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
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
used to start inspiration
what makes it deliver a breath (flow, pressure or time)
what ends a breath (pressure or time)
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
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
-Hyphoscoliosis patients (restrictive disorder)
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)
-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)
recent esophageal surgery
active untreated TB (because of coughing and cavities)
readiographic evidence of blebs
recent facial, oral, or skull surgery
Hazards and Complicaitons
Increased RAW (secretions)
Pulmonary barotrauma, pneumothorax
Respiratory alkalosis (blowing off too much CO2)
Hyperoxia (when using oxygen as gas source, air mix or 100%)
Impaired venous return
air trapping, auto-PEEP, over distention
Respiratory alkalosis from hyperventilating
effects last < 1 hour post tx
MDI's and aerosols should be considered for asthma and COPD patients
Hypoventilation or hyperventilation
Impaction of secretions from inadequately humidified gas
adjusts the trigger sensitivity to patient effort
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
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
what patient is getting
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
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
Pushed in (ON) = 40%
Pulled out (OFF) = 100%
Opposite of Bird Mark 7
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
Which Oxygen setting is most commonly used?
What condition may increase the FiO2?
If flow is restricted
Less room air in entrained
What may decrease the FiO2?
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
Indications for IPPB
Need to improve lung expansion
Short term ventilator support
What is the absolute contraindication?
Untreated Tension Pneumothorax
List 4 things to check if unit won't turn on?
Check gas flow
Machine won't cycle off after inspiration has begun
Exhalation valve stuck
Sticking Bennett Valve
Bird ceramic switch
leak in circuit