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IPPB_EzPap

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					                     IPPB vs. EzPap

Ruby Bueno, Michael Cua, Sherria Miller, Myaa Smith, and Subrina Vohra
                                Lonestar-Kingwood College respiratory Care Program
                                                          Respiratory Care 2243-22001
                           Facilitator: Elizabeth Kelley Buzbee, AAS-RRT-NPS, RCP
                            Abstract

We conducted our study on 10 healthy individuals. The data we gathered
included our study participants vital signs, tidal volumes, and peak flows.
Each participant first used the IPPB and then the EzPap. Then we compared
their peak flows after each use. One of our limitations was that we
conducted our research on healthy participants. Each participant did not
show that much of a change in percentage. We believe if the study had been
conducted on participants with lung disorders there would have been a true
comparison.
                      Hypothesis


IPPB will increase peak flow results when compared to EZPAP
treatments in healthy adults.
IPPB
                  IPPB Background

IPPB is indicated for the need to improve lung expansion. Patients who
cannot cooperate to therapy are also candidates for IPPB(AARC,2003).
IPPB is also indicated for patients who have the inability to clear
secretions due to a certain disease that severely limit themselves to
ventilate or cough on their own (AARC,2003). IPPB is also indicated to
deliver aerosol medication (AARC,2003). In a healthy person, it can
cause barotrauma or pneumothorax, physiological dependence,
nosocomial infections, hypocarbia, hypo- or hyper- ventilation, increased
mismatch of ventilation or perfusion and gastric distention (AARC,
2003).
EZPAP
               EZPAP Background

EZPAP is indicated to treat, prevent and reverse atelectasis. It is also used
to mobilize retained secretions, reduce air trapping and is used as an
aerosol medication delivery device adjunct.
                                  Methodology
1.   EZPAP


       Positive Airway Pressure Device
          1. Ambient Air Inlet
          2. Gas Inlet Port
          3. Pressure Monitoring Port with Cap

       Patient interface – mouthpiece

       7 foot O2 tubing to connect gas inlet port to wall flow meter

      Intended use: EzPap is indicated for use in conjunction with a medical need for lung
      expansion therapy and the treatment and prevention of atelectasis. EzPap may be used
      with nebulizer between patient and device. EzPap is also available with various mask
      sizes.
                       Methodology cont.

Set up: Connect one end of tubing to a 0 -15 lpm flow meter that is connected to 50-60
psi medical air. Connect the patient end of tubing coming from the flow meter to the
device’s gas inlet port. Connect the device pressure port to a pressure gauge. This is
recommended for initial set-up to become aware of pressures transmitted to the patient. If
pressure monitoring is not being done, seal port with attached pressure monitoring port cap.
Pressure monitoring port should not be exposed to ambient air while in use. Attach the
mouthpiece to rounded end of the device. Serrated end is to be exposed to ambient air at all
times. DO NOT OCCLUDE.

Manufacturer:      Smiths Medical ASD Inc
                    10 Bowman Drive
                    Keene, NH 03431 USA
                    www.smiths-medical.com
                        Methodology cont.



2. IPPB (BIRD MARK 7)
    Bird Mark 7 - have two connections on the right side of the machine (the pressure
   side): a large-bore connection for the main breathing hose and one small connection
   for a single drive line. This line splits at the nebulizer to power both the nebulizer and
   the exhalation valve. A splitting device fits over the connection on the nebulizer. The
   drive line connects to this device, and the short piece of tubing connects to

    Positive Airway Pressure Device
       1. Ambient Chamber
       2. Gas source inlet
                      Methodology cont.
Pressure Manometer

IPPB Machine is connected to a 50 psig gas source with high-pressure hose.

Set up: IPPB BIRD 7 machines have a connection for the large-bore tubing, which is
usually attached before being packaged, and a connection on the nebulizer for the line
splitter. Attach the tubing to the appropriate connections on the respirator, making sure all
connections are tight. The connections and tubing are sized so that only the correct tubing
will fit on the connector. Attach the tubing to the nebulizer and exhalation valve assembly.
Again the tubing and connections are sized to prevent incorrect assembly. The small drive
line is attached to the line splitter. The short piece of tubing on the line splitter connects to
the exhalation valve. Attach the patient connection to the nebulizer assembly. Most
disposable circuits come with a six-inch length of large-bore tubing which provides a
reservoir for medication and connects the mouthpiece or other device to the nebulizer.

 Manufacturer: Bird Products Corporation
                1100 Bird Center Drive
                Palm Springs, CA, 92262
                    Methodology cont.


3. PEAK FLOW (Respironics Personal Best Peak Flow Meter)
   A peak flow measures how fast air flows from your lungs. It's a small device that you
  are able to hold in your hand. It's also portable so it can be used for bedside. The peak flow
  meter is known to assist in the management of the asthmatic patients. If any changes are
  needed with their medications, then monitoring the patient's peak flow measurements
  would not be a useful tool.

   Available in both full range (60 – 810 l/min) and low range (50 – 390 l/min).

   Manufacturer: Respironics Houston (RIHS)
                  3605 Willowbend, Suite 500
                  Houston, TX 77054
                     Methodology cont.
Protocol (Experiment) for Methodology

 After obtaining informed consent, explaining the procedure to the test subject,
performing a physical exam with a complete medical history, and getting approval from
the institutional review board, we then conducted our research.

Subject Selection:
   1. No specific age. Adults only
   2. Healthy adults of both sexes
   3. Subjects were selectively chosen from a small population, rural college and the
       local community.
   4. Subjects were selected on health only. Anyone was able to participate as long as
       they were healthy adults without any major health restrictions. If the subject had
       any condition that could complicate their health or the study, he/she was
       eliminated from the study.
                     Methodology cont.
 Prevented disconnection of equipment during usage, made sure all tubing and
connections were securely attached.

 Projected times:
     1. Explained procedures, answered questions and signed consents – 15       minutes
     2. Pt filled out questionnaire – 10 minutes
     3. Vital signs and peak flows were done – 5 minutes
     4. IPPB performed – 10 breath cycles for 1 to 2 minutes
     5. There was a 1 minute break
     6. Checked Peak flows and documented – 2 minutes
     7. There was a 5 minute break between each equipment use
     8. EZ Pap performed – 10 breath cycles for 1 to 2 minutes
     9. There was a 1 minute break
    10. Checked Peak flows and documented – 2 minutes

 Aseptic technique was used between each equipment use and in between each patient.

 There were disposable bacterial filters and tubing for the EZ Pap and IPPB machine.
Patient Code          Peak Flow Results                 Percent (%) Change


               IPPB                       EzPap


Z001                          475                 460                         -3.16


Z002                          350                 400                        14.29


Z003                          330                 330                            0


Z004                          475                 345                        -27.37


Z005                          385                 410                         6.49


Z006                          280                 270                         -3.57


Z007                          340                 300                        -11.76


Z008                           n/a                n/a                          n/a


Z009                          300                 300                            0


Z010                          470                 470                            0


Z011                          375                 355                         -5.33
                                                          Peak Flow

Patient Code     Expected PF          1st PF             2nd PF           3rd PF                    Peak Flow Results

                                                                                             IPPB                       EzPap

Z001                            638               460              475                490               475                        460

Z002                            448               360              390                400               350                        400

Z003                            375               320              320                320               330                        330

Z004                            385               350              290                350               475                        345

Z005                            565               375              430                430               385                        410

Z006                            385               275              280                290               280                        270

Z007                            386               300              325                300               340                        300

Z008                            n/a                n/a             n/a                 n/a               n/a                        n/a

Z009                            497               334              320                310               300                        300

Z010                            622               450              480                470               470                        470

Z011                            469               340              330                360               375                        355

AVERAGE (MEAN)                  477              356.4             364                372               378                        364

RANGE                      375-638             275-460        280-480              290-490          280-475                     270-470

MEDIAN                         458.5              345             327.5               355              362.5                       350
500
                        475                               475                                                               470 470
                              460
450
                                                                            410
                                          400
400                                                                   385
                                                                                                                                      375
                                    350                                                                                                     355
                                                                345                           340
350                                             330 330

                                                                                                    300           300 300
300                                                                               280
                                                                                        270

250


200


150


100


50

      0         0   0                                                                                     0   0
 0
      Patient            Z001        Z002         Z003     Z004        Z005        Z006        Z007       Z008      Z009      Z010     Z011
       Code
                 Limitations
   Money
   Time
   Unhealthy patients
           Recommendations
We would like a research group to mimic our
study on patients:
 With COPD

 With Asthma

 After bronchodilator treatments
                      Conclusion


Based on the results from our research, we found that IPPB
improved peak flows more than EzPap. With the patients that we
have chosen, the difference was very minimal.
                               Glossary
   AARC – American Association of Respiratory Care
   Acapella – A small PEP device that helps to mobilize secretions by providing
    positive expiratory pressure (PEP) therapy and airway vibrations.
   Alveoli – any of the small thin-walled air-containing compartments of the lung
    that are typically arranged in saclike clusters into which an alveolar duct
    terminates and from which respiratory gases are exchanged with the pulmonary
    capillaries
   Ambulatory – Refers to the ability to walk.
   Asthmatic – A chronic respiratory disease, in which the airways unexpectedly and
    suddenly narrow
   Atelectasis – collapse of the expanded lung; defective expansion of the pulmonary
    alveoli
   Auscultation – Listening for sounds within the body, especially from the chest,
    neck, or abdomen. A stethoscope is typically used.
   Barotrauma – Injury caused by increased air or water or pressure
   Bronchodilator – A drug that expands he bronchi by relaxing bronchial muscles.
                        Glossary cont.
   COPD- (chronic obstructive pulmonary disease) a progressive lung disease
    process characterized by difficulty breathing, wheezing, and a chronic cough
   CPT Chest physiotherapy; technique used to mobilize or loose secretions in the
    lungs and respiratory tract.
   Dyspnea-Air hunger resulting in labored breathing or difficult breathing,
    sometime accompanied by pain
   EKG (Electrocardiogram) – A record of the electrical activity of the heart
    consisting of waves called P, Q, R, S, T and sometimes U.
   Emesis – Vomiting. It may be of gastric, systemic, or neurological origin.
   Exacerbation-Worsening or a “flare up” of COPD
   Fistula- an abnormal connection between two organs, or between an organ and the
    outside of the body
   Gastric-Stomach
                         Glossary cont.
   Hemoptysis-Blood spitting, the act of coughing up blood
   Hypercapnia – An increase in the partial pressure of carbon dioxide in the blood,
    typically to levels greater than 45-50 mmHg.
   Hyperoxia-An excess of oxygen in the system
   Hyperventilation – Excessive ventilation; excessive rate and depth of respirations
    leading to loss of carbon dioxide from the blood
   Hypocarbia - Less than normal level of carbon dioxide in the blood.
   Hypoventilation- deficient ventilation of the lungs that results in reduction in the
    oxygen content or increase in the carbon dioxide content of the blood or both
   Hypoxemia-A deficiency in the concentration of dissolved oxygen in arterial
    blood
   Infiltrates- Allowing dirt and water to enter into something
   Infiltrates- Allowing dirt and water to enter into something
   Intracranial pressure- Pressure of the cerebrospinal fluid in the head with sensor
    inserted through the skull
                         Glossary cont.
   Intubation-The insertion of a tube into any hollow organ. Intubation of the trachea
    provides an open airway and thus is an essential step in advanced life support.
   IPPB- Intermittent positive pressure ventilation
   IS – (incentive spirometry); also referred to as sustained maximal inspiration
    (SMI), is a component of bronchial hygiene therapy
   Kyphoscoliosis- Lateral curvature of the spine accompanied by the anterioposterior
    hump.
   MDI- ( metered dose inhaler)small aerosol canister in a plastic container that
    releases a mist of medication when pressed down from the top. This medication
    can be breathed into the airways
   Mechanical ventilation-Artificially inflating and deflating the lungs to force gas
    exchange in the lungs
   Nebulizer-An apparatus for producing a fine spray or mist. This may be done by
    rapidly passing air through a liquid or by vibrating a liquid at a high frequency so
    that the particles produced are extremely small.
   Neuromuscular-Concerning both nerves and muscles
                         Glossary cont.
   Nosocomial infections-Any infection that first occur during a patient’s stay at a
    health-care facility, regardless of whether it was detected during or after the stay.
   NPPV (non-invasive positive pressure ventilation); refers to delivery of
    ventilatory support using a mechanical ventilator connected to a mask or
    mouthpiece instead of an endotracheal tube.
   Peak Flow-A peak flow meter is a small, hand-held device used to manage asthma
    by monitoring airflow through the lungs
   PEEP Positive end expiratory pressure; term used in mechanical ventilation to
    denote the amount of pressure above atmospheric pressure present in the airway at
    the end of the expiratory cycle
   PEP – Positive Expiratory Pressure
   Perfusion- An act of perfusing the pumping of a fluid through an organ or tissue
   Pneumothorax- accumulation of air or gas in the pleural cavity.
   Pneumatically-Powered by compressed air
                         Glossary cont.
   Spirometer- A spirometer is an instrument for measuring the volume of air
    inspired and expired by the lungs.
   Sputum – Mucus expelled from the lung by coughing. It may contain a variety of
    materials from the respiratory tract, including in some instances cellular debris,
    mucus, blood, pus, caseous material and/or microorganisms.
   Stethoscope – An instrument used to transmit o the examiners ears sounds
    produced in the body. It ordinarily consists of rubber tubing in a Y shape and a
    bell or diaphragm.
   TB (tuberculosis)-A disease caused by the bacterium Mycobacterium tuberculosis
    that usually causes an infection of the lungs.
   Venous- Venous blood is blood returning to the heart in veins.
   Ventilation- The movement of air into and out of the lung
   Wheezing- A wheeze is a continuous, coarse, whistling sound produced in the
    respiratory airways during breathing Infiltrates- Allowing dirt and water to enter
    into something
                          Bibliography
AARC. (2003).AARC clinical practice guideline: intermittent positive pressure
        breathing-2003 revision and update. Respiratory Care, 48(5), 540-546.

AARC. (1993). AARC clinical practice guidelines: use of positive airway pressure
          adjuncts to bronchial hygiene therapy. Respiratory Care, 38(5), 516-521.
.
van der Scahans, Cees P.(2007) Conventional chest physical therapy for obstructive
          lung disease. Respiratory Care, 52(9), 1198-1208

Taber, Clarence Wilbur. (2005). Taber’s cyclopedic medical dictionary (Ed. 20).
          Philadelphia: Davis Co.
THE END