INTRAPULMONARY PERCUSSIVE VENTILATION (IPV)

SUGGESTED VENTILATOR PROTOCOL

 

 

VENTILATOR PATIENT PROCEDURE:

1.             For PB 7200 ventilator: Treatment can be done in either volume or pressure control

A.                  Place ventilator in the SIMV or CPAP Mode.

1.             A/C mode with volume control ventilation will cause each percussion to be delivered at ventilator settings.

B.            Turn off Pressure Support/Flow-By

C.                   Respiratory rate of  > 8 breaths per minute (bpm) (7200 ventilator only)

1.             On the 7200, with respiratory rates < 8 bpm, while administering Intrapulmonary Percussive Ventilation therapy inline, perceived tidal volumes my register at > 8 L during one breath cycle.  This will cause a 4205-error code.  When this error code appears, the 7200 shuts down. 

2.               If three of the 4205 alarms occur, within a 24-hour period, the 7200 stops operation and                 

requires an EST to be run.

3.             Mean Airway Pressures will increase slightly with the administration of Intrapulmonary Percussive Ventilation inline with the ventilator.  The Respiratory Care Practitioner needs to be aware of this effect and monitor the patient closely for any adverse side effects.

D.                  PEEP levels may be maintained.

 

2.             Fill medication nebulizer with Normal Saline along with prescribed dosage of respiratory medication if indicated, for a total volume of 20 cc’s. (i.e.; 0.5 cc Albuterol and 3.0 cc Mucomyst and 16.5 cc’s Normal Saline).

 

3.             Place ventilator Intrapulmonary Percussive Ventilation circuit inline (see drawing)

A.      A starting drive pressure of 30 psi is recommended for ventilated patients.

B.       A starting percussive rate of approximately 200 bpm is recommended.

 

4.             Remote Switch knob must be activated manually. Percussion should be continued through two complete ventilator cycles. Release Control knob and allow ventilator to deliver severa1 machine breaths. Observe visible chest movement. Monitor breath sounds and observe pulse oximeter for oxygen saturation improvement.

 

5.             After several percussion intervals lower the endotracheal tube/tracheostomy tube cuff pressure approximately 1-2 cmH2O to facilitate secretion mobilization around the ET tube and to prevent possible ET tube obstruction by secretion impaction.

 

6.             If chest percussion is inadequate, raise Drive Pressure (PSI gauge) and scan Frequency Rate to mobilize secretions. Suction as required.

 

7.             Therapy should continue intermittently for approximately twenty minutes.

 

8.             Patients who are performing T-tube trials or CPAP sprinting may be taken off of the ventilator for the Intrapulmonary Percussive Ventilation treatment utilizing an elbow adapter and 6 inches of aerosol tubing.  Decreasing cuff pressure still applies to this patient population.

 

Note: manually cancel occasional high-pressure alarms as they occur.  The goal is to achieve approximately twice the ventilator Peak Inspiratory Pressures (PIP), to a maximum of 50 cmH2O.

 

9.             At Completion of Therapy

A.            Reset cuff pressure.

B.            Remove Intrapulmonary Percussive Ventilator circuit assembly and store appropriately.

C.            Return ventilator settings if changed prior to starting Intrapulmonary Percussive Ventilation treatment.

                                                           INTRAPULMONARY PERCUSSIVE VENTILATION (IPV)

SUGGESTED VENTILATOR PROTOCOL

 

VENTILATOR PATIENT PROCEDURE:

 

1.             For PB 840 ventilators, settings need to be set as follows: Treatment can be done in either volume or pressure control

A.                  In the SIMV or CPAP Mode.

B.                   Turn off Pressure Support

C.                   PEEP levels may be maintained

1.             Mean Airway Pressures will increase slightly with the administration of Intrapulmonary Percussive Ventilation inline with the ventilator.  The Respiratory Care Practitioner needs to be aware of this effect and monitor the patient closely for any adverse side effects.

 

2.             Fill medication nebulizer with Normal Saline along with prescribed dosage of respiratory medication if indicated, for a total volume of 20 cc’s. (I.e. 0.5 cc Albuterol and 3.0 cc Mucomyst and 16.5 cc’s Normal Saline).

 

3.             Place ventilator Intrapulmonary Percussive Ventilator circuit  (see drawing) inline.

A.      A starting drive pressure of 30 psi is recommended for ventilated patients.

B.       A starting percussive rate of approximately 200 bpm is recommended.

 

4.             Remote Switch knob must be activated manually. Percussion should be continued through two complete ventilator cycles. Release Control knob and allow ventilator to deliver severa1 machine breaths. Fine-tune and observe visible chest movement. Monitor breath sounds and observe pulse oximeter for oxygen saturation improvement.

 

5.             After several percussion intervals lower the endotracheal tube/tracheostomy tube cuff pressure approximately 1-2 cmH2O to facilitate secretion mobilization around the ET tube and to prevent possible ET tube obstruction by secretion impaction.

 

6.             If chest percussion is inadequate, raise Drive Pressure (PSI gauge) and scan Frequency Rate to mobilize secretions. Suction as required.

 

7.             Therapy should continue intermittently for approximately twenty minutes.

 

8.             Patients who are performing T-tube trials or CPAP sprinting may be taken off of the ventilator for the Intrapulmonary Percussive Ventilation treatment utilizing an elbow adapter and 6 inches of aerosol tubing.  Decreasing cuff pressure still applies to this patient population.

 

Note: manually cancel occasional high-pressure alarms as they occur.  The goal is to achieve approximately twice the ventilator Peak Inspiratory Pressures (PIP), to a maximum of 50 cmH2O.

 

9.             At Completion of Therapy

A.                  Reset cuff pressure.

B.                   Remove Intrapulmonary Percussive Ventilator circuit assembly and store appropriately.

C.            Return ventilator settings if changed prior to starting Intrapulmonary Percussive Ventilation treatment.

 

 

 

                                                           INTRAPULMONARY PERCUSSIVE VENTILATION (IPV)

SUGGESTED VENTILATOR PROTOCOL

 

VENTILATOR PATIENT PROCEDURE:

 

1.             For ALL BIRD ventilators, settings need to be set as follows: Treatment can be done in either volume or pressure control

D.                  In the SIMV or CPAP Mode.

E.                   Turn off Pressure Support

F.                   PEEP levels may be maintained

1.             Mean Airway Pressures will increase slightly with the administration of Intrapulmonary Percussive Ventilation inline with the ventilator.  The Respiratory Care Practitioner needs to be aware of this effect and monitor the patient closely for any adverse side effects.

 

2.             Fill medication nebulizer with Normal Saline along with prescribed dosage of respiratory medication if indicated, for a total volume of 20 cc’s. (I.e. 0.5 cc Albuterol and 3.0 cc Mucomyst and 16.5 cc’s Normal Saline).

 

3.             Place ventilator Intrapulmonary Percussive Ventilator circuit  (see drawing) inline.

C.       A starting drive pressure of 30 psi is recommended for ventilated patients.

D.      A starting percussive rate of approximately 200 bpm is recommended.

 

4.             Remote Switch knob must be activated manually. Percussion should be continued through two complete ventilator cycles. Release Control knob and allow ventilator to deliver severa1 machine breaths. Fine-tune and observe visible chest movement. Monitor breath sounds and observe pulse oximeter for oxygen saturation improvement.

 

5.             After several percussion intervals lower the endotracheal tube/tracheostomy tube cuff pressure approximately 1-2 cmH2O to facilitate secretion mobilization around the ET tube and to prevent possible ET tube obstruction by secretion impaction.

 

6.             If chest percussion is inadequate, raise Drive Pressure (PSI gauge) and scan Frequency Rate to mobilize secretions. Suction as required.

 

7.             Therapy should continue intermittently for approximately twenty minutes.

 

8.             Patients who are performing T-tube trials or CPAP sprinting may be taken off of the ventilator for the Intrapulmonary Percussive Ventilation treatment utilizing an elbow adapter and 6 inches of aerosol tubing.  Decreasing cuff pressure still applies to this patient population.

 

Note: manually cancel occasional high-pressure alarms as they occur.  The goal is to achieve approximately twice the ventilator Peak Inspiratory Pressures (PIP), to a maximum of 50 cmH2O.

 

9.             At Completion of Therapy

C.                   Reset cuff pressure.

D.                  Remove Intrapulmonary Percussive Ventilator circuit assembly and store appropriately.

C.            Return ventilator settings if changed prior to starting Intrapulmonary Percussive Ventilation treatment.

                                                                                


                                                           INTRAPULMONARY PERCUSSIVE VENTILATION (IPV)

SUGGESTED VENTILATOR PROTOCOL

 

VENTILATOR PATIENT PROCEDURE:

 

1.             For Bear ventilators, settings need to be set as follows: Treatment can be done in either volume or pressure control

G.                   In the SIMV or CPAP Mode.

H.                  Turn off Pressure Support

I.                     PEEP levels may be maintained

1.             Mean Airway Pressures will increase slightly with the administration of Intrapulmonary Percussive Ventilation inline with the ventilator.  The Respiratory Care Practitioner needs to be aware of this effect and monitor the patient closely for any adverse side effects.

 

2.             Fill medication nebulizer with Normal Saline along with prescribed dosage of respiratory medication if indicated, for a total volume of 20 cc’s. (I.e. 0.5 cc Albuterol and 3.0 cc Mucomyst and 16.5 cc’s Normal Saline).

 

3.             Place ventilator Intrapulmonary Percussive Ventilator circuit  (see drawing) inline.

E.       A starting drive pressure of 30 psi is recommended for ventilated patients.

F.       A starting percussive rate of approximately 200 bpm is recommended.

 

4.             Remote Switch knob must be activated manually. Percussion should be continued through two complete ventilator cycles. Release Control knob and allow ventilator to deliver severa1 machine breaths. Fine-tune and observe visible chest movement. Monitor breath sounds and observe pulse oximeter for oxygen saturation improvement.

 

5.             After several percussion intervals lower the endotracheal tube/tracheostomy tube cuff pressure approximately 1-2 cmH2O to facilitate secretion mobilization around the ET tube and to prevent possible ET tube obstruction by secretion impaction.

 

6.             If chest percussion is inadequate, raise Drive Pressure (PSI gauge) and scan Frequency Rate to mobilize secretions. Suction as required.

 

7.             Therapy should continue intermittently for approximately twenty minutes.

 

8.             Patients who are performing T-tube trials or CPAP sprinting may be taken off of the ventilator for the Intrapulmonary Percussive Ventilation treatment utilizing an elbow adapter and 6 inches of aerosol tubing.  Decreasing cuff pressure still applies to this patient population.

 

Note: manually cancel occasional high-pressure alarms as they occur.  The goal is to achieve approximately twice the ventilator Peak Inspiratory Pressures (PIP), to a maximum of 50 cmH2O.

 

9.             At Completion of Therapy

E.                   Reset cuff pressure.

F.                   Remove Intrapulmonary Percussive Ventilator circuit assembly and store appropriately.

C.            Return ventilator settings if changed prior to starting Intrapulmonary Percussive Ventilation treatment.

 

 

 

 

 

 

 

                                                                                                               

 

 

INTRAPULMONARY PERCUSSIVE VENTILATION (IPV)

SUGGESTED VENTILATOR PROTOCOL

 

VENTILATOR PATIENT PROCEDURE:

1.             For Servo 300A ventilators, settings need to be set as follows: Treatment can be done in either volume or pressure control

J.                    In the SIMV or CPAP Mode.

K.                  Turn off Pressure Support

L.                   PEEP levels may be maintained

1.        Mean Airway Pressures will increase slightly with the administration of Intrapulmonary Percussive Ventilation inline with the ventilator.  The Respiratory Care Practitioner needs to be aware of this effect and monitor the patient closely for any adverse side effects.

C.       If patient has Automode on, it needs to be turned off.

D.      Treatment can be done in both PRVC and VS modes of ventilation.

1.        In PRVC and VS modes, when IPV is started and extra flow begins to be added to the circuit, the 300A ventilator will make adjustment.

a.                    Initially, Vt will drop due to extra flow being added.

b.                   The 300A will the increase pressure in order to compensate for the lost volume

Vt will be maintained during the rest of the treatment while IPV is being delivered

c.                    At the end of the IPV treatment and it is turned off, the ventilator will deliver 1 – 4 breaths at higher pressures, which will result in a higher Vt being delivered to your patient.

d.                   The 300A ventilator will, after approximately 4 breaths, return pressure to where it was prior to IPV treatment

2.             Fill medication nebulizer with Normal Saline along with prescribed dosage of respiratory medication if indicated, for a total volume of 20 cc’s. (i.e. 0.5 cc Albuterol and 3.0 cc Mucomyst and 16.5 cc’s Normal Saline).

3.             Place ventilator Intrapulmonary Percussive Ventilator circuit  (see drawing) inline.

G.       A starting drive pressure of 30 psi is recommended for ventilated patients.

H.      A starting percussive rate of approximately 200 bpm is recommended.

4.             Remote Switch knob must be activated manually. Percussion should be continued through two complete ventilator cycles. Release Control knob and allow ventilator to deliver severa1 machine breaths. Fine-tune and observe visible chest movement. Monitor breath sounds and observe pulse oximeter for oxygen saturation improvement.

5.             After several percussion intervals lower the endotracheal tube/tracheostomy tube cuff pressure approximately 1-2 cmH2O to facilitate secretion mobilization around the ET tube and to prevent possible ET tube obstruction by secretion impaction.

6.             If chest percussion is inadequate, raise Drive Pressure (PSI gauge) and scan Frequency Rate to mobilize secretions. Suction as required.

7.             Therapy should continue intermittently for approximately twenty minutes.

8.             Patients who are performing T-tube trials or CPAP sprinting may be taken off of the ventilator for the Intrapulmonary Percussive Ventilation treatment utilizing an elbow adapter and 6 inches of aerosol tubing.  Decreasing cuff pressure still applies to this patient population.

 

Note: manually cancel occasional high-pressure alarms as they occur.  The goal is to achieve approximately twice the ventilator Peak Inspiratory Pressures (PIP), to a maximum of 50 cmH2O.

 

9.             At Completion of Therapy

G.                   Reset cuff pressure.

H.                  Remove Intrapulmonary Percussive Ventilator circuit assembly and store appropriately.

C.            Return ventilator settings if changed prior to starting Intrapulmonary Percussive Ventilation treatment.

 

 

 

 

Considerations For Delivering IPV In-Line In Any Pressure Mode Of Ventilation

 

 

For IPV treatments given in pressure control mode, when IPV is turned on, it adds flow to the circuit.  The ventilator senses this extra flow and decreases the flow it has been delivering.  This will result in a slight loss of Vt.  The best way to determine how much volume is lost, is to utilize the Volume / Pressure loop on your graphics monitor if you have one.  If not, you might try to hook up a wrights respirometer to the inspiratory side of the circuit.  This will be hard to read, but might give you a better idea as to how much Vt is being delivered.

 

If the Vt being lost during the IPV treatment is consider significant, you can overcome this problem by simply increasing your set PC limit to achieve a desired Vt.

                                                              IPV Protocol Algorithm