Indications for IPPB Therapy

Abstract

No consensus on the indications for IPPB has been published in 25 years, largely because so many variables of treatment, technique, and patients make generalizations extremely difficult. The term IPPB lacks a common definition and is a primary source of confusion. Indications for IPPB involve consideration of pressure definition, the clinical problem, physiologic variables of the problem, objective and subjective goals, use with or without aerosol, and qualifications of the therapist. Clinical problems are mainly hypoventilation, hypoxemia, need for prophylaxis, and need for aerosolization. COPD patients are especially controversial as consumers, partly because of indiscriminate "routine" use of IPPB. Yet bronchospasm, excess secretions, and other problems in COPD are frequently ameliorated with precisely prescribed and applied IPPB. Objective goals can include bronchodilatation and improved airflow, while subjective goals usually refer to "feeling better." New tests may help define successful therapy. Because there are many methods of IPPB administration, the knowledgeable therapist is often more important than the specific design of equipment. Successful IPPB must be coordinated with breathing training, cough therapy, tests of results, infection control, and the entire respiratory therapy program.