What has been learned about IPV® since it was first introduced?
At this writing, certain (living) home COPD patients have used IPV® for over eighteen years. During this period of time, IPV® protocols employed in the home and institution, have not demonstrated any side effects or trauma which would not be expected by any other positive pressure (trach positive) mechanical respirator/ventilator. Because IPV® does not maintain a static apneustic "peak inspiratory pressure” against the pulmonary structures, which is possible with "volume oriented mechanical ventilators”, little if any barotrauma could be expected when IPV® advisory programs are followed and typical contraindications for all trach-positive ventilatory devices are honored.
Experiences from Home Care patients remaining on IPV® for many years, confirm the Safety and Effectiveness of IPV®. Backing up Domiciliary Care are many Institutional experiences with IPV® which continue to expand in scope and quantity. Current Guidelines for IPV® Therapy have been influenced by these experiences.
The Patient must be comfortably positioned in a sitting or recumbent posture. Experience has demonstrated, it is not necessary to employ traditional "postural drainage" positions for IPV® Patients, during or after the Therapeutic session.
After activation of the Air or Oxygen Respiratory Gas source, the Patient should become familiar with the device by breathing Aerosol alone; without Percussion. Special attention must be directed toward sealing the lips around the flange of the Mouthpiece.
By learning how to "pucker" the lips around the mouthpiece, minimal "cheek flapping" will occur, when Percussive Therapy is started. Have the Patient learn the correct relaxed holding positions.
After the Patient has totally conformed to Dense Aerosol Therapy, and is comfortably managing the holding positions, a low amplitude Percussive Therapy can commence.
Establish an Operational Pressure of 30 psig and rotate the PERCUSSION control knob Arrow to EASY (the fastest cycling rate). First ask the Patient (with the Breathing Head held away from the lips) to repeatedly press and release the REMOTE start/stop (ON/OFF BUTTON). Briefly, further explain the Percussive Impactions (Bursts of Air) from the Mouthpiece.
Second, have the Patient actually start low amplitude Percussion by "puckering" the lips around the mouthpiece and holding the Remote Percussion Button depressed. Ask the Patient to breathe in and out of the Mouthpiece whenever he or she feels like taking a breath.
This is a critical point in the teaching of IPV®. More than likely the Patient will either not keep their lips tight around the Mouthpiece or they will let Air out of their Nose. Nasal "venting" must be stopped "NOW”. Nose Clips will "NOT” be used. Ask the Patient to more forcefully exhale through the Mouthpiece. Observe the Chest and look for a Percussive "shaking" as the Patient forcefully exhales. Keep repeating your exhale commands until a constant Percussion is noted by observing the Chest, during both the inspiratory and expiratory effort. If the Patient tires have them breathe Aerosol without Percussion for a minute or so, as you further explain "Nasal Venting".
Continue to Coach the Patient to Breathe through the Mouthpiece only, with the lips sealed comfortably around the Mouthpiece. With proper training "nasal venting " can be resolved within very few minutes. Make certain the Patient is allowed to rest if stress is observed.
Check to see if the Patient is actually Percussing his or her Lungs, by looking at the Chest and observing a Percussive "shaking" on both sides from top to bottom. If the IPV® device does have a Proximal Airway Pressure Manometer the Needle should be Oscillating between 5-15 cm H2O. If Intrapulmonary Percussion is not observed revert to the basic teaching program.
When the Patient obligatorily has to cough or expectorate, the ON/OFF Button must be released. Do not obstruct a cough with a Mouthpiece.
NOTE: A Face Mask should only be used, if the patient "absolutely” can not master a mouthpiece.
After the mastering of nasal venting "cheek flapping" should be gradually concentrated upon. The Patient should be periodically reminded to "hold" his or her Cheeks firm.
The next Gateway is to teach the Patient control over the Therapeutic Interval. Simply hold the Button down for continuous Percussion, breathing in and out through the Percussion as desired. Release the Button when expectoration or a rest period is desired. This is the typical method which may be observed in Patients with Chronic Bronchitis, aggravated with Sub Clinical left congestive failure. This is NOT Harmful in any way. At this point a Patient may ask how often they can use IPV®? The answer is, as often as they desire, the same general IPV®/VDR® protocol is used to Ventilate Critical Care Patients for weeks at a time.
Remember to imprint upon the Patient, that they can Start or Stop Percussion any time they desire, by their total control over the Remote Percussion ON/OFF Switch. This is especially important when they feel as if they must cough or expectorate.
Initial rest periods of several minutes are acceptable as long as Aerosol is breathed while not Percussing.
After the Patient has mastered initial instructions and is performing well, the Amplitude of Percussion should be increased by increasing the Operational Pressure to 35-40 psig. This will provide a 10-15 cm H2O Needle Oscillation if a Manometer is used. Increasing the Percussive Operational Pressure increases the Impact Velocities at all Percussive rates. If Percussive Operational Pressures are too high (before the Patient has gained lip control over the Mouthpiece), leakage between the lips and the mouthpiece will be observed.
Therefore, slowly upgrade the Percussive Impaction forces. Ideally, a Percussive pressure selection should provide for an Intrapulmonary Wedge Pressure of about 5-10 cm H2O, which should be the ultimate goal after lip sealing fatigue is mastered. This will be scheduled with Operational Pressures of from 35-40 cm H2O with the PERCUSSION control knob Arrow under the 12:00 Index. Lip and Cheek control is similar to learning to play a Wind Instrument.
During the developmental years of Intrapulmonary Percussive Ventilation (IPV®), unique sine waves were studied to determine Impaction Forces which were compatible with "stretch receptors" (Hering Breuer) within the Lungs. With the advent of the Phasitron® physical/physiological converter, the proper Venturi Geometry for absolute fluid clutching was determined under Clinical conditions. The advent of the novel Phasitron® injector/exhalation valve was a major key in obtaining high levels of Clinical Efficacy.
While IPV® evolved from a long lineage of F. M. Bird conceived Pulmonary Care devices, the quest for determining a universal Calibration, evolved from a considerable data base. Essentially, IPV® is based upon a composite of High Density Aerosol Therapy, Volume oriented Intermittent Positive Pressure Breathing, CPAP and Chest Physiotherapy.
Note: A special Hydrophobic Filter is available to install in the (red) Manometric Pressure Sensing Tubing in IPV Devices employed for multiple Patient use.
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