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What will be the O2 percentage delivered when air mix control is pulled out on Bird Mark 7, or pushed in on PR-2,

40 - 60%

With the IPPB pressure-cycled ventilator, inspiration ends when?

the preset pressure is reached

Push the air /mix control in on the Bird Mark 7

to give a pulmonary edema pt an IPPB tx with ethyl alcohol on 100% Oxygen

If pt attempts to trigger a Bird Mark 7 into inspiration during an IPPB tx, and the pressure manometer shows a deflection of negative 8 cmH2O on the indicator after which the indicator rises rapidly to the preset pressure.

Correct by increasing the sensitivity

During Mr. Kinney's IPPB tx, after a breath is initiated, the unit does not cycle to expiration. What should the RCP do?

Check for a leak in the circuit

If administering 0.5 ml of Albuterol Q6 to a pt using IPPB device, the pt's HR before ex is 68, and during tx icreased to 86, what action should be taken?

continue to monitor. Did not increase more than 20.

15 minutes after completing IPPB tx with 0.5 ml of albuterol on 40% O2, the blood gas results are
pH = 7.52
PaCO2 = 29
PaO2 = 99
Which action should be recommended?

have the patient slow their breathing down. Blowing off too much CO2.

What should not be turned on when setting up the Bird Mark 7 for IPPB therapy?

expiratory timing device

What is the purpose of the terminal flow knob on the PR-2?

helps compensate for small leaks

If pt unable to trigger the machine into inspiratory phase, What should be done?

Increase the sensitivity
make sure all tubing connections are tight
make sure the machine is plugged into the gas outlet
make sure the lips are sealed around the mouthpiece

What should be charted after IPPB tx?

duration of therapy
medication dosage and type used
peak pressure used
patient's response
sputum production

What is the function of the venturi system on the Bird Mark and PR-2 machines?

To provide air entrainment.

Define IPPB therapy

Intermittent, short-term therapy
Applies positive pressure during inspiration to spontaneously breathing patients
Originated as ventilators
have built in neb cups
need 50 psi gas source

Trigger

used to start inspiration
what makes it deliver a breath (flow, pressure or time)

Cycle

what ends a breath (pressure or time)

Limit

certain pressure or volume

Physiologic Effects of IPPB

During inspiration - positive pressure applied to mouth is transmitted to alveoli and to the pleural space.
During expiration - strored potential energy created from recoil forces of lung and chest wall cause passive exhalation
Pt triggered breaths
Increased MAP
Increased Vt
Decreased WOB (vent does all the work)
Change I:E ratio (slow down breathing)

Indications for IPPB therapy

Need to improve lung expansion
-Significant atelectasis not responsive to IS or CPT
-Prophylactically for pt's at risk for atelectasis who
can't cooperate with simpler techniques.
Need short-term ventilatory support
Need to deliver aerosol medication to
-fatigued patients
-Neromuscular patients
-Hyphoscoliosis patients (restrictive disorder)

IPPB therapy

Should not be used alone for tx of re-absorpion atelectasis caused by secretions.
The unaffected lung regions will become over-inflated

Goal of IPPB

Increased Vt >/= 25% during IPPB tx
Increased FEV1 or peak flow (before and after to get baseline)
Enhanced cough and secretion clearance
Improved CXR, B/S oxygenation, subjective response, and vitals

Assessment of need

Presence of significant atelectasis (that hasn't been resolved)
reduced PFT's:
-FEV1< 65%
-FVC < 70%
-MVV < 50%
-VC < 10%
Neuromuscular disorders of Kyphoscoliosis
Fatigue or muscle weakness
Patient stated preference
Acute severe bronchospasm (proceed with caution)
Prophylactic prevention of atelectasis

Contraindications to IPPB

Absolute : untreated tension pneumo
Increased ICP > 15 mmHg
Hemodynamic instability (BP)
Active hemoptysis
Trachealesophogeal fistulas
recent esophageal surgery
active untreated TB (because of coughing and cavities)
readiographic evidence of blebs
recent facial, oral, or skull surgery
hiccups
air swallowing
nausea

Hazards and Complicaitons

Increased RAW (secretions)
Pulmonary barotrauma, pneumothorax
Nosocomial infections
Respiratory alkalosis (blowing off too much CO2)
Hyperoxia (when using oxygen as gas source, air mix or 100%)
Impaired venous return
hemoptysis
gastic distention
air trapping, auto-PEEP, over distention
Psychological dependence
Respiratory alkalosis from hyperventilating
effects last < 1 hour post tx
MDI's and aerosols should be considered for asthma and COPD patients
Increased V/Qmm
Hypoventilation or hyperventilation
Impaction of secretions from inadequately humidified gas

Sensitivity Control

adjusts the trigger sensitivity to patient effort
Start inspiration

Flow Rate Control

adjusts from 0 - 80 lpm
determines I:E time

Air Mix Control

Pulled out (ON) = 40% gives 65-80 lpm flow (Venturi)
Pushed in (OFF) = 100% gives 40 lpm of flow

Hand Timing Rod

Allows for manual control of breath delivery

Bennett valve

flow sensitive (flow will decrease when lungs are full)
The unit will end inspiration when flow drops
Heart of unit
breathes with patient and responds to flow

system pressure

what patient is getting

control pressure

setting pressure

Rate control knob

set for automatic cycling ( 0-70)
use for ventilator patients
not used during IPPB

Expiratory Time Control Knob

used with rate knob to adjust expiratory time
modifying rate control setting

Expiratory Timer

used duing controlled ventilation to set a rate
not used during IPPB treatments
caused the unit to time trigger each breath

Terminal Flow Setting

helps compensate for leaks by allowing valve to close
Terminal flow will decrease FiO2 when set on 100%
Pulls in Room Air

Air Dilution

Pushed in (ON) = 40%
Pulled out (OFF) = 100%
Opposite of Bird Mark 7

Air Mix

if flow is restricted: FiO2 increases from 40% to higher because less room air is entrained by injectors

What is the maximal flow with air mixer on (IN)?

40% & 65-80 lpm

What is maximum flow with air mixer off (OUT)?

100% & 40 lpm

What manual control manually controls inspiration or expiration?

Hand Timing Rod

What control do you set to run the nebulizer?

None. It is automatic

What happens if nebulizer line falls off?

Have a leak
Won't cycle off
Won't nebulize

Which Oxygen setting is most commonly used?

Air Mix

What condition may increase the FiO2?

If flow is restricted
Less room air in entrained

What may decrease the FiO2?

Terminal Flow
Air Mix

What is the purpose of terminal flow?

Helps compensate for leaks
Determines when Bennett valve will close
Can add up to 15 lpm of flow to patient

What causes the unit to cycle to expiraton?

When flow drops
Automatic cycling

Indications for IPPB

Need to improve lung expansion
Short term ventilator support
Medication delivery

What is the absolute contraindication?

Untreated Tension Pneumothorax

List 4 things to check if unit won't turn on?

Gas supply
Sensitivity
Circuit disconnects
Check gas flow

Machine won't cycle off after inspiration has begun

Exhalation valve stuck
Sticking Bennett Valve
Bird ceramic switch
leak in circuit

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