Use Of Intermittent Positive Pressure Breathing Research Articles

Quelle utilisation du relaxateur de pression chez la personne polyhandicapée ? Un cas clinique

This case study follows the literature review entitled “What use of intermittent positive-pressure breathing in severe cerebral palsy?” published in Revue Motricité Cérébrale 434 (2022) 45–50. It aims to confront the results of literature and clinic on the impact of the use of intermittent positive-pressure breathing in severe cerebral palsy. The literature review didn’t allow clear-cut conclusions. However, it let us think that, in severe cerebral palsy, the use of intermittent positive-pressure breathing at suitable pressure levels could improve and maintain over time lung compliance, mobilize the patient's rib cage, ventilate poorly ventilated lung areas and remove atelectasis. It could also facilitate bronchial drainage by increasing the volume of air mobilized when using chest physiotherapy technics. Therefore, this clinical case study seeks to assess the impact of intermittent positive-pressure breathing in a patient with severe cerebral palsy, on his chronic bronchial congestion, his respiratory volumes, his ability to cope with an increase in the respiratory load and his quality of life as well than that of his parents.

The use of positive pressure devices by physiotherapists.

The aim of this paper is to review the indications for use by physiotherapists, such as physiological rationale and the comparative efficacy of intermittent positive pressure breathing (IPPB) and continuous positive airway pressure (CPAP). A brief discussion of nasal intermittent positive airway pressure is also included. The use of IPPB for post operative prophylaxis has not been supported in the literature. In patients with low lung volumes resulting from neuromuscular disease or spinal injury, IPPB may be useful in the acute phase to improve tidal volume and cough effectiveness. The physiological benefits of CPAP to improve lung volumes are well documented in the literature. Physiotherapists use CPAP as an intermittent application in patients with low lung volumes following surgery. It is predominantly used as a second line intervention in the presence of refractory atelectasis and poor gas exchange. It may also be indicated in other patient groups with similar physiological problems. Nasal intermittent positive airway pressure combines the beneficial effects of intermittent positive pressure breathing and continuous positive airway pressure. There have been many studies evaluating its effectiveness. These have been supportive for patients with neuromuscular disease and sleep disordered breathing, but more research is needed in patients with acute respiratory failure.

Intermittent Positive Pressure Breathing A Dying Art?

Summary Intermittent positive pressure breathing (IPPB) has been used as an adjunct to chest physiotherapy for many years. There have been many conflicting studies of IPPB on patients, but the studies of the physiological effects have demonstrated three clear benefits during treatment: an increase in ventilation, an improvement in arterial blood gases and a reduction in the work of breathing. This paper attempts to give an overview of some of the work on IPPB and concludes that there is reasonable evidence to support the continuing use of IPPB as a desirable and effective adjunct to physiotherapy treatment.

The protracted demise of medical technology. The case of intermittent positive pressure breathing.

In this study, the effects of hospital, staff, and patient characteristics on the rates of use and abandonment of an outmoded medical technology, intermittent positive pressure breathing (IPPB) are analyzed. The study focuses specifically on the use of IPPB to treat inpatients with chronic obstructive pulmonary disease in a national sample of more than 500 community hospitals from 1980 to 1987. Cross-sectionally, hospitals with shorter case-mix-adjusted lengths of stay, private nonprofit or investor-owned hospitals, and hospitals located outside of the north central United States were more likely to abandon IPPB by 1980. Teaching status, location, ownership, volume, and source of payment all appeared to affect rates of IPPB use in 1980. The longitudinal analysis examines both the probability a hospital abandoned IPPB and declines in rates of IPPB use over the study period, conditioned on the availability of IPPB in 1980. The results show that changes in the characteristics of hospitals, patients, and physicians all help to explain variations in the abandonment of IPPB. These findings contrast with previous studies of technological change, which find hospital size to be the most important variable. Size is important in explaining the rate of use in 1980, but it has no effect on the rate of decline in use or abandonment after 1980. In general, the analysis demonstrates that a combination of factors, economic incentives as well as information, contribute to the abandonment of outmoded medical technologies. Given the surprisingly long time periods required for this process to occur, the analysis underscores the need to strengthen financial incentives that encourage appropriate medical decisions and to disseminate information about the efficacy of specific procedures more widely and effectively.

Nebulized salbutamol in life-threatening asthma: Is IPPB necessary?

A double-blind crossover trial compared equal doses of nebulized salbutamol delivered with and without intermittent positive pressure breathing (IPPB) in 20 patients admitted to hospital with life-threatening asthma. No significant differences were observed between the two forms of treatment. It was concluded that the use of IPPB to administer nebulized salbutamol in oxygen had no advantage over passive inhalation in the initial treatment of patients with severe acute asthma.

Nebulized salbutamol in life-threatening asthma: Is IPPB necessary?

A double-blind crossover trial compared equal doses of nebulized salbutamol delivered with and without intermittent positive pressure breathing (IPPB) in 20 patients admitted to hospital with life-threatening asthma. No significant differences were observed between the two forms of treatment. It was concluded that the use of IPPB to administer nebulized salbutamol in oxygen had no advantage over passive inhalation in the initial treatment of patients with severe acute asthma.

Good News! Bad News? The Status of Respiratory Therapy in the 1980s

An interesting article in this issue ofThe Journal(p 2033) by Braun et al appears to confirm what many physicians had already suspected. There has been a widespread opinion that the use of intermittent positive-pressure breathing (IPPB) therapy has been decreasing and that expression of skepticism about its value has become a common occurrence. Braun and co-workers have shown that in both a teaching and nonteaching hospital, there has been a noticeable reduction in the number of IPPB treatments ordered from 1971 to 1979. Many would consider this good news. Intermittent positive-pressure breathing has never been universally accepted as an effective therapeutic procedure. Its phenomenal rise in popularity was accompanied by a number of reports and statements of a critical nature questioning the value of IPPB in most if not all clinical situations. 1-3 If the data of Braun et al are indicative of a national trend, it would

Lung Volume and Blood Oxygenation after Intermittent Positive Pressure Breathing

Functional residual capacity (FRC) was measured in 12 postoperative patients and in one preoperative patient before and after they received intermittent positive pressure breathing (IPPB) with room air for ten minutes at a peak delivered pressure of 15 cm H2O. Ten patients had a normal or low pretreatment FRC. After cessation of IPPB, the mean FRC decreased further. Arterial oxygen tensions, measured in 11 of the 13 patients, decreased in all 11 from a pretreatment mean of 67.8 +/- 4.3 mm Hg to an immediate posttreatment mean of 57.7 +/- 4.2 mm Hg. In five patients repeated arterial blood gases were measured. At 30 minutes, their arterial oxygen tensions had returned to the pre-IPPB values. This study demonstrates that the routine use of IPPB in postoperative patients accentuates preexisting hypoxia and, therefore, must be used with caution.

Lung volume and blood oxygenation after intermittent positive pressure breathing.

Functional residual capacity (FRC) was measured in 12 postoperative patients and in one preoperative patient before and after they received intermittent positive pressure breathing (IPPB) with room air for ten minutes at a peak delivered pressure of 15 cm H2O. Ten patients had a normal or low pretreatment FRC. After cessation of IPPB, the mean FRC decreased further. Arterial oxygen tensions, measured in 11 of the 13 patients, decreased in all 11 from a pretreatment mean of 67.8 +/- 4.3 mm Hg to an immediate posttreatment mean of 57.7 +/- 4.2 mm Hg. In five patients repeated arterial blood gases were measured. At 30 minutes, their arterial oxygen tensions had returned to the pre-IPPB values. This study demonstrates that the routine use of IPPB in postoperative patients accentuates preexisting hypoxia and, therefore, must be used with caution.

Croup: IPPB and/or Racemic Epinephrine Therapy

In 1975 Taussig and associates1 evaluated the use of intermittent positive-pressure breathing (IPPB) with racemic epinephrine in the treatment of croup. Apparently their untreated control group received neither racemic epinephrine nor IPPB although all patients received mist tent therapy with 30% to 40% oxygen. A statistically significant benefit was observed in the treated group. A previous controlled study evaluating the effectiveness of aerosol racemic epinephrine alone, without IPPB, failed to show a significant difference between treated patients and placebo (aerosolized saline)-treated controls.2

Intermittent positive-pressure breathing. A critical appraisal.

There are relatively few valid indications for the use of intermittent positive-pressure breathing (IPPB). It is of limited or no value as prophylaxis of postoperative pulmonary problems (pneumonia, atelectasis) or as a means of delivering aerosol medications or treating stable chronic obstructive pulmonary disease. In these situations, IPPB has few if any advantages over voluntary hyperventilation or deep breathing.

Indications for the use of mechanical ventilation in COPD.

When continuous mechanical respiratory assistance is needed to improve alveolar ventilation in CORD, a volume-limited respirator offers certain advantages over the pressure-limited type. The use of intermittent positive-pressure breathing in bronchodilator therapy is controversial.

AN EVALUATION OF INTERMITTENT POSITIVE PRESSURE BREATHING IN THE PREVENTION OF POSTOPERATIVE PULMONARY COMPLICATIONS

Pulmonary complications, notably atelectasis and pneumonitis, continue to complicate the postoperative course of 5% to 72% of patients undergoing upper abdominal surgery. 1-7 Intermittent positive pressure breathing (IPPB) has been widely advocated as a means of reducing this incidence, 8-13 but there is disagreement as to its effectiveness. 14 St. Mary's Hospital is a 400-bed community hospital with an established Department of Inhalation Therapy. The department is under the supervision of an internist with special interest and training in pulmonary disease and inhalation therapy. The technicians who administer IPPB treatments to the patient have a wide variety of educational backgrounds and undergo an initial three- to four-week period of on-the-job training, as well as a departmental program of continuing education in the field of inhalation therapy. The availability of this talent engendered great enthusiasm among the surgical staff for the use of IPPB in the postoperative patient to reduce the

Congestive heart failure--acute pulmonary edema.

To the Editor:— In their paper, Congestive Heart Failure—Acute Pulmonary Edema ( 208 :1895, 1969), Burch and De Pasquale made several therapeutic recommendations which merit additional comment, I believe. The use of intermittent positive-pressure breathing (IPPB) devices may often be life saving in the patient rendered hypoxic by the pulmonary congestion. But pulmonary obstruction may be intensified by the froth of the edema, and in this situation, the addition of 90% ethyl alcohol by nebulization greatly reduces the foaming. 1 It must be remembered, however, that the administration of high concentrations of oxygen by any means can be lethal for patients with underlying pulmonary insufficiency and must be used with great caution. In the majority of patients digoxin might be preferable to deslanoside. The onset of action of digoxin is comparable to deslanoside, and later, the need to change to another digitalis preparation for maintenance is obviated with digoxin. Deslanoside and

Airway responsiveness in chronic obstructive pulmonary disease

Airway resistance measured at FRC (functional residual capacity) and related to a specific thoracic gas volume (Vtg × Raw) by plethysmographic technic is the most sensitive measurement, among other currently used measurements, of the effectiveness of bronchodilator drugs. The product Vtg × Raw (thoracic gas volume × airway resistance) is shown to correlate best with the MEFR (maximal expiratory flow rate) in a group of normal subjects. In patients with chronic obstructive lung disease there is a significant negative correlation between Vtg × Raw and the MEFR, FEV 1 (one second forced expiratory volume) and MMF (maximal mid-flow). A group of selected patients with chronic obstructive lung disease, exclusive of bronchial asthma, demonstrated significant responsiveness of the airway to bronchodilator drugs, indicating that airway obstruction is not “fixed” in these subjects. Isoproterenol delivered directly to the bronchial tree by IPPB (intermittent positive pressure breathing) produced statistically significant reduction in the product Vtg × Raw. Comparable reduction was noted in the normal group. Epinephrine given subcutaneously in a 0.3 ml. dose produced greater favorable changes in Vtg × Raw than did 0.5 gm. theophyllin injected intravenously. Neither drug produced statistically significant reductions in Vtg × Raw when compared to IPPB with saline solution. Theophyllin administered intravenously and isoproterenol by IPPB resulted in statistically significant improvement in spirometric indices of ventilation in the patient group when compared to the results of the use of these drugs in normal subjects. Since isoproterenol produced significant effects on the airways and theophyllin did not, the spirometric improvement following the administration of theophyllin is attributed, in part, to the effects of this drug on other organ systems. Normal subjects fail to show supernormal spirometric performance following the use of IPPB with isoproterenol. When diffuse obstructive pulmonary disease is present, the response to broncho-dilators is reflected by spirometric improvement to variable degrees. The factors in the underlying lung mechanics in the normal and patient groups are discussed to suggest an explanation for this apparent discrepancy in spirometric improvement. The usefulness of bronchodilator therapy in chronic obstructive pulmonary disease is confirmed and a wide range of individual variation is demonstrated. The necessity for choice of a sensitive measurement technic and statistical evaluation of therapeutic agents in chronic obstructive pulmonary disease is emphasized.

NEW TYPE OF TUBE FOR TRACHEOTOMY WITH INFLATABLE CUFF AND INNER CANNULA.

For several years the use of intermittent positive-pressure breathing in the postoperative period has been used on neurosurgical patients at this hospital with increasing frequency. The positive pressure with resultant alveolar inflation has helped prevent postoperative atelectasis and pneumonitis. Intermittent positive-pressure breathing has been particularly useful in patients with quadriplegia who lack intercostal respiratory action and for the first 48 hours after a prolonged neurosurgical procedure. Adequate inflation of the alveoli, however, was impossible utilizing the Chevalier Jackson type of tube for tracheotomy as there was no way to prevent air from escaping from around the tube. Small-cuff type of tubes for endotracheal anesthesia were utilized next, but these had no inner cannula and hence secretions would form on the inside of the tube that were impossible to remove. The tube for tracheotomy that is pictured (Figs. I and ~) has been developedt and used with coinplete success. I t provides not only an inner cannula for cleansing but an inflatable cuff for coinplete occlusion when the intermittent positivepressure breathing is administered (usually for a period of 10 minutes every ~ hours) with a Byrd type of respirator, and an adapter to receive a Byrd type of respirator or fitting for anesthesia. The adapter is a standard size-15 Foregger adapter for anesthesia and is coupled permanently to the cannula for tracheotomy so that there is no