This RT thinks IPPB therapy is useless

So, I'm watching this old show called Emergency for no better reason than the fact I loved this show when I was a kid. I remember watching it in, say, 1976 or so on Saturdays. In fact, every Saturday I looked forward to this show.

Anyway, it's 30 years later and I find a re-run of this show at 3:00 in the morning while I'm working one night here at Shoreline, and just as I'm about ready to get up and go check on my patients, the scene switches to a patient in critical care on a ventilator.

The room looked nothing like the rooms of today, and the acting was of questionable quality, but I can tell you that my eyes lit up when I saw the ventilator: a bird mark 7 respirator.

Heck, we have these sitting at the back side of our respiratory storage room collecting dust, and most hospitals have probably thrown theirs out or given them to some foreign nation as a charitable donation.

What a sight it was not just to see this old IPPB machine, but to see it used as a ventilator.

Believe it or not, I have seen this machine used as a ventilator short term during a catscan of an intubated patient, but that was before we had super fast catscan technology, and before the advent of the transport ventilator.

And to believe that on occasion we still use this piece of junk, the same piece of junk that was used to ventilate patients 30 years ago, is scary medicine.

Last weekend I could have choked one of my co-workers because she asked a doctor to write an order for this machine. I wanted to choke her because it was a doctor who never would have thought of ordering this on his own.

However, I diplomatically smiled at my favorite co-worker and said, "Cool."

Why was I disgruntled at this IPPB request, when my co-worker was only trying to do what she thought was best for the patient? Because I'd hate for this doctor to learn to like the IPPB and want to order it again.

Yes, the patient did get better that day, but it was his fourth day post-op, and during the night before I had decreased his oxygen from a NRB to a 50% VM. He was making great progress with cough and deep breathing excercises and Preventolin breathing treatments alternated with cracklin nebs to re-inflate the collapsed alveoli (see olins bottom of blog for more detail here).

Needless to say, the IPPB (Bird mark 7) was a good machine in its day, but now its used to force air into a patient and force them to take a deep breath -- if it is used or taught properly, and it rarely is.

The theory is that it is good for post-op patients, in that it works as a glorified incentive spirometer to expand collapsed (atelectic) alveoli, and exercise the good alveoli. It's about a 5-10 minute therapy session.

However, most studies show that all the IPPB really does is over-expand the good alveoli, and does nothing for the collapsed alveoli. In other words, it's an over-hyped piece of junk.

(Click here for a video of how the IPPB works that might soon be seen only in RT museums.)

Now, some of the RTs who have worked here a lot longer than me, however, truly believe this IPPB can do some good for some patients. They say that it has kept some patients off the ventilator.

However, I think what really kept those patients off the ventilator was the special attention they received from the RT, the incentive spirometry enforcements, the encouraging of the patient to cough and deep breathe with good breath hold. All of that coupled with moving the patient as often as possible.

I don't think it was the IPPB that made my patient better. I hate that thing. I think it's an ineffective waste of my time and the patient's time. I think the only thing it's good for is good old TV, like I saw the other day when I watched that old re-run of Emergency.

I loved that show.

Further reading:

• Up with IPPB (coming soon to RT cave)
• Down with IPPB