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Administering IPPB

2. Equipment preparation. While respiratory care departments have standard protocols regarding preventive maintenance and calibration of equipment, it is the RCP's responsibility to ensure that all components are in proper working order prior to any patient use. For example, it is important to check the patency of the patient's breathing circuit prior to each use. The RCP merely needs to aseptically occlude the patient connector, manually triggering a breath at a low flow setting. If the system pressure rises and the machine cycles off, the circuit is free of any major leaks.
   
   
3. Patient orientation. Prior to treatment, the RCP must provide the patient with an explanation (tailored to meet the individual patient's level of understanding) of the what is about to take place. At very least, the explanation should address the following:
   
   
   • why the physician ordered the treatment
     
     
   • what the treatment does
     
     
   • how it will feel
     
     
   • what the expected results are
     
     
   To avoid intimidating the patient, the RCP should bring the IPPB device to the bedside only after confirming that the patient adequately understands the procedure and the importance of cooperation. For some patients, a simulated demonstration of the procedure may be needed to successfully implement the treatment.
   
   
4. Patient positioning. To assure effective delivery of IPPB therapy, patients should be positioned in as close to an upright posture as possible.
   
   
5. Adjusting parameters. When the treatment has commenced and the patient's basic ventilatory pattern has been established, settings can be adjusted and monitored according to the goals of the individual patient's therapy.
   
   
6. Discontinuance and follow-up. Depending on the goals of therapy and condition of the patient, IPPB treatments typically last from 15 to 20 minutes. Followup activities include post-treatment assessment of the patient, documentation, and equipment maintenance. Specific follow-up assessments provide information relevant to evaluating progress toward achieving the goals of therapy.

Monitoring of IPPB therapy involves both machine performance and patient response. The information gathered during monitoring directs the RCP's troubleshooting efforts to adjustment the therapy, and can aid in the identification of common problems. The monitoring of IPPB therapy includes the following:

Machine performance:

• Sensitivity
• Peak pressure
• Flow setting
• FIO2
• Inspiratory time
• Expiratory time
• I:E ratio

Patient response:

• Breathing rate and expired volume
• Peak flow of FEV1/FVC%
• Pulse rate and rythm (from EKG if available)
• Sputum characteristics
• Mental function
• Skin color
• Breath sounds
• Blood pressure
• SpO2 (when hypoxemia is suspected)
• ICP
• Chest X-ray
• Subjective responses to therapy

Machine performance. Large negative pressure swings early in inspiration indicate an incorrect sensitivity or trigger setting on the machine. A flow that is set too high can cause the device to cycle off prematurely. Leaks can also be a problem, and to troubleshoot leaks, the RCP should differentiate between the machine and patient interface.

Patient response. RCPs monitoring patient response must take into account both the goals of the therapy and the patient's clinical conditions. If any significant adverse responses are encountered, RCPs should follow the triple-S rule: stop, stay, stabilize. Stop the treatment; stay with the patient, calling for help if needed; and, don't leave until the patient's condition is stabilized.