IPPB lecture Part ii of ii

By Elizabeth Kelley Buzbee A.A.S., R.R.T.-N.P.S., R.C.P.

Read:

Bird IPPB machines

  • Mosby’s Equipment page 199-204
  1. Describe how the Bird IPPB machine delivers its volume to the patient, using the following terms: ambient magnet, ambient pressure chamber, ambient clutch plate, pressure chamber, pressure magnet, pressure clutch plate &, ceramic switch, diaphragm.

Look at Bird tutorial

  1. On a drawing of the Bird Mark 7 or 8 label the knobs, controls and other parts:page 201 Figure 7-17
  2. Patient effort: sensitivity control
  3. Air-mix or 100%mode: selects the Fi02 and the flow pattern
  4. Pressure control:selects the PIP which will deliver the VT
  5. Flow rate:controls the flow going to both the mainstream and to the SVN
  6. Manual trigger:knob that starts inspiration without the patient needing to create a negative pressure
  7. On a drawing of the Bird IPPB circuit, label the parts of the circuit from machine outlet to the patient connectionpage 200 Figure 7-15
  8. Draw and label the mushroom valve during inspiratory phase and discuss the actions of the mushroom valve: See Handout.
  9. Identify the flow pattern of the Bird IPPB machine in air/mix and in 100% mode. Why does changing the Fi02 alter the flow pattern and the flow rate?
  10. A flow pattern is a description of how the flow acts during the entireinspiratory phase. For IPPB machines we really only have two types of flow patterns:
  11. Descending ramp: At the start of the breath the flow rate is at the set flow, but as pressure rises in the line, the flow slows down. This will be seen during a breath on Air Mix because as the pressure in the line slows down and finally ends air entrainment, the total flow will slow down
  1. Square or rectangular wave: when the IPPB is set atFi02 100%, there will be a set flowrate that goes to its peak immediately and stays there throughout the breath. Because there is no entrainment the flow is alwaysthe level dialed into the machine.

Reading Assignment: Bennett IPPB

Mosby’s Equipment page 194-2-199

  1. Describe how the Bennett IPPB machine delivers its volume to the patient. Use these terms: Bennett valve, drum, counter weight, mushroom valve

See PR II tutorial

  1. On a drawing of the Bennett PRII, label the knobs, controls and other parts.

Page 196, Figure 7-7

  1. On a drawing of the Bennett IPPB circuit, label the parts of the circuit from machine outlet to the patient connection.
  2. Draw and label the mushroom valve during inspiratory phase and during exhalation
  3. Discuss the effect of changing the following on the PRII:
  4. Sensitivity knob: sensitivity on the PR II cannot be turned off. This IPPB machine can only become more sensitive and easier to trigger
  5. System pressure: changes the PIP which controls the VT delivered
  6. flow rate: a needle valve increases or decreases the flow going into the Bennett valve
  7. Nebulizer flow rate: the PRII has separate controls for running the nebulizer all the time or just running it during inspiration.Note that the Fi02 of the SVN is 100% even in air mix mode.
  8. Fi02 from air/mix to 100%: entrainment of room air occurs above the Bennett valve. The flow is also descending flow
  9. Terminal flow: adds extra gas below the drum to compensate for tiny internal leaks in the machine will not prevent the machine from cycling off
  1. Briefly, differentiate between the Bennett PRII and the AP5. The AP 5 is electronically powered, so that you don’t need 50 psig pressure to operate it. The controls are simpler: only Pressure control and increase nebulizer flow rate.
  1. Which of these two machines might best be used at home? The AP 5 is popular because it is cheaper and most COPD patients need air for Tx anyway
  2. Which of these machines would you select for a patient with a hypoxic drive?AP-5 because it uses compressed air [Fi02 21%]
  1. Briefly compare the Bird IPPB machine to the Bennett PRII.
  1. Which of these could be operated on the international space station?The bird works on magnets, so could be used on the space station, while the PRII needs gravity to operate
  2. Which of these two machines cannot have the sensitivity turned off?The PRII cannot haveits sensitivity turned off
  3. Which of these machines can you not increase the flow rate without increasing the nebulizer flow rate?The Bird has a single flow to run both the SVN and the mainstream flow
  4. What is an advantage to having separate controls for the nebulizer flow and for the main line flow to the patient?If the patient only gets nebulization during inspiration instead of continuously, he will get more medication into his lungs.
  5. Which of these two machines cycles off when the inspiratory flow rate drops below 1-3 lpm? The PRII
  6. Which of these two machines has an internal leak compensator? The PRII has a terminal flow that can add a bit of extra flow to the bottom of the drum so that it will close in the face of a tiny internal leak
  7. Which of these two machines has two manometers? The PRII