion were similar in both the groups.ConclusionBoth IPPB and MI-E therapies have similar effects on preventing post-operative complications in cardiac surgery patients. However, compared to IPPB therapy, MI-E therapy was associated with better-preserved pulmonary function and higher incidence of chest pain.

Review of the status of intermittent positive pressure breathing therapy.

With the advent of diagnosis related groups reimbursement schedules, the cost-effectiveness of therapies needs to be assessed. The safety and efficacy of intermittent positive pressure breathing (IPPB) has been controversial. IPPB employs the dilating effects of positive-pressure ventilation to deliver aerosolized particles to small and medium-sized bronchi of patients with obstructive airways disease. IPPB is expensive to implement and maintain. The hazards of IPPB (infection, pneumothorax, decreased cardiac output), although rare, could prolong hospital stays. Except for severely ill patients with fatigued respiratory muscles, IPPB offers no advantages over the less costly and safer compressor-nebulizer or metered-dose delivery of a beta-agonist.

Maximal Inspiratory Volume and Postoperative Pulmonary Complications

The results of this study indicate that, in order to use any method of respiratory therapy intelligently and effectively in the postoperative period, it is imperative to know the preoperative maximal inspiratory volume of the patient and to measure the inspired volume during treatment. Only then can a physician determine if specific treatment is necessary at all, and if it is, whether or not incentive spirometry would be of greater benefit to the patient than intermittent positive pressure breathing therapy.

ASSESSMENT OF THE VALUE OF POSITIVE PRESSURE BREATHING APPARATUS IN INDUCING COUGH

In the last decade, numerous papers have discussed what has been called the indiscriminate use of intermittent positive pressure breathing therapy (IPPB) for the treatment of obstructive airways disease (Curtis et al., 1968; Loke and Anthonisen, 1974; Cheney et al., 1976; Baker, 1974; Murray, 1974; Barach and Segal, 1975; Sheldon and Gold, 1976; Dolovich et al., 1977). These papers have all failed to show any advantage of positive pressure breathing therapy, either in the acute or chronic stages of obstructive airways disease. IPPB apparatus is expensive, requires careful maintenance and cleaning and may lead to patient dependence. However, physiotherapists in this hospital gained the impression that patients who were receiving nebulisation with positive pressure appeared to cough more frequently, and to produce greater volumes of sputum, suggesting that IPPB apparatus may be a useful adjunct of physiotherapy. Therefore a study was designed to compare the effectiveness of nebulisation therapy, with and without positive pressure, on the production of cough and sputum volume in patients with chronic obstructive airways disease.

Blood studies in untreated patients with acute asthma.

Arterial and venous blood samples were obtained from 23 patients with acute asthma before they received systemic or intermittent positive-pressure breathing therapy. Serum lactate, electrolyte, and enzyme concentrations, arterial pH, arterial PCO2, arterial PO2, peak expiratory flows, and 2,3-diphosphoglycerate concentrations were measured. The serum glutamic oxaloacetic transaminase, lactic dehydrogenase, and creatine phosphokinase activities were increased in 90, 81, and 38 per cent of the patients, respectively, and the individual values correlated poorly with the arterial PO2. In addition, there was a close correlation between the 2,3-diphosphoglycerate concentration and arterial PO2 (r = -0.75), indicating an active intraerythrocytic compensatory mechanism for enhancing O2 delivery operative in acute asthma.

The Present Status of IPPB Therapy

For more than 25 years, intermittent positive pressure breathing (IPPB) for certain clinical conditions other than apnea has been utilized. For those who use it extensively the argument goes something like this: IPPB is an extremely useful therapeutic approach for the patient who is unable to take deep enough breaths, for the patient requiring aerosol medication to be carried deep into his tracheobronchial tree, and for the patient who has difficulty coordinating spontaneous breathing. For the skeptical, the argument is quite different: IPPB is an overused therapeutic approach created by the American belief in the superiority of machines, encouraged by the recent fervor for paramedical aid—all compounded with organized nursing’s flight from the bedside—and perpetuated with total cooperation from hospital administrators aided by third party financial support. Does the correct approach lie somewhere in between?

Review of the state of the art in intermittent positive pressure breathing therapy.

Intermittent positive pressure breathing has not been evaluated adequately enough to permit a definite statement about its role in the treatment of stable patients with COPD. On the basis of the short- and long-term studies carried put thus far, no convincing rationale for the use of IPPB in patients with COPD has been demonstrated. Satisfactory trials have not been conducted and insufficient attention has been directed toward assessment of possible psychosocial benefits of IPPB. Clearly, additional studies need to be carried out. In the interim, owing to the lack of evidence to support the widespread application of IPPB and the costs and possible hazards of this modality of treatment, it is recommended that further use of IPPB in patients with stable COPD be discouraged in favor of comprehensive treatment programs, including exercise conditioning, with more clearly established clinical benefits.

Conference on the scientific basis of respiratory therapy. Intermittent positive pressure breathing therapy. Introduction.

Conference on the scientific basis of respiratory therapy. Intermittent positive pressure breathing therapy. Introduction.

Preoperative Intermittent Positive Pressure Breathing Therapy in Patients With Chronic Obstructive Lung Disease

Preoperative Intermittent Positive Pressure Breathing Therapy in Patients With Chronic Obstructive Lung Disease

IPPB Therapy in Chronic Obstructive Pulmonary Disease

A group of 187 patients with chronic bronchitis and emphysema were periodically followed up for an average of more than four years to determine if objective benefit was obtained from long-term intermittent positive-pressure breathing (IPPB) home treatment. The 78 patients who used their own IPPB valves at home showed no demonstrable benefit when compared to 109 controls in regard to changes in pulmonary function test values, blood gas values, weight, or number of deaths. Fifty patients treated with IPPB were paired with 50 controls according to results of initial tests of forced expiratory volume in one second (FEV1). Deterioration in FEV1value was 99 ml/yr in the treated group and 44 ml/yr in the controls. Significantly less patients in the treated group showed improvement in FEV1. Long-term IPPB home treatment of emphysematous patients cannot be recommended with assurance of deriving objective improvement.

Effects of intermittent positive pressure breathing on emphysematous patients

Eight subjects free of pulmonary disease and eighteen with moderate to severe pulmonary emphysema were subjected to 15 minutes of continuous intermittent positive pressure breathing (IPPB) and followed for 2 hours after cessation of therapy. Continuous measurements of ventilation, expiratory gas composition and frequent determinations of arterial blood gases were made. As indicated by improvement of PaCO 2 which persisted throughout the 2 hour recovery period, IPPB was shown to be therapeutically beneficial when properly utilized in patients with moderate to severe pulmonary emphysema. Data are presented which demonstrate that IPPB produces passive hyperventilation and a resultant ventilatory CO 2 loss in patients with moderate disease. In patients with severe disease, slight if any ventilatory loss of CO 2 occurred but improvement in PaCO 2 was shown to be augmented by decreased metabolic CO 2 production related to decreased work of breathing produced by IPPB. Patients in this latter group were found to breathe at an improved level of efficiency following IPPB. The clinical rationale for IPPB therapy in emphysematous patients is presented.

STUDIES OF THE EFFECT OF INTERMITTENT POSITIVE PRESSURE BREATHING UPON THE CARDIOPULMONARY DYNAMICS

The cardio-pulmonary dynamics were studied in 8 cases of obstructive pulmonary emphysema, 2 cases of non-obstructive pulmonary emphysema and 3 cases of bronchial asthma before, during and after IPPB (intermittent positive pressure breathing) for 10 minutes using room air, and 2 cases of obstructive pulmonary emphysema before and 3 weeks after IPPB therapy and 2 cases of bronchial asthma before and 1 week after the same treatment. We also compared the changes in cardiopulmonary function by IPPB with those by inhalation of 100 percent oxygen. The alveolar hypoventilation was corrected by IPPB causing mechanical hyperventilation, with resultant improvement of ventilation-perfusion relationships. Thus hypoxemia and hypercapnia were corrected. As for the acid base balance, respiratory acidosis was markedly improved. As far as the hemodynamics are concerned, the cardiac output was increased, while the pulmonary arterial pressure and the pulmonary blood volume were decreased, which could be considered to show the therapeutic effect of IPPB on cor pulmonale. The same tendency was observed after treatment with IPPB for 1 or 3 weeks. A danger of respiratory acidosis could be avoided when inhalation of pure oxygen was done by means of IPPB. The conclusion is that IPPB is not a symptomatic treatment, but a therapeutic measure aiming to correct disturbed pulmonary function, and is at present the most effective treatment for chronic pulmonary insufficiency, for which there had not been good therapeutic means.