INTRAPULMONARY PERCUSSIVE VENTILATION
(IPV®)
What is Intrapulmonary Percussive Ventilation (IPV®)?
The term Intrapulmonary Percussive Ventilation (IPV®) was coined by Dr. Forrest M Bird in 1980, to describe a Clinical Protocol and the Administering Device, to mechanically ventilate the Lungs with successive Percussive Sub Tidal Volume Deliveries, without firing the Hering Breuer stretch receptors, provoking an expiratory "cough like response”.
Essentially, IPV® in oversimplified terms, assists the respiration of patients with diseases which limit their normal respiration by helping to clear retained secretions from the lungs and then providing deep breathing to increase oxygen delivery to the alveoli as well as flushing carbon dioxide from the pulmonary airways.
To receive this type of mechanical ventilation, the patient breathes through an IPV® accessory device called a Phasitron®, which delivers rapid, high flow, mini-bursts (percussions) of Air or Oxygen into the lungs while simultaneously delivering therapeutic aerosols. IPV® loosens and helps propel deep retained airway secretions upward from the lungs where they can be more easily expectorated (coughed up).
IPV® has been proven to be an outstanding combining therapeutic procedure, in patients with obstructive pulmonary diseases; including, Bronchiolitis, Cystic Fibrosis, Asthma, Chronic Bronchitis, Bronchiectasis, Neuro-muscular disorders, Emphysema, (General COPD), as well as for Post Operative and Emergency Room (ER) airway management. IPV® can be self administered by home care patients through a mouthpiece or mask. In the hospital IPV® can be administered by, mouthpiece, mask or endotracheal tubes, as well as in combination with an intensive care ventilator.
IPV® is a universal Ventilatory program, combining the maximum Clinical Efficacies of all existing routine mechanical ventilatory procedures, directed toward:
1. Mobilizing pulmonary airways, congested by secretion retention, mucosal and sub mucosal edema and bronchiolar spasm.
2. Creating a bilateral uniform alveolar ventilation for enhancing oxygen uptake and carbon dioxide elimination.
3. Mechanically mixing Intrapulmonary Gases through "diffuse intrapulmonary percussion” to enhance endobronchial diffusion of Oxygen and the mobilization of peripheral CO2.
4. Providing a major periodic "Convective Tidal Flow” to wash out CO2.
5. Potentially providing a Mechanical "Vesicular Peristalsis” to augment "Physiological Vesicular Peristalsis” within the Pulmonary and Bronchial Circulation’s, as well as to provide for an augmenting "Intrathoracic Lymph Pump”.
Essentially, IPV® COMBINES the best features of ALL existing Pulmonary Care devices including:
1. High Density Aerosol Therapy.
2. Extrathoracic Percussion (Chest Physiotherapy).
3. Intermittent Positive Pressure Breathing.
4. Mechanical Chest Thumpers, Squeezers and Vibrators.
5. Upper Airway Secretion mobilizers.
6. Bi level (I-E PAP) breathing devices.
7. CPAP devices.
8. Postural Drainage.
The institutional use of IPV®, beyond secretion clearance and the resolution of diffuse or localized atelectasis, has been greatly expanded, secondary to the recent incrimination of High Intrapulmonary Tidal Volume deliveries under High Inspiratory Flowrates, creating Preferential Airway Delivery leading to barotrauma within the dependant lung structures.
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CLASSICAL WAVE FORMAT DEPICTING IPV® LOGIC
A special manifold assembly, can interconnect the IPV® Phasitron® and Aerosol Generator assembly into conventional breathing circuits, employed on the majority of volume oriented ventilators. This enables the intrabronchial "Percussive Mechanical Mixing” of Respiratory Gases being delivered convectively, during scheduled tidal exchange.
Therefore, IPV® when employed during controlled volume oriented convective ventilation, provides for percussive intrapulmonary gas mixing and associated diffusion, thus allowing a decrease in the scheduled Tidal Volume pressure amplitude (PIP), without the atelectatic consequences of Low Tidal Volume Programming
Additionally, aerosolized medications and wetting agents can be delivered during the continuous IPV® percussion, of the pulmonary structures.
IPV® programming, allows the patient to breathe spontaneously through the "percussive ventilatory programming”, providing for an assisted step inflation of the lungs, followed by a percussive step down deflation to the programmed expiratory baseline; during passive exhalation.
INTRAPULMONARY PERCUSSIVE VENTILATION
(IPV®)
GENERAL CLINICAL DESCRIPTION OF INTRAPULMONARY
PERCUSSIVE VENTILATION (IPV®)
What are some of the cardinal Clinical considerations of (IPV®)?
Intrapulmonary Percussive Ventilation (IPV®) is a form of cardio-respiratory therapy, administered to the Pulmonary Airways by a pneumatic (air) powered device called a Percussionator®.
The patient breathes through a mouthpiece which delivers high flow mini-bursts of air into the lungs at rates of over one hundred fifty (150) times each minute.
During the percussive bursts of air into the lungs, a continued pressure wedge is maintained, while a high velocity percussive inflow opens airways and enhances intra-bronchial secretion mobilization.
A traditional medication for Aerosol Therapy, called racemic epinephrine in a 2.25% aqueous concentration, one half cc (6 drops), is diluted with 20 cc of water and aerosolized into the lungs by a special therapeutic mist generator.
NOTE: Beta (bronchial dilators) are widely used with IPV®, they should be diluted with normal (.85%) Saline. Do not employ Pharmaceutical Agents for intrapulmonary topical delivery without Clinical Data to support their dilution and use during IPV® therapy.
The aerosol mist is delivered topically throughout the lungs, during therapeutic percussion, by the IPV® Intrapulmonary Percussionator®.
The misting of topical dilute Alpha/Beta aerosols within the lungs, reduces the adhesive and cohesive forces of retained airway secretions, decreases swelling within the walls of the pulmonary airways and relaxes potential spasm of the terminal bronchioles (small terminal airways) of the lungs.
Each percussive interval is programmed by the Clinician and/or Patient. Normally, the ON/OFF Percussion Button is depressed, creating a continuous Percussion allowing the Patient to Breath through the Percussion as desired. While the Percussion Button is held depressed, the lungs are percussed, mixing oxygen, carbon dioxide and nitrogen with a medicated mist. At the end of the Percussive Interval, the Percussive Button is released allowing the exhalation of the well mixed intrapulmonary gases from the lungs. The Button is only released to Expectorate or rest.
After each deep exhalation, the percussive interval is started anew, refilling the lungs with fresh, moist, medicated respiratory gases. The cyclical intrapulmonary exchange of well mixed respiratory gases serves to flush out carbon dioxide and renew oxygen.
Whenever there is a desire to cough or expectorate, the Percussion Button is released until the coughing episode is completed or the secretions are raised and cleared. A routine IPV® therapy session lasts approximately twenty minutes.