Airway Clearance therapy is one of the most common therapies used in the medical field to help clear out or thin mucous secretions.
Thick secretions twenty to thirty mL a day that does not have the ability to mobilize secretions benefits from Airway Clearance therapy (Kacmarek, Stoller, Heuer 2017). This technique comes with different methods that help patients with mobilizing secretions such as: Chest Percussions, Insensitive Spirometry, Flutter Valve, Chest Vest, PAP therapy and so many more. This literature review will focus on one in specific the Intrapulmonary Percussive Ventilation (IPV) which is expensive, but used when majority of the other therapies have failed.
In this paper I will discuss the benefits of IPV by reviewing how it works, the indications and contraindications, and complications and the hazards that comes along with this therapy.Intrapulmonary Percussive Ventilation (IPV) is an Airway Clearance Therapy that is used as an Invasive or Non-Invasive Ventilation to help clear secretions while treating atelectasis or consolidation, and preventing pulmonary complications that may come along while improving oxygenation. This device is used to assist patients with neuromuscular disorders, Cystic Fibrosis, Bronchial congestion, etc. by giving fast deep burst of air for up to three minutes at a time to help break up secretions and fixing ventilation issues. Helping these patients obtain deep breaths so that the mucous in their air way can become loose and easier to cough up is the key to a shorter stay in the Intensive Care Unit. Medications given along with this device can be normal or hypertonic saline given alone or along with a Bronchodilator. The AARC CPG for IPV states “There is a major increase in medications dosage with this therapy compared to other therapies”(Kacmarek, Stoller, Heuer 2017).
Before Intrapulmonary Percussive Ventilation is started all patients are carefully evaluated to assess the indications and contraindications for the use of IPV. Patients are indicated for this therapy when they are stable with inability to clear secretions, atelectasis when the previous therapy did not improve lung function, and when they are not able to cough. This device can also be used for patients that have problems with Cystic Fibrosis, Bronchiectasis, Ciliary dyskinetic syndromes, and patients suffering from muscle weakness to prevent or lower the time of intubation AARC Clinical Practice Guidelines(2013). The goal of this therapy is to help patients achieve a deep breathing with a forced effort to help mobilize and remove retained secretions. This therapy cannot be used if therapist spot some contraindications in the patient such as: Pleural Effusion, intracranial pressure greater than 20, Hemodynamic instability, active or untreated TB, recent surgery of the face, head, or esophageal, and patients who are AARC Clinical Practice Guidelines(2013). Any patients that suffer these conditions before treatment is started is advised not to do the therapy or to be closely monitored to determine if this is the right treatment. It is important to remember that every therapy and medication comes with some side effect weather it is a minor headache or an increase in heart rate, but some are worse than others. Hazards and complications of Intrapulmonary Percussive ventilation includes Increase airway resistance, can cause barotrauma, hospital acquired infection, and hyperoxia.
There are other complications that can accompany Intrapulmonary Percussive Ventilation like respiratory alkalosis due to the patient hyperventilating during the treatment causes a decrease in CO2 and leads to an increase in pH and PaO2(Kacmarek, Stoller, Heuer 2017). Heart arrhythmias is another effect if the alkalosis is not tamed, and the patient has a significant heart disease. The best way to avoid these problems is to properly adjust the patient settings to the device before using it on the patient to ensure it will not tire them out this will help prevent the risk of these hazards and complications.In conclusion Intrapulmonary Percussive Ventilation is used in many hospital settings. Most often, it is used to help with airway clearance when patients have some kind of muscle weakness or not able to clear out congestion. Even though this device is used commonly on patients it is important that this resource is used properly. The main focus comes with the patient understandings of the objective, and the consequences that can come about with this therapy, but the goal is to provide the best possible care to the patient that is more beneficial no matter the cost.