IPPB USER GUIDE 2008A
Contents
1. VORTRAN Medical Technology 1 Inc Rev 10 23 2008 IPPB User s Guide Ill Protocol VORTRAN I PPB Date Adopted Dates Revised Dates Reviewed p a nn 1 0 PURPOSE To give guidance and direction in the proper set up and delivery of IPPB 2 0 APPLICABILITY All respiratory therapy clinical staff 3 0 AUTHORITY 3 1 Medical Director of Respiratory Therapy 3 2 Department Manager of Respiratory Therapy 4 0 DEFINITIONS 4 1 IPPB Intermittent positive pressure breathing 5 0 REFERENCES 5 1 AARC Clinical Practice Guidelines Respiratory Care November 93 Vol 38 No 11 Intermittent Positive Pressure Breathing 6 0 POLICY 6 1 IPPB treatments are given only on the order of a physician 6 1 1 Said order must include the frequency and the medication with the dosage 6 2 Caution should be used in regard to pressures and rates achieved during PPB treatments to avoid possible pneumotho rax or hyperventilation 6 3 When medication is ordered add normal saline up to 20 mL solution for treatment 6 4 Ifthe tidal volume is not specified use the least amount of pressure to deliver 10 to 15 mL per kilogram of body weight 6 5 If oxygen percentage is not ordered use air mix attached to the oxygen If the patient is a COPD with carbon dioxide retention compressed air should be used 6 6 If orders are incomplete the physician must be contacted and the situation clarified Page 5 VORTRAN Medical Technology 1 Inc R2. 7 6 3 18 Document treatment Refer to 7 8 Assessment of Outcome 7 7 1 Chest x ray improved 7 7 2 Tidal volume during IPPB greater than during spontane ous breathing by at least 25 7 3 More effective cough 7 4 Increase in peak flow or FEV 7 5 Improvement in breath sounds ocumentation 8 1 Complete all charting and place into the patient s medical chart 7 8 1 1 Tolerance to therapy 7 8 1 2 Complications 7 8 1 3 Medication dosage 7 8 1 4 Vital signs pre and post heart rate respiratory rate and pattern 7 8 1 5 Date time 7 8 1 6 Other relative information 7 8 1 7 Operating pressure cm H O 7 8 1 8 7 8 1 9 7 7 re D vs Cough effort and production FiO air mix 100 Note Do not include in charting any reference that an Occurrence Report was completed 7 8 2 Out patient charting is to be completed on a PIC Patient Information Card Place yellow copy in metal filing bin located in RT report room Page 8 VORTRAN Medical Technology 1 Inc Rev 10 23 2008 IPPB User s Guide IV Cautions and Warnings Cautions Federal law restricts the use of this device to sale by or on order of a physician or properly licensed practitioner To be used only by persons having adequate training Patients connected to this device are to be monitored continuously by persons having adequate training Do not leave patients unat tended Positive End Expiratory Pressure PEEP is intrinsic to this device
3. PEEP will typically be 1 10 PIP and will range from 2 to 5 cm H O depending on pressure settings Verify actual PEEP with a ma nometer Smoking or open flames in an oxygen enriched environment is extremely dangerous Warnings This device is to be used by properly trained personnel to deliver intermittent positive pressure breathing aerosol Page 9 VORTRAN Medical Technology 1 Inc Rev 10 23 2008 IPPB User s Guide V VORTRAN I PPB COMPETENCY How to set up and deliver PPB Intermittent Positive Pressure Breathing treat ments using the VORTRAN IPPB a single patient use device that is easier to set up and more cost effective than the conventional IPPB machine Objectives 1 To be able to set up clean and care for the VORTRAN IPPB 2 To know the recommended flow and pressure settings for the I PPB 3 To know the total amount of medication and saline diluent that should be used for a 15 minute treatment Troubleshooting 1 If the patient complains that it is hard to exhale should adjust the rate dial clock wise to increase exhalation resistance True False 2 IfI dilute the concentration of medication with saline diluent my patient should be getting the same amount of medication after completing the 20 minute treatment True False After completion of the VORTRAN IPPB competency the Respiratory Care Practitioner should be able to set up the IPPB and troubleshoot problems t
4. Rev 10 23 2008 USER S GUIDE VORTRAN I PPB Unique single patient multiple use disposable PPB o VORTRAN IPPB only o VORTRAN IPPB o VORTRAN IPPB IP 4020 with Water Trap with Manometer IPW 4021 IPM 4022 TABLE OF CONTENTS Tab OT Contents tered et eh cera tere tay EEEE a uns Petey Parte 1 I Functional and Operational Characteristics eeee 2 Figure 1 VORTRAN IPPB Component Description 2 Il Clinical Considerations ccceeee cece eee eee eee eee ee ee ee eens 3 Table 1 Estimated Tidal Volume at Various Flow Rate 3 Figure 2 Airway pressures PIP amp PEEP ccce 4 IHI Protocol Setup Instructions IPPB 5 IV Cautions and WarningS w22 5052 icicle ve boat bil ddeeteut Meadkoe pl an dhodk ae 9 V VORTRAN IPPB Competency cccceeee cece tees eee eee e eee eeaaee 10 VI Frequently Asked Questions ceceeeeee eee eee eeeeeeeeeaes 11 VII Clinical Reference s 2622 3 2castec needed eeebibe ize eats towered Meee orate 13 VIH Coding Informatio ssri inai ei a a o te Ma ee eter 15 IX Tr ublesh oting asnos a coe eee 16 X Ordering Information 22 4 0i 02 Ags ees autece cea gens ede les ie iaced cals 16 Xie AQUICK GUJE eclosion rane eased E E neues pace ec aie eeaas 17 VORTRAN Medical Technology 1 Inc 21 Goldenland Court 100 Sacramento CA 95834 Tel 800 434 4034 www vortran com Fax 916 648 9751 office vortran com VORTRAN
5. Care Policy and Research AHCPR Health Technology Report Intermittent Positive Pressure Breathing IPPB Therapy 1991 Number 1 2 Walter J O Donohue Jr M D F C C P Maximum Volume IPPB for the Management of Pulmonary Atelectasis Chest December 1979 76 6 683 687 Page 14 VORTRAN Medical Technology 1 Inc Rev 10 23 2008 IPPB User s Guide VIII Coding information HCPCS HCFA Health Care Financing Administration Common Procedure Coding System PRODUCT VORTRAN I PPB CODE E0500 DESCRIPTION IPPB machine all types with built in nebulization manual or automatic valves internal or external power source INSTRUCTIONS Coverage issue CIM 60 9 Rental only CPT Current Procedure Terminology American Medical Association PRODUCT VORTRAN I PPB CODE 94640 DESCRIPTION The code for the nebulizer treatment 94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes e g with an aerosol generator nebulizer metered dose inhaler or intermittent positive pressure breathing IPPB device CODE 94664 DESCRIPTION The code for the nurse s instructions 94664 Demonstra tion and or evaluation of patient utilization of an aerosol generator nebulizer metered dose inhaler or IPPB device REMARKS You should submit th
6. Medical Technology 1 Inc Rev 10 23 2008 IPPB User s Guide l Functional and Operational Characteristics The VORTRAN I PPB is a disposable IPPB device intended to provide an inter mittent positive pressure aerosol treatment The VORTRAN I PPB is a H modulator coupled with a nebulizer and provides the same ventilatory affect as the VORTRAN Automatic Resuscitator VAR combined with aerosol from the nebulizer The nebulizer provides the continuous flow of gas and a patient demand valve When pressure reaches the peak inspiratory pressure PIP as set by the 1 a PIP dial on the modulator the modulator opens and exhalation begins through the Rate dial As with the VAR flow and inspiratory time control the tidal volume see Table 1 Inspiratoy time is controlled once the flow is set by the PIP dial The VORTRAN IPPB is intended to be used primarily in the pressure support mode so each inhalation is triggered by the patient Figure 1 VORTRAN IPPB Component Description 4 Demand valve N1 Modulator J al Nebulizer top SO 2c Dati Rate dial hn Gass Patient mouthpiece 2 b Nebulizer reservoir 3 i Water trap l Gas inlet not shown Optional Suitable patient body weight Greater than 30 kg adults Adjustable peak pressure range 20 to 50 cm H O PEEP Ea a OA a dict iene A nutes ds 2 to 5 cm H O Supply pressure sssssssssssrrrrrrrrrrrree 50 5 PSIG Aerosol output during inhala
7. correct the problem The following case reports are presented to demonstrate the usefulness of IPPB in hospitalized patients with atelectasis when it can be documented that the inspiratory capacity is increased by means of this therapy Page 13 VORTRAN Medical Technology 1 Inc Rev 10 23 2008 VII IPPB User s Guide Clinical Reference continued Mario Romano RCP CLINICAL COMPARISON OF TWO IPPB DEVICES PIPER IPPB amp BIRD IPPB presented at 45 AARC International Respiratory Congress in Las Vegas Nevada December 13 16 1999 BACKGROUND Intermittent Positive Pressure Breathing IPPB is a technique used to provide short term or intermittent mechanical ventilation to augment lung expansion deliver aerosol medica tion or assist ventilation for the treatment of atelectasis The use of IPPB to provide large inspira tory volumes when patients cannot take deep breaths has been found to be beneficial in the manage ment of atelectasis where other approaches have failed Since the Bird IPPB is no longer being manufactured the shortage of spare parts makes it difficult to maintain existing units This study compares a new single patient use IPPB device the Piper IPPB VORTRAN Medical Technology 1 with the conventional IPPB Bird Mark 7 Positive Phase Medical Respirator Bird Corpora tion METHODS Two clinically stable female patients one with COPD and one with CHF ages 72 and 74 received 10 minut
8. apy have the patient relax and let the ma chine do the work for him her RCP must stay in the room or close proximity Have the patient breath slowly and evenly through the mouth with the mouthpiece between the teeth and keeping lips tight When the mouthpiece is in front of the teeth the medi cations are not being delivered to the lungs Have the patient perform breathing exercises making sure to relax the accessory muscles Coaching is impor tant Page 7 VORTRAN Medical Technology 1 Inc Rev 10 23 2008 Ill Protocol 7 7 7 8 IPPB User s Guide VORTRAN IPPB continued 7 6 3 10 Have the patient do inspiratory holds 2 to 3 times every 10 to 20 breaths 7 6 3 11 Take the pulse rate and respiratory rate If the pulse rate increases 20 over baseline stop the treatment and have the patient rinse his her mouth Notify the physician RN and complete Occurrence Report 7 6 3 12 Ask the patient how he she feels mid treatment as far as dizziness nausea tingling fingers or any other strange feeling Tell the patient to let you know as soon as any of these things occur 7 6 3 13 Observe the patient for respiratory distress or other adverse reactions 7 6 3 14 Mid treatment have the patient take a rest deep breath and cough 7 6 3 15 At completion of therapy take the pulse rate respiratory rate and listen to breath sounds 7 6 3 16 Have the patient take a deep breath and cough 7 6 3 17 Clean up area and wash hands
9. ased by turning the rate dial counter clockwise If rotating the rate dial counter clockwise substantially does not re initiate cycling an adequate seal may not exist between patient and mouthpiece The VORTRAN IPPB runs on a continuous flow of gas inspiratory flow of up to 40 L min When connected to a 50 PSIG flow source the VORTRAN I PPB will automatically deliver 40 L min Peak pressure may be adjusted from 20 and 50 cm H O set PEEP is typically 1 10 of Peak Pressure Inspiratory time and rate are adjustable over a wide range The VORTRAN IPPB nebulizer is equipped with an air entrainment valve which allows the patient to entrain additional air through the nebulizer when de sired and allows the VORTRAN PPB to respond to the demands of the patient Pressure Support When the patient entrains outside air the percent oxy gen delivered to the patient will decrease otherwise the patient receives the concentration of oxygen supplied to the VORTRAN IPPB The design of the modulator is similar to that of a pop off valve and is inherently safe The VORTRAN PPB is not equipped with a redundant pop off valve Table 1 Estimated Tidal Volume mL at Various Flow Rate LPM Flow Inspiratory Time seconds LPM 1000 Page 3 VORTRAN Medical Technology 1 Inc Rev 10 23 2008 IPPB User s Guide Clinical Considerations continued Peak pressures listed on the side of the pressure dial are only approximate A manometer may be conn
10. e appropriate evaluation and man agement E M office visit code and the correct J code for the supply of the nebulizer drug You should also add modifier 25 to the E M code to indicate that it was a significant separately identifiable service from the other services described Page 15 VORTRAN Medical Technology 1 Inc IX Troubleshooting e Flow meter only go to 15 or 16 L min e No visible aerosol output e Exhalation is too hard X Ordering information Product Description VORTRAN I PPB only VORTRAN I PPB with Water Trap VORTRAN IPPB with Manometer Rev 10 23 2008 IPPB User s Guide N e Accessories Order Number X I PW 4021 IPM 4022 Cause Action Flush open Typical flow meter with 50 PSIG source pressure will deliver up to 40 L min Use a high flow flow meter go to 75 L min Increased gas flow an increase in supply gas flow may increase nebulizer output maximum 40 L min Out of solution refill reservoir require 3 to 5 mL solution minimum to charge the nebu lizer High supply flow reduce supply gas flow Low PIP setting increase PIP as needed High exhalation resistance adjust rate dial out counter clockwise or remove rate dial completly VORTRAN Medical Technology 1 Inc Rev 10 23 2008 IPPB User s Guide XI Quick Guide Add medication Step 1 Add the medication Rotate the nebu lizer bottom a quarter tur
11. ected between the modulator and the nebulizer The VORTRAN IPPB will still function when there is some leaking In the presence of a leak VORTRAN IPPB will still cycle between peak pressure and PEEP Noticeable changes in the presence of a leak are increased inspiratory times and decreased expiratory times When reassembling the VORTRAN IPPB it is important to ensure that the nebulizer cap is screwed on securely and that the modulator is firmly connected to the nebulizer The VORTRAN IPPB may be cleaned by disconnecting the modulator from the nebulizer removing the nebulizer cap rinsing and allowing it to air dry Additionally if needed the rate dial may also be removed to facilitate clean ing Inhalation and exhalation are audibly detectable and easily recognizable during operation of the VORTRAN I PPB Figure 2 Airway Pressures PIP amp PEEP 1 PIP BEGINNING OF EXHALATION i END OF EXHALATION 2 PEEP PATIENT AIRWAY PRESSURE cm H20 4 INSP TIME 5 EXHALATION TIME PIP Set by PIP DIAL control INSPI RATORY TIME tinsp PEEP Approximately 1 10 of PIP setting INSPIRATORY FLOW RATE Q Maximum 40 L min 667 mL sec INSPIRATORY TIME tinsp Time required to reach PIP EXHALATION TIME texni Time required to drop from PIP to PEEP Tidal Volume Q X tinsp RESPIRATORY RATE RR 60 tinsp texni RATE DIAL Set exhalation resistance and change RR ONOUBWNE Page 4
12. edure 7 6 1 Preparing the patient 7 6 1 1 7 6 1 2 7 6 1 3 Check the patient s chart for specific order The order must include frequency and medication Review the patient s chart as for history lab work medications allergies and any known history of ad verse reactions to IPPB Enter the patient s room and introduce yourself also check the patient s identification band Explain the therapy etting up the equipment Wash hands Attach the IPPB device to the appropriate 50 PSIG out let Place the appropriate medications in the nebulizer cup Patient Application 7 6 3 3 7 6 3 4 7 6 3 5 7 6 3 6 7 6 3 7 7 6 3 8 7 6 3 9 Position the patient in the most comfortable and advan tageous way to receive therapy 1 Sitting in a chair or on the edge of the bed 2 Postural drainage positions may improve efficacy of therapy depending on the patient Turn on the flow The normal flow for VORTRAN IPPB is 30 L min to maximum of 40 L min Using a flow meter that covers the range from 0 75 L min such as a Timeter Classic Series Flowmeter 0 75 L min Model A 75 for air or Model O 75 for oxygen Allied Healthcare Products Inc Initially adjust the pressure low and slowly readjust until desired level obtained Nebulizer will stay on during expiration as well as inspi ration to keep mist in dead space Take the patient s pulse rate respiratory rate and listen to breath sounds During ther
13. es of the Bird IPPB and the Piper IPPB in alternate therapy sessions Each treatment included 0 5 cc albuterol 2 5 mg unit dose ipartropium bromide 0 5 mg and 10 cc normal saline A compressed gas source was used for both devices and pulse oximetry O Sat heart rate HR blood pressure BP and breath sounds BS were monitored before and after each therapy Piper IPPB Bird IPPB Piper IPPB Bird IPPB PIP Set 20 cm H O 15 cm H O 25 cm 25 cm H O 3 Pee fe be a pa e 136 67 128 64 141 70 142 70 148 45 154 50 139 46 151 49 Crackle at bases Diminished at base session RESULTS Patients vital signs are summarized below DISCUSSION One patient reported that the work of breathing was easy and that the inspiratory flowrate was just right for both devices The other patient reported that the inspiratory flowrate for both IPPBs was too slow and that the work of breathing for Piper IPPB was slightly harder No significant changes in vital signs were noted with either device Both patients found the Piper IPPB easy to use and preferred it to the conventional Bird IPPB CONCLUSIONS The Piper IPPB can be a safe and effective method of delivering IPPB treatment without the need for conventional IPPB capital equipment Using a larger patient population in a future study can help establish the Piper IPPB as a safe and effective treatment modality Supported by VORTRAN Medical Technology 1 Inc 1 Agency for Health
14. ev 10 23 2008 IPPB User s Guide Ilil Protocol VORTRAN IPPB continued 7 0 PROCEDURES 7 1 7 2 7 3 7 4 7 5 Age specific considerations age 12 or greater Equipment 7 2 1 VORTRAN IPPB 7 2 2 Compressed air source Indications 7 3 1 Atelectasis when other forms of therapy have been unsuccessful incentive spirometry chest PT deep breath ing exercises or the patient cannot cooperate 7 3 2 Inability to clear secretions adequately because of pathol ogy that severely limits the ability to ventilate or cough effectively 7 3 3 To deliver aerosol medications when other techniques MDI or nebulizer have been unsuccessful ontraindications 4 1 Intracranial pressure gt 15 mm Hg 4 2 Hemodynamic instability 4 3 Recent facial oral or skull surgery 4 4 Tracheoesophageal fistula 4 5 Recent esophageal surgery 4 6 Active hemoptysis 4 7 Nausea 4 8 Air swallowing 4 9 Active untreated tuberculosis 4 10 Radiographic evidence of bleb 4 11 Singulation hiccups azards Complications 1 Increased airway resistance 2 Barotrauma pneumothorax 3 Nosocomial infection 4 Hypocarbia 5 Hemoptysis 6 Gastric distention 7 Impedance of venous return 8 Hypoventilation 9 Air trapping 10 Increased ventilation perfusion mismatch 11 Impaction of secretions Page 6 VORTRAN Medical Technology 1 Inc Rev 10 23 2008 IPPB User s Guide Ilil Protocol VORTRAN IPPB continued 7 6 7 6 2 7 6 3 Proc
15. hat may arise in its use Department Dates Completed Page 10 VORTRAN Medical Technology 1 Inc Rev 10 23 2008 IPPB User s Guide Vi FAQ Frequently Asked Questions Question Answer 1 What is the sensitivity The VORTRAN IPPB is pressure cycled between or pressure drop required to trigger the VORTRAN I PPB into inhalation PIP and PEEP Therefore as soon as the patient draws a breath to the baseline PEEP 1 10 of PIP inhalation will start Sensitivity may be set as light as 1 cm H O or less Does the VORTRAN IPPB work with a mask or an endotra cheal tube The VORTRAN I PPB is inherently safe but is not equipped with a redundant pop off valve Therefore the VORTRAN IPPB should never be used with an endotracheal tube and used cau tiously with a mask Peak pressure ranges are indicated on the pressure dial but what is the expected PEEP 4 Can I use a manometer to record patient PI P How can measure tidal volume when using the VORTRAN IPPB If connect to a 15 L min flowmeter and dial it all the way up what flow will get through the VORTRAN I PPB Can connect the VORTRAN IPPB di rectly to a wall source of 50 PSIG Peak pressure indications on the pressure dial are approximate only PEEP is typically 1 10 peak pressure Peak pressure ranges between 20 and 50 cm H O and PEEP ranges between 2 and 5 cm H O respectively Pressures may be verified by c
16. ion I time x Flow Tidal Volume Flow 40 LPM Results The average measured and calculated tidal volumes are summarized below I time Sec Meas Vt L Calc Vt L Difference 1 0 565 663 14 76 1 2 707 829 14 79 1 5 862 1 033 16 57 1 9 1 157 1 290 10 30 2 2 1 210 1 451 16 65 Discussion To assess the therapeutic efficacy of an IPPB treatment tidal volume may be measured Handheld spirometers and venticomp bags are two of the volume measuring devices currently used Tidal volume can also be calculated using the calculation I time x Flow There is only an approximate 15 difference between the measured tidal volume of the Piper IPPB and the calculated tidal volume This may be due to inherent leaks or timing errors Conclusion Since there is only an approximate 15 difference between the calculated and measured tidal volumes The calculated value may be a more efficient and cost effective way to monitor patient tidal volume when giving IPPB treatments Further studies are warranted Supported by VORTRAN Medical Technology 1 Inc 1 Agency for Health Care Policy and Research AHCPR Health Technology Reports intermittent positive pressure breathing IPPB therapy 1991 Number 1 Walter J O Donohue Jr M D F C C P Maximum Volume IPPB for the Management of Pulmonary Atelectasis Chest December 1979 76 6 683 687 There are few therapeutic modalities in medicine that are more controversial than the use of i
17. n and remove it Mea sure the prescribed amount of medication and dilute with saline to obtain the desired total volume There should be 1 mL of solution for every minute of treatment Connect tubing Step 2 Connect the oxygen supply tubing and set the de sired flow A quick function check be performed on the PPB prior to connecting it to the patient Observe the aerosol coming from the mouthpiece then occlude the mouthpiece and watch for aerosol flowing from the rate dial Set desired flow Step 3 Instruct the patient to create a seal on the mouthpiece Set pressure Step 4 Set the pressure dial to achieve the de sired peak inspira tory pressure as prescribed by the physician Adjust rate pS ep 5 Adjust the r te dial to the p tient s comfort This Quick Guide is intended to help you gain a general understanding of the VORTRAN IPPB product Please be certain to read understand and follow the information listed in this User s Guide before using this product 2005 VORTRAN Medical Technology 1 Inc Sacramento California U S A Page 17
18. nspiratory positive pressure breathing IPPB Studies which have failed to separate the therapeutic effect of bronchodilators from possible mechanical effects of IPPB have clouded the issue considerably Today there is substantial evidence that the delivery of a bronchodilator by means of a positive pressure breathing device does not enhance bronchodilation Additionally there is no evidence that IPPB is beneficial as part of the routine management program for patients with stable chronic obstructive lung disease It is possible that there are subgroups of patients with obstructive pulmonary disease who may derive some beneficial effects from IPPB but substantiating data are not currently available The lack of demonstrable efficacy of IPPB as it has been commonly employed along with strenuous attempts at cost containment of medical care has resulted in the general assumption by some that IPPB is of no value under any circumstance The swing of the pendulum against IPPB has led to the substitution of other thera peutic techniques which are unproven by critical evaluation The assumption that IPPB is not useful for any pulmonary disorder simply because it has been abused and misused in the past is unjustified and scientifically naive The use of IPPB as a technique to provide large inspiratory volumes when patients will not or cannot take deep breaths has been found to be beneficial in the management of atelectasis where other approaches have failed to
19. onnecting a manometer between the modulator and the nebulizer Yes You can connect an in line manometer between the modulator outlet and water trap inlet Tidal volume may be determined by using the tidal volume chart included with the instructions Tidal volume is the inspiratory time multiplied by the flow rate Orifice type flowmeters similar to those com monly used on E cylinders will flow at a maxi mum of what is indicated on the gauge Timeter and other flowmeters using a floating ball as an indication of flow are capable of being adjusted to flows above what is indicated If connecting to a Timeter flowmeter and adjusting the dial all the way open the float will be slightly above the 15 L min flow mark but 40 L min will actually be flowing through the VORTRAN IPPB As long as the hospital gas supply or cylinder regulators are adjusted to 50 PSIG which is the standard the design flow going through the VORTRAN IPPB is 40 L min Yes when connected directly to a 50 PSIG source the maximum flow is 40 L min 10 Page 11 VORTRAN Medical Technology 1 Inc Rev 10 23 2008 Vi IPPB User s Guide FAQ Frequently Asked Questions Question Answer 8 Does the gas supplied to the VORTRAN I PPB flow continuously during exhalation and inhalation Yes 10 11 12 13 have a patient who needs to use the VORTRAN IPPB at home Will it work with the Pulmoaide How much and
20. stly ensure that you are still providing adequate flow and there is a good seal between the patient and the mouthpiece Page 12 VORTRAN Medical Technology 1 Inc Rev 10 23 2008 IPPB User s Guide VII Clinical Reference Shawan Huff RRT COMPARISON OF THE MEASURED TIDAL VOLUME VS THE CALCULATED TIDAL VOLUME IN THE PIPER IPPB presented at 46 AARC International Respiratory Congress in Cincinnati Ohio October 7 10 2000 BACKGROUND Intermittent Positive Pressure Breathing IPPB is a technique used to provide short term or intermittent mechanical ventilation for the purpose of augmenting lung expansion delivering aerosol medica tion or assisting ventilation 1 To assess the therapeutic efficacy of an IPPB treatment tidal volume may be measured This study compares the measured tidal volume and the calculated tidal volume of the Piper IPPB device Methods The Piper IPPB is connected via a custom adapter to a Wrights Respirometer Mark 14 and then to a Michigan Instruments Inc Vent Aid TTL Timing is accomplished using a Sportline Alpha 1 410 Splitimer A Timeter flow meter is connected to a 50 PSI air source and 40 LPM is supplied to Piper IPPB nebulizer The inspiratory time is controlled by adjusting PIP and lung compliance For ten breaths cycles both I time and delivered tidal volume are summed and averaged Fifteen points are collected and the average tidal volumes obtained The calculated tidal volume is obtained using the calculat
21. tion Up to 1 mL min Operating environmental limits 10 to 50 C Storage environmental limits 20 to 60 C Nebulizer reservoir 2 ceeeeee 20 mL Gas IMIG e peels ener seeks ate a DISS oxygen connection VORTRAN Medical Technology 1 Inc Rev 10 23 2008 IPPB User s Guide Clinical Considerations The VORTRAN IPPB provides short term pressure cycled constant flow ventilatory support in combination with aerosol The VORTRAN PPB is pres sure cycled on inhalation and exhalation PIP and PEEP which minimizes the possibility of gas trapping During inhalation exhalation will not start until peak pressure is reached During exhalation inhalation will not begin until the patient draws the pressure to baseline Unlike the VAR the VORTRAN IPPB only provides the spontaneous mode pressure support for most set tings Pressure control is not available Set up and use of the VORTRAN IPPB is simple see instructions in Section 3 Setup Protocol Set desired flow adjust pressure dial to obtain desired pressure I time or tidal volume see Table 1 Estimated Tidal Volume and adjust rate dial to obtain desired sensitivity The rate dial actually controls the rate of exhalation and typically the VORTRAN IPPB will be in the Pres sure Support mode when delivering a treatment If the patient has trouble initiating inhalation then it is possible that the sensitivity has been set too high and may be decre
22. what kind of medication do place in the nebulizer How do I get 20 mL of fluid in the nebu lizer Is there a problem with my IPPB if it leaks a little fluid The VORTRAN I PPB am using was work ing fine on prior treatments and is now not cycling well What s wrong No the maximum flow generated by the Pulmoaide and other similar compressors used with small volume nebulizers is about 10 L min Most hospital equipment rental agencies rent larger compressors If the compressor gener ates enough pressure and flow for the patient to be comfortable and to produce aerosol then it is sufficient The nebulizer will start generating aerosol at about 15 L min at a pressure of 15 20 PSIG Most patients will desire more than 15 L min of flow to be comfortable A physician must prescribe the medication and amount for each treatment Commonly used medications are b agonists anticholinergics and mucolytics To mix the medication first place the prescribed amount of medication into the nebulizer reser voir then add saline or respiratory quality water to make a total volume of 20 mL A small amount of fluid leakage is inherent in any non sealed pressurized vessel It is important to assemble the VORTRAN I PPB tightly If a large leak is present it will not work as well This is particularly important after cleaning Be sure the nebulizer cap is screwed on tightly and the modulator has been pushed firmly in place La
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