IPV® "A Worldwide Clinical Technology"
2006 Dec;21(4):328-32.
Efficacy and safety of intrapulmonary percussive ventilation superimposed on conventional ventilation in obese patients with compression atelectasis.
Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan. ryosan-ygc@umin.ac.jp
PURPOSE: To investigate the efficacy and safety of intrapulmonary percussive ventilation (IPV) in obese patients. (10 patients) CONCLUSIONS: These results demonstrated that IPV was effective and safe in improving compression atelectasis without adverse effects in obese patients.
2006 Dec;34(12):3043-5.
Intrapulmonary percussive ventilation and noninvasive positive pressure ventilation in patients with chronic obstructive pulmonary disease: "Strength through unity"?
2006 Dec;34(12):2940-5.
Comment in:
Crit Care Med. 2006 Dec;34(12):3043-5.
Intrapulmonary percussive ventilation improves the outcome of patients with acute exacerbation of chronic obstructive pulmonary disease using a helmet.
Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara Hospital, Trieste University School of Medicine, Trieste, Italy.
OBJECTIVE: To evaluate the effect of intrapulmonary percussive ventilation (IPV) by mouthpiece during noninvasive positive-pressure ventilation with helmet in patients with exacerbation of chronic obstructive pulmonary disease (COPD). As historical control group, (40) patients receiving noninvasive positive pressure and ventilated by face mask treated with respiratory physiotherapy were studied. CONCLUSIONS: IPV treatment was feasible for all patients. Noninvasive positive-pressure ventilation by helmet associated with IPV reduces the duration of ventilatory treatment and intensive care unit stay and improves gas exchange at discharge from intensive care unit in patients with severe exacerbation of COPD.
2006 Dec;32(12):1994-2001. Epub 2006 Oct 24.
Intrapulmonary percussive ventilation in tracheostomized patients: a randomized controlled trial.
Department of Pulmonary Rehabilitation, University of Modena, and Ospedale Villa Pineta, Via Gaiato 127, 41020, Pavullo, Italy.
OBJECTIVE: To investigate whether the addition of intrapulmonary percussive ventilation to the usual chest physiotherapy improves gas exchange and lung mechanics in tracheostomized patients. DESIGN AND SETTING: Randomized multicenter trial in two weaning centers in northern Italy. PATIENTS AND PARTICIPANTS (46) tracheostomized patients. CONCLUSIONS: The addition of percussive ventilation to the usual chest physiotherapy regimen in tracheostomized patients improves gas exchange and expiratory muscle performance and reduces the incidence of pneumonia.
2006 Aug;192(2):191-5.
High-frequency percussive ventilation improves oxygenation in trauma patients with acute respiratory distress syndrome: a retrospective review.
Department of Surgery, University of Texas Southwestern Medical Center at Dallas, 75390-9158, USA.
BACKGROUND: High-frequency percussive ventilation (HFPV), a hybrid of conventional mechanical ventilation and high-frequency oscillatory ventilation, has been used to salvage patients with persistent hypoxemia on conventional mechanical ventilation. CONCLUSIONS: HFPV may improve oxygenation in patients with ARDS without a concomitant increase in mPaw.
2006 Jul-Aug;27(4):463-71.
High-frequency percussive ventilation with systemic heparin improves short-term survival in a LD100 sheep model of acute respiratory distress syndrome.
Department of Surgery, Shriners Hospitals for Children, University of Texas Medical Branch, Galveston, Texas 77555-0528, USA.
We undertook an assessment of high-frequency percussive ventilation (HFPV) and systemic heparin on survival in our LD100 sheep model of smoke/burn-induced acute respiratory distress syndrome (ARDS). In our smoke/burn-induced LD100 sheep model of ARDS, volume-controlled mechanical ventilation with systemic heparin achieved a 50% survival whereas HFPV with systemic heparin achieved 100% survival at 60 hours after the onset of ARDS.
2006 Apr;96(4):533-6. Epub 2006 Feb 20.
High-frequency percussive ventilation during surgical bronchial repair in a patient with one lung.
Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara Hospital, Trieste University School of Medicine, Strada diFiume 447, I-34139 Trieste, Italy. u.lucangelo@fmc.units.it
We report the case of a patient that had undergone a left pneumonectomy during which a double-lumen tube was used and an undetected right bronchial laceration occurred. After diagnosis the patient underwent a second operation to repair the tear. The role of high-frequency percussive ventilation in enabling adequate gas exchange during the bronchial repair is described and discussed.
2006 Sep;100(9):1526-33. Epub 2006 Feb 21.
Physiological response to intrapulmonary percussive ventilation in stable COPD patients.
Respiratory Intensive Care Unit, Fondazione S.Maugeri, IRCCS, Istituto Scientifico di Pavia, Via Ferrata 8, 27100 Pavia, Italy. snava@fsm.it
Intrapulmonary percussive ventilation (IPV) is a ventilatory technique that delivers bursts of high-flow respiratory gas into the lung at high rates, intended for treating acute respiratory failure and for mobilization of secretions. In 5 normal subjects a prolonged apnea trial lasting > 2 min was also performed, without any significant decrease in SaO2 or subjective discomfort. In conclusion, IPV was able to guarantee an adequate ventilation, while inducing a significant unloading of the diaphragm during the "low-frequency" trials.
2005 Dec;106(12):740-4.
[Smoke inhalation injury: diagnosis and respiratory management]
[Article in Japanese]
Department of Traumatology and Acute Critical Medicine, Osaka University Medical School, Osaka, Japan.
Smoke inhalation is a significant comorbid factor following major thermal injury. Smoke exposure is only a trigger for the sequence of events responsible for the development of inhalation injury. In the respiratory management of inhalation injury, repeated removal of pseudomembrane by fiberoptic bronchoscopy and the use of adequate PEEP to avoid airway obstruction are essential. High-frequency percussive ventilation can be a suitable mode of ventilation for inhalation injury.
Aug;9(4):R382-9. Epub 2005 Jun 1.
Intrapulmonary percussive ventilation in acute exacerbations of COPD patients with mild respiratory acidosis: a randomized controlled trial [ISRCTN17802078].
Departement de Reanimation Medicale, Hopital Pellegrin-Tripode, Bordeaux, France. frederic.vargas@chu-bordeaux.fr
INTRODUCTION: We hypothesized that the use of intrapulmonary percussive ventilation (IPV), a technique designed to improve mucus clearance, could prove effective in avoiding further deterioration in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) with mild respiratory acidosis. Thirty-three patients with exacerbations of COPD with a respiratory frequency >or= 25/min, a PaCO2 > 45 Torr and 7.35 <or= pH <or= 7.38 were included in the study. RESULTS: Thirty minutes of IPV led to a significant decrease in respiratory rate, an increase in PaO2 and a decrease in PaCO2 (p < 0.05). CONCLUSION: IPV is a safe technique and may prevent further deterioration in patients with acute exacerbations of COPD with mild respiratory acidosis.
2005 Jul;37(4):332-6.
[Effect of intrapulmonary percussive ventilation in a severely disabled patient with persistent pulmonary consolidation]
[Article in Japanese]
Department of Pediatrics, National Rehabilitation Center for Children with Disabilities, Tokyo. wada_naoko@kurume-u.ac.jp
An intrapulmonary percussive ventilator (IPV) improves airway clearance and lung function, and is useful for wide variety of respiratory disorders, such as cystic fibrosis, chronic obstructive pulmonary disease, aspiration pneumonia, and neuromuscular diseases. In patients with severe motor and intellectual disabilities, it is sometimes difficult to control progressive deterioration of pulmonary function and persistent atelectasis even with tracheostomy, mechanical ventilation, and conventional physiotherapy. Our results indicate that IPV may improve respiratory function and the quality of life in such patients.
2005 Jun;159(6):526-31.
Intrapulmonary percussive ventilation vs incentive spirometry for children with neuromuscular disease.
Pulmonary Center, Boston University School of Medicine, Boston, MA
BACKGROUND: Pulmonary infections can be life threatening for children with neuromuscular diseases who have impaired ability to clear secretions. Intrapulmonary percussive ventilation (IPV) is a pneumatic device that delivers air and aerosol to the lungs at frequencies of 200 to 300 cycles per minute at peak pressures from 20 to 40 cm H(2)O.
Anecdotal reports and pilot studies show its safety and effectiveness in mobilizing secretions in patients with cystic fibrosis. OBJECTIVE: To test the hypothesis that IPV used in a pulmonary program for adolescents with neuromuscular disease would reduce the number of days of antibiotic use for pulmonary infection. (18 Patients)The IS group spent more days hospitalized (4.4/1000 patient-days vs 0/1000 patient-days) than the IPV group (incidence rate ratio, 8.5; 95% confidence interval, 1.1-67). The IPV group had 0 episodes of pneumonia or bacterial bronchitis compared with 3 events in the IS group, although this did not meet statistical significance. CONCLUSION: Intrapulmonary percussive ventilation as part of a preventive pulmonary regimen reduced days of antibiotic use and hospitalization for respiratory illness in adolescents with neuromuscular disease.
2005 Mar;33(3 Suppl):S241-5.
Comment in:
Crit Care Med. 2005 Sep;33(9):2155; author reply 2155-6.
High-frequency percussive ventilation.
Department of Surgery, Division of Trauma and Critical Care, University of Southern California Keck School of Medicine, USA.
OBJECTIVE: To review the technique and clinical application of high-frequency percussive ventilation in critically ill patients. DESIGN: Literature search and descriptive review. RESULTS: High-frequency percussive ventilation is a time-cycled, pressure-limited mode of ventilation that delivers subphysiologic tidal volumes at rates that can exceed 500 breaths/min. It offers the potential advantage over conventional ventilation of providing equal or improved oxygenation and ventilation at lower peak and end-expiratory pressures. CONCLUSIONS: High-frequency percussive ventilation has been shown to provide favorable gas exchange in several well-defined patient populations. It reliably improves oxygenation and provides adequate ventilation at lower peak pressures than conventional ventilation.
2004 Sep;57(3):542-6.
High-frequency percussive ventilation: an alternative mode of ventilation for head-injured patients with adult respiratory distress syndrome.
Department of Surgery, Division of Trauma and Critical Care, University of Southern California Keck School of Medicine and the Los Angeles County-University of Southern California Medical Center, USA. asalim@surgery.usc.edu
BACKGROUND: Adult respiratory distress syndrome develops in up to 20% of patients with severe head injury. This complicates the treatment of head-injured patients because lung-protective strategies such as high positive end-expiratory pressure (PEEP) and permissive hypercapnia may increase intracranial pressure (ICP) and reduce cerebral perfusion pressure. The use of high-frequency percussive ventilation (HFPV) is an alternate mode of ventilation that may improve oxygenation for head-injured patients while also lowering ICP. METHODS: (10 patients) Clinical data were collected retrospectively over a 1-year period. CONCLUSIONS: Therapy with HFPV produced a significant improvement in oxygenation with a concomitant reduction in ICP during the first 16 hours. This therapy may represent an important new method for the management of adult respiratory distress syndrome among head-injured trauma patients.
2004 Aug 20;142(1):81-91.
Effects of mechanical load on flow, volume and pressure delivered by high-frequency percussive ventilation.
Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara Hospital, Trieste University School of Medicine, Strada di Fiume 447, I-34139, Italy. u.lucangelo@fmc.units.it
High-frequency percussive ventilation (HFPV) has proved its unique efficacy in the treatment of acute respiratory distress, when conventional mechanical ventilation (CMV) has demonstrated a limited response. We analysed flow (V(dot)), volume (V) and airway pressure (Paw) during ventilation of a single-compartment mechanical lung simulator, in which resistance (R) and elastance (E) values were modified, while maintaining the selected ventilatory settings of the HFPV device. These signals reveal the physical effect of the imposed loads on the output of the ventilatory device, secondary to constant (millisecond by millisecond) alterations in pulmonary dynamics. V(dot), V and Paw values depended fundamentally on the value of R, but their shapes were modified by R and E. Although peak Paw increased 70.3% in relation to control value, mean Paw augmented solely 36.5% under the same circumstances (maximum of 9.4 cm H2O).
2003 Nov;69(11):853-7, 858-60.
High frequency percussive ventilation (HFPV). Case reports.
[Article in English, Italian]
Department of Perioperative Medicine, Intensive Therapy and Emergency, University of Trieste, Trieste, Italy. u.lucangelo@fmc.units.it
In the last few years high frequency ventilation techniques have been employed as a therapy for adult respiratory distress syndrome (ARDS) and acute respiratory failure (ARF). We applied high frequency percussive ventilation (HFPV) to (3 patients) affected by ARDS or ARF, who did not improve after 24 hours of conventional mechanical ventilation (CMV). All our patient underwent 12 hours of HFPV, and showed an improvement of both respiratory exchange and radiological imaging. Even if the pathogenesis of ARF was quite different, in all patient we registered a good response and no complications.
2003 Nov;69(11):841-8, 848-51.
High frequency percussive ventilation (HFPV). Principles and technique.
[Article in English, Italian]
Unit of Anesthesia and Resuscitation Department of, Perioperative Medicine Intensive Therapy and Emergency, University of Trieste, Trieste, Italy. u.lucangelo@fmc.units.it
In recent years, the usefulness of high frequency ventilation (HFV) has been clinically reassessed as an alternative to conventional mechanical ventilation (CMV). HFV has often been combined with or in some cases even completely replaced CMV in the attempt to reduce iatrogenic injury. High frequency percussive ventilation (HFPV) is a specific mode of HFV that has been successfully applied in the treatment of acute respiratory failure after smoke inhalation. This article gives an introduction to and a description of the basic principles of HFPV, a mode of ventilation which we found particularly versatile and reliable in our preliminary clinical experience with the maneuver.
2003 Oct;48(10):940-7.
Effect of intrapulmonary percussive ventilation on mucus clearance in duchenne muscular dystrophy patients: a preliminary report.
Subacute Respiratory Rehabilitation Unit, Mechanical Ventilation Centre and Neuromuscular Excellency Centre, Vrije University Brussel-Ziekenhuis De Bijtjes, Brussels, Belgium. therapeut@debijtjes.be.
OBJECTIVE: To determine the effects of intrapulmonary percussive ventilation (IPV) on mucus clearance in tracheostomized Duchenne muscular dystrophy patients. METHODS: We studied( 8 patients,) 5 of whom had mucus hypersecretion (> 30 mL/d). In a randomized, cross-over study we compared assisted mucus clearance techniques with and without IPV. CONCLUSIONS: IPV is a safe airway clearance method for tracheostomized Duchenne muscular dystrophy patients, and this preliminary study suggests that IPV increases the effectiveness of assisted mucus clearance techniques.
2003 Sep;29(6):603-8.
High frequency percussive ventilation in burn patients: hemodynamics and gas exchange.
Critical Care Department, Queen Astrid Military Hospital, Bruinstreet, 1, 1120 B-, Brussels, Belgium. reper@smd.be
This study investigates the influence of HFPV on hesmodynamics, blood oxygenation and ventilatory parameters in eight stable ICU burn patients requiring artificial ventilatory support during a postoperative period following traumatic injury. Blood oxygenation and CO(2) elimination were significantly improved under HFPV.(8 patients) No side effects were noted. These observations suggest that HFPV could improve pulmonary gas exchanges under lower peak pressures and without hemodynamic compromise. HFPV could represent an interesting alternative open lung strategy method to improve alveolar recruitment.
2003 Jan;48(1):24-8.
Comment in:
Respir Care. 2003 Jan;48(1):20-1.
A comparison of the therapeutic effectiveness of and preference for postural drainage and percussion, intrapulmonary percussive ventilation, and high-frequency chest wall compression in hospitalized cystic fibrosis patients.
Respiratory Therapy Division, The Ohio State University, Columbus 43210, USA. varekojis.16@osu.edu.
OBJECTIVE: Compare the effectiveness of and patient preferences regarding 3 airway clearance methods: postural drainage and percussion (PD&P), intrapulmonary percussive ventilation (IPV), and high-frequency chest wall compression (HFCWC). (24 patients)
CONCLUSIONS: HFCWC and IPV are at least as effective as vigorous, professionally administered PD&P for hospitalized CF patients, and the 3 modalities were equally acceptable to them. A hospitalized CF patient should try each therapy and choose his or her preferred modality.
2002 Oct;68(10):852-6; discussion 856.
High-frequency percussive ventilation as a salvage modality in adult respiratory distress syndrome: a preliminary study.
Adult Burn Center, Department of Surgery, Medical University of South Carolina, Charleston 29425, USA.
Despite multiple advances in critical care patients with severe adult respiratory distress syndrome (ARDS) can exhaust the capability of conventional ventilation; this results in respiratory failure and death. High-frequency percussive ventilation (HFPV), which was initially utilized for salvage of burn patients with smoke inhalation injury refractory to conventional ventilation, has evolved as a standard of burn care. Seven of ten patients failing conventional ventilation survived to hospital discharge after salvage therapy with HFPV. We advocate further studies of HFPV in non-burn patients with ARDS both as salvage therapy and as replacement for conventional ventilation for the initial treatment for ARDS.
2002 Nov;95(5):1189-91, table of contents.
Bronchial stenting and high-frequency percussive ventilation treatment of descending aortic aneurysm-induced atelectasis of the left lung.
Klinik fur Anaesthesiologie, Medizinische Universitat zu Lubeck, Ratzeburger Allee 160, D-23538 Lubeck, Germany. heringlake@t-online.de
IMPLICATIONS: This case report shows that atelectasis of the left lung-induced by extrinsic compression of the left main bronchus by an aortic aneurysm and persisting despite aggressive conservative treatment-may be effectively treated by bronchial stenting and high-frequency percussive ventilation.
2002 Oct;47(10):1162-7.
A comparison of intrapulmonary percussive ventilation and conventional chest physiotherapy for the treatment of atelectasis in the pediatric patient.
Department of Respiratory Care, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
OBJECTIVE: Compare intrapulmonary percussive ventilation (IPV) to conventional chest physiotherapy (CPT) and determine their effects on improving atelectasis and static compliance in pediatric patients.(46 patients) CONCLUSIONS: In the retrospective study a clinically important improvement in atelectasis was seen in patients who received IPV therapy. In the controlled, clinical trial the IPV group showed more clinically important improvement in atelectasis than the CPT group. IPV is a safe and effective method of alternative airway clearance and can be used on patients with artificial airways.
2002 Aug;28(5):503-8.
High frequency percussive ventilation and conventional ventilation after smoke inhalation: a randomised study.
Critical Care Department, Queen Astrid Military Hospital, Bruinstreet 1, 1120 B, Brussels, Belgium. reper@smd.be
Inhalation injury and bacterial pneumonia represent some of the most important causes of mortality in burn patients.( Thirty-five )severely burned patients were randomised on admission for conventional ventilation (CV; control group) versus high frequency percussive ventilation (HFPV; study group). Our findings suggest that HFPV can improve blood oxygenation during the acute phase following inhalation injury allowing reduction of FiO(2). No significant differences were observed between groups for mortality nor incidence of infectious complications in this study.
2002 Mar;30(3):692-4.
Successful management of severe respiratory failure combining heliox with noninvasive high-frequency percussive ventilation.
Pediatric Intensive Care Unit, CHUV University Hospital, Lausanne, Switzerland.
High-frequency percussive ventilation has recently been advocated to treat lung injury in children with reduced lung compliance. We report our experience of combining heliox with noninvasive high-frequency percussive ventilation in a 5-yr-old boy with severe acute respiratory failure resulting from advanced cystic fibrosis lung disease. The dramatic improvement allowed stabilization and withholding of endotracheal intubation. We hypothesize that this approach improved gas exchange by enhancing molecular diffusion and by favoring laminar flow throughout the upper and lower airways. Further investigations should study the mechanisms of this noninvasive bimodal therapy.
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