Intermittent Positive Pressure Breathing (IPPB)

Intermittent Positive Pressure Breathing (IPPB) is a short-term breathing treatment where increased breathing pressures are delivered via ventilator to help treat atelectasis, clear secretions or deliver aerosolized medications. The PVA clinical guidelines on respiratory management following SCI (PVA 2005) include IPPB as a treatment. However, there are few studies looking directly at the effects of IPPB in spinal cord injury.

Table 10: Intermittent Positive Pressure Breathing (IPPB)

Stiller et al. (1992) found an increase in lung volume while IPPB was being administered, and tidal volume to return to baseline values immediately after stopping IPPB. While the mean vital capacity remained significantly higher after ceasing IPPB, the improvement was not considered clinically significant. More recently, Laffont et al. (2008) found that IPPB had no short-term or long-term effects on pulmonary function, lung compliance or work of breathing in patients within one year of SCI who were not in respiratory failure. They commented that IPPB is expensive in terms of staff and equipment and is reported as unpleasant by many subjects.

While IPPB does not appear to be effective on lung function and compliance, further studies that look at the role of IPPB on atelectasis, secretion management and in acute respiratory failure following SCI are needed.

Conclusion

  • There is level 2 evidence (from 1 RCT) (Laffont et al. 2008) that intermittent positive-pressure breathing (IPPB) has no short-term or long-term effects on lung function within one year of SCI.
  • There is level 4 evidence (from 1 Pre-post trial) (Stiller et al. 1992) that IPPB has no effects on lung function immediately following onset of SCI.