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Respiratory Management (Rehab Phase)

Intermittent Positive Pressure Breathing (IPPB)

Intermittent Positive Pressure Breathing (IPPB) is a short-term breathing treatment where increased breathing pressures are delivered via ventilator to help treat atelectasis, clear secretions or deliver aerosolized medications. The PVA clinical guidelines on respiratory management following SCI (PVA 2005) include IPPB as a treatment. However, there are few studies looking directly at the effects of IPPB in spinal cord injury.

Author Year; Country
Score
Research Design
Total Sample Size
Methods Outcome
Laffont et al. 2008; France
PEDro = 5
RCT
N = 4
Population: 14 traumatic SCI participants (C5-T6, AIS A or B), injured within the last 6 months with no thoracic injuries.
Treatment: Intermittent positive-pressure breathing (IPPB), at least 20 minutes twice daily for 5 days a week; patients treated with 2 months IPPB treatment and 2 months without IPPB, in random cross-over design.
Outcome Measures: Lung function tests; lung compliance; work of breathing.
  1. IPPB had no short-term or long-term effects on VC, lung compliance, or work of breathing.

Stiller et al. 1992; Australia
Pre-Post
N=5

Population: 5 patients with acute tetraplegia during first 7 to 10 of hospitalization. Age range 14-52 years, 2F 3M; C5-C6/7. Two individuals were heavy smokers.
Treatment: IPPB performed every 2 hours consisted of 4 repetitions of 6 breaths using the ventilator, interspersed with a period of 20-60 seconds of natural breathing.
Outcome: TV, VC.
  1. The mean lung volume during IPPB was significantly higher than the groups mean resting values for both TV and VC.
  2. TV returned to baseline values as soon as IPPB was ceased.
  3. VC remained significantly higher than baseline vlues as soon as IPPB was ceased, but the mean(SD) increase of 43(89) mls is not clinically significant.

Discussion

In a pre-post study, Stiller et al. (1992) found an increase in lung volume while IPPB was being administered, and tidal volume to return to baseline values immediately after stopping IPPB. While the mean VC remained significantly higher after ceasing IPPB, the improvement was not considered clinically significant. More recently, in a RCT, Laffont et al. (2008) found that IPPB had no short-term or long-term effects on pulmonary function, lung compliance or work of breathing in patients within one year of SCI who were not in respiratory failure. They commented that IPPB is expensive in terms of staff and equipment and is reported as unpleasant by many subjects. While IPPB does not appear to be effective on lung function and compliance, further studies that look at the role of IPPB on atelectasis, secretion management and in acute respiratory failure following SCI are needed.

Conclusion

There is level 2 evidence (from 1 RCT: Laffont et al. 2008) that intermittent positive-pressure breathing (IPPB) has no short-term or long-term effects on lung function within one year of SCI.

There is level 4 evidence (from 1 Pre-post trial: Stiller et al. 1992) that IPPB has no effects on lung function immediately following onset of SCI.

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