IPPB vs. EzPap
Ruby Bueno, Michael Cua, Sherria Miller, Myaa Smith, and Subrina Vohra
Lonestar-Kingwood College respiratory Care Program
Respiratory Care 2243-22001
Facilitator: Elizabeth Kelley Buzbee, AAS-RRT-NPS, RCP
Abstract
We conducted our study on 10 healthy individuals. The data we gathered
included our study participants vital signs, tidal volumes, and peak flows.
Each participant first used the IPPB and then the EzPap. Then we compared
their peak flows after each use. One of our limitations was that we
conducted our research on healthy participants. Each participant did not
show that much of a change in percentage. We believe if the study had been
conducted on participants with lung disorders there would have been a true
comparison.
Hypothesis
IPPB will increase peak flow results when compared to EZPAP
treatments in healthy adults.
IPPB
IPPB Background
IPPB is indicated for the need to improve lung expansion. Patients who
cannot cooperate to therapy are also candidates for IPPB(AARC,2003).
IPPB is also indicated for patients who have the inability to clear
secretions due to a certain disease that severely limit themselves to
ventilate or cough on their own (AARC,2003). IPPB is also indicated to
deliver aerosol medication (AARC,2003). In a healthy person, it can
cause barotrauma or pneumothorax, physiological dependence,
nosocomial infections, hypocarbia, hypo- or hyper- ventilation, increased
mismatch of ventilation or perfusion and gastric distention (AARC,
2003).
EZPAP
EZPAP Background
EZPAP is indicated to treat, prevent and reverse atelectasis. It is also used
to mobilize retained secretions, reduce air trapping and is used as an
aerosol medication delivery device adjunct.
Methodology
1.
EZPAP
 Positive Airway Pressure Device
1. Ambient Air Inlet
2. Gas Inlet Port
3. Pressure Monitoring Port with Cap
 Patient interface – mouthpiece
 7 foot O2 tubing to connect gas inlet port to wall flow meter
Intended use: EzPap is indicated for use in conjunction with a medical need for lung
expansion therapy and the treatment and prevention of atelectasis. EzPap may be used
with nebulizer between patient and device. EzPap is also available with various mask
sizes.
Methodology cont.
Set up: Connect one end of tubing to a 0 -15 lpm flow meter that is connected to 50-60
psi medical air. Connect the patient end of tubing coming from the flow meter to the
device’s gas inlet port. Connect the device pressure port to a pressure gauge. This is
recommended for initial set-up to become aware of pressures transmitted to the patient. If
pressure monitoring is not being done, seal port with attached pressure monitoring port cap.
Pressure monitoring port should not be exposed to ambient air while in use. Attach the
mouthpiece to rounded end of the device. Serrated end is to be exposed to ambient air at all
times. DO NOT OCCLUDE.
Manufacturer:
Smiths Medical ASD Inc
10 Bowman Drive
Keene, NH 03431 USA
www.smiths-medical.com
Methodology cont.
2. IPPB (BIRD MARK 7)
 Bird Mark 7 - have two connections on the right side of the machine (the pressure
side): a large-bore connection for the main breathing hose and one small connection
for a single drive line. This line splits at the nebulizer to power both the nebulizer and
the exhalation valve. A splitting device fits over the connection on the nebulizer. The
drive line connects to this device, and the short piece of tubing connects to
 Positive Airway Pressure Device
1. Ambient Chamber
2. Gas source inlet
Methodology cont.
Pressure Manometer
IPPB Machine is connected to a 50 psig gas source with high-pressure hose.
Set up: IPPB BIRD 7 machines have a connection for the large-bore tubing, which is
usually attached before being packaged, and a connection on the nebulizer for the line
splitter. Attach the tubing to the appropriate connections on the respirator, making sure all
connections are tight. The connections and tubing are sized so that only the correct tubing
will fit on the connector. Attach the tubing to the nebulizer and exhalation valve assembly.
Again the tubing and connections are sized to prevent incorrect assembly. The small drive
line is attached to the line splitter. The short piece of tubing on the line splitter connects to
the exhalation valve. Attach the patient connection to the nebulizer assembly. Most
disposable circuits come with a six-inch length of large-bore tubing which provides a
reservoir for medication and connects the mouthpiece or other device to the nebulizer.
 Manufacturer: Bird Products Corporation
1100 Bird Center Drive
Palm Springs, CA, 92262
Methodology cont.
3. PEAK FLOW (Respironics Personal Best Peak Flow Meter)
 A peak flow measures how fast air flows from your lungs. It's a small device that you
are able to hold in your hand. It's also portable so it can be used for bedside. The peak flow
meter is known to assist in the management of the asthmatic patients. If any changes are
needed with their medications, then monitoring the patient's peak flow measurements
would not be a useful tool.
 Available in both full range (60 – 810 l/min) and low range (50 – 390 l/min).
 Manufacturer: Respironics Houston (RIHS)
3605 Willowbend, Suite 500
Houston, TX 77054
Methodology cont.
Protocol (Experiment) for Methodology
 After obtaining informed consent, explaining the procedure to the test subject,
performing a physical exam with a complete medical history, and getting approval from
the institutional review board, we then conducted our research.
Subject Selection:
1. No specific age. Adults only
2. Healthy adults of both sexes
3. Subjects were selectively chosen from a small population, rural college and the
local community.
4. Subjects were selected on health only. Anyone was able to participate as long as
they were healthy adults without any major health restrictions. If the subject had
any condition that could complicate their health or the study, he/she was
eliminated from the study.
Methodology cont.
 Prevented disconnection of equipment during usage, made sure all tubing and
connections were securely attached.
 Projected times:
1. Explained procedures, answered questions and signed consents – 15
2. Pt filled out questionnaire – 10 minutes
3. Vital signs and peak flows were done – 5 minutes
4. IPPB performed – 10 breath cycles for 1 to 2 minutes
5. There was a 1 minute break
6. Checked Peak flows and documented – 2 minutes
7. There was a 5 minute break between each equipment use
8. EZ Pap performed – 10 breath cycles for 1 to 2 minutes
9. There was a 1 minute break
10. Checked Peak flows and documented – 2 minutes
minutes
 Aseptic technique was used between each equipment use and in between each patient.
 There were disposable bacterial filters and tubing for the EZ Pap and IPPB machine.
Patient Code
Peak Flow Results
IPPB
Percent (%) Change
EzPap
Z001
475
460
-3.16
Z002
350
400
14.29
Z003
330
330
0
Z004
475
345
-27.37
Z005
385
410
6.49
Z006
280
270
-3.57
Z007
340
300
-11.76
Z008
n/a
n/a
n/a
Z009
300
300
0
Z010
470
470
0
Z011
375
355
-5.33
Peak Flow
Patient Code
Expected PF
1st PF
2nd PF
3rd PF
Peak Flow Results
IPPB
EzPap
Z001
638
460
475
490
475
460
Z002
448
360
390
400
350
400
Z003
375
320
320
320
330
330
Z004
385
350
290
350
475
345
Z005
565
375
430
430
385
410
Z006
385
275
280
290
280
270
Z007
386
300
325
300
340
300
Z008
n/a
n/a
n/a
n/a
n/a
n/a
Z009
497
334
320
310
300
300
Z010
622
450
480
470
470
470
Z011
469
340
330
360
375
355
AVERAGE (MEAN)
477
356.4
364
372
378
364
375-638
275-460
280-480
290-490
280-475
270-470
458.5
345
327.5
355
362.5
350
RANGE
MEDIAN
500
475
475
470 470
460
450
410
400
400
385
350
350
375
355
345
340
330 330
300
300
280
300 300
270
250
200
150
100
50
0
0
0
0
0
0
Patient
Code
Z001
Z002
Z003
Z004
Z005
Z006
Z007
Z008
Z009
Z010
Z011
Limitations



Money
Time
Unhealthy patients
Recommendations
We would like a research group to mimic our
study on patients:
 With COPD
 With Asthma
 After bronchodilator treatments
Conclusion
Based on the results from our research, we found that IPPB
improved peak flows more than EzPap. With the patients that we
have chosen, the difference was very minimal.
Glossary









AARC – American Association of Respiratory Care
Acapella – A small PEP device that helps to mobilize secretions by providing
positive expiratory pressure (PEP) therapy and airway vibrations.
Alveoli – any of the small thin-walled air-containing compartments of the lung
that are typically arranged in saclike clusters into which an alveolar duct
terminates and from which respiratory gases are exchanged with the pulmonary
capillaries
Ambulatory – Refers to the ability to walk.
Asthmatic – A chronic respiratory disease, in which the airways unexpectedly and
suddenly narrow
Atelectasis – collapse of the expanded lung; defective expansion of the pulmonary
alveoli
Auscultation – Listening for sounds within the body, especially from the chest,
neck, or abdomen. A stethoscope is typically used.
Barotrauma – Injury caused by increased air or water or pressure
Bronchodilator – A drug that expands he bronchi by relaxing bronchial muscles.
Glossary cont.








COPD- (chronic obstructive pulmonary disease) a progressive lung disease
process characterized by difficulty breathing, wheezing, and a chronic cough
CPT Chest physiotherapy; technique used to mobilize or loose secretions in the
lungs and respiratory tract.
Dyspnea-Air hunger resulting in labored breathing or difficult breathing,
sometime accompanied by pain
EKG (Electrocardiogram) – A record of the electrical activity of the heart
consisting of waves called P, Q, R, S, T and sometimes U.
Emesis – Vomiting. It may be of gastric, systemic, or neurological origin.
Exacerbation-Worsening or a “flare up” of COPD
Fistula- an abnormal connection between two organs, or between an organ and the
outside of the body
Gastric-Stomach
Glossary cont.










Hemoptysis-Blood spitting, the act of coughing up blood
Hypercapnia – An increase in the partial pressure of carbon dioxide in the blood,
typically to levels greater than 45-50 mmHg.
Hyperoxia-An excess of oxygen in the system
Hyperventilation – Excessive ventilation; excessive rate and depth of respirations
leading to loss of carbon dioxide from the blood
Hypocarbia - Less than normal level of carbon dioxide in the blood.
Hypoventilation- deficient ventilation of the lungs that results in reduction in the
oxygen content or increase in the carbon dioxide content of the blood or both
Hypoxemia-A deficiency in the concentration of dissolved oxygen in arterial
blood
Infiltrates- Allowing dirt and water to enter into something
Infiltrates- Allowing dirt and water to enter into something
Intracranial pressure- Pressure of the cerebrospinal fluid in the head with sensor
inserted through the skull
Glossary cont.








Intubation-The insertion of a tube into any hollow organ. Intubation of the trachea
provides an open airway and thus is an essential step in advanced life support.
IPPB- Intermittent positive pressure ventilation
IS – (incentive spirometry); also referred to as sustained maximal inspiration
(SMI), is a component of bronchial hygiene therapy
Kyphoscoliosis- Lateral curvature of the spine accompanied by the anterioposterior
hump.
MDI- ( metered dose inhaler)small aerosol canister in a plastic container that
releases a mist of medication when pressed down from the top. This medication
can be breathed into the airways
Mechanical ventilation-Artificially inflating and deflating the lungs to force gas
exchange in the lungs
Nebulizer-An apparatus for producing a fine spray or mist. This may be done by
rapidly passing air through a liquid or by vibrating a liquid at a high frequency so
that the particles produced are extremely small.
Neuromuscular-Concerning both nerves and muscles
Glossary cont.








Nosocomial infections-Any infection that first occur during a patient’s stay at a
health-care facility, regardless of whether it was detected during or after the stay.
NPPV (non-invasive positive pressure ventilation); refers to delivery of
ventilatory support using a mechanical ventilator connected to a mask or
mouthpiece instead of an endotracheal tube.
Peak Flow-A peak flow meter is a small, hand-held device used to manage asthma
by monitoring airflow through the lungs
PEEP Positive end expiratory pressure; term used in mechanical ventilation to
denote the amount of pressure above atmospheric pressure present in the airway at
the end of the expiratory cycle
PEP – Positive Expiratory Pressure
Perfusion- An act of perfusing the pumping of a fluid through an organ or tissue
Pneumothorax- accumulation of air or gas in the pleural cavity.
Pneumatically-Powered by compressed air
Glossary cont.







Spirometer- A spirometer is an instrument for measuring the volume of air
inspired and expired by the lungs.
Sputum – Mucus expelled from the lung by coughing. It may contain a variety of
materials from the respiratory tract, including in some instances cellular debris,
mucus, blood, pus, caseous material and/or microorganisms.
Stethoscope – An instrument used to transmit o the examiners ears sounds
produced in the body. It ordinarily consists of rubber tubing in a Y shape and a
bell or diaphragm.
TB (tuberculosis)-A disease caused by the bacterium Mycobacterium tuberculosis
that usually causes an infection of the lungs.
Venous- Venous blood is blood returning to the heart in veins.
Ventilation- The movement of air into and out of the lung
Wheezing- A wheeze is a continuous, coarse, whistling sound produced in the
respiratory airways during breathing Infiltrates- Allowing dirt and water to enter
into something
Bibliography
AARC. (2003).AARC clinical practice guideline: intermittent positive pressure
breathing-2003 revision and update. Respiratory Care, 48(5), 540-546.
AARC. (1993). AARC clinical practice guidelines: use of positive airway pressure
adjuncts to bronchial hygiene therapy. Respiratory Care, 38(5), 516-521.
.
van der Scahans, Cees P.(2007) Conventional chest physical therapy for obstructive
lung disease. Respiratory Care, 52(9), 1198-1208
Taber, Clarence Wilbur. (2005). Taber’s cyclopedic medical dictionary (Ed. 20).
Philadelphia: Davis Co.
THE END