Hyperinflation therapy and bronchopulmonary hygiene

Whar are the types of hyperinflation therapy?

IS, IPPB, PAP

what does IS treat?

Micro atelectasis

What does Is prevent ?

atelectasis

What does IPPB treat?

atelectasis

What does PAP treat and prevent?

atelectasis

If a patient couldn’t reach their goal using IS, which hyperinflation therapy would be recommended?

IPPB (the bird)

IS could be used as an therapeutic tool and also an?

diagnostic tool

The paitent should have the minimum of what VC when using hyperinflation therapies?

At least 2-3x normal VC or At least 10-15cc/kg IBW

What are some complications when using IS?

Hyperventilation, pneumothorax, increasing intrapleural pressure, stimulation of the vagal reflex

What could happen if the patient does a sustained maximal inspiratory pause against a closed glottis?

bradycardia

Is IS considered effort-dependent or patient-dependent?

Effort-dependent and is ineffective if it’s not performed correctly

When a patient's exact age or height isn’t on the nomogram, what would you do?

make them younger and taller

Which position should the patient perform IS?

semi fowlers or fowlers position

What is a short term for IPPB?

Positive pressure breathing treatment

How long does IPPB last?

10-15 minutes

IPPB is delivered via?

pneumatic pressure-limited ventilator (Bird)

What is being set when you’re setting up IPPB?

a pressure

What does pneumatic mean?

gas powered and pressure limited

The more Pressure equals

more volume

The less pressure equals

less volume

What are the indications for IPPB

treats atelectasis

helps decrease the WOB

post op patients recovering from chest or abdominal surgery

impending ventilatory failure

What are some hazards of IPPB

Excessive ventilation

Decrease CO2 and dizziness

increase O2

Decrease CO

Increased ICP

Pneumothorax

Gastric distention

increased air trapping in patients with COPD (give those pts longer pauses)

What are some contraindications of IPPB?

Pneumo, Untreated pnumo, tension pneumo

pulmonary hemorrhage

Active TB

Blebs

Hemodynamic instability

Tracheoesophageal fistula

recent esophageal surgery

actiuve hemoptysis

nausea

increase ICP

What is all needed to step up the IPPB Bird Mark 7?

pressure, flow, sensitivity, apnea, air mix

Pressure and volume are ?

directly related

What is normal flow?

45-60 lpm

Flow and I time are?

Inversely related. if flow goes up I time goes down

The greater the sensitivity?

The easier it is to trigger

if there is less sensitivity?

The harder it is to trigger

Apnea and E time are ?

Directly related. more apnea equals an increase in E time

The air mix controller determines?

100% source gas or Air mix

If the knob in the air mix is out that means?

Room air is entrained and is giving 40-80% oxygen

If the knob in the air mix is in that means?

100% oxygen

What would happen if the patient doesn’t hold their breath for about 3 seconds before exhalation?

They will blow off too much CO2

The pressure is set to achieve?

2-3 times normal Vt or 10-15 cc/kg IBW

What is normal I:E ratio?

1:1.5 or greater

The sensitivity is based on?

how much effort or work the patient must perform to trigger a breath

What number should sensitivity be set at ?

-2 cmH2O and 15 on the machine

When the patient sips where should the dial move?

to -2

When the machine triggers the dial goes to ?

15

the less senstivity equals

Increase number and too hard

If the senstivity is too high it equals

Smaller number auto trigger and its too easy

What is the initial pressure settings for IPPB/Bird

5 and you want to look at the volume

What is the initial flow rate for IPPB/ bird

25

What is the initial setting for sensitivity for IPPB/ Bird

15 (-2cmH2O)

What is the initial setting for apnea on IPPB/ Bird?

7 o’ clock

What do you want to adjust to achieve the appropriate I:E ratio?

Flow rate and apnea