• Door Han Franssen
  • In ARDS
  • 2016-01-30 10:44:05

Management of Localized Pneumothoraces After Pulmonary Resection With Intrapulmonary Percussive Ventilation

Background. Intrapulmonary percussive ventilation (IPV) aims at clearing retained secretions through oscillary vibrations generated by high frequency bursts of gas delivered into the airways at rates between 200 and 300 breaths per minute and at a delivery pressure of 10 to 20cm water. In addition, IPV can improve recruitment of alveolar units and deliver aerosolized medications. The use of IPV to resolve challenging postlobectomy localized pneumothoraces is hereafter described.
Methods. Between January 2005 and March 2009, four patients with long-term complicated postresectional residual air spaces persisting 6 months (mean, 187 days) after primary surgery were treated by IPV. The type of operation was upper lobectomy and lower lobectomywedge resection in 1 and 3 patients, respectively. Mean preoperative and immediate postsurgical forced expiratory volume in the first second of expiration were 2.31 L and 1.49 L, respectively. Mean preoperative and immediate postsurgical forced vital capacity were 3.13 L and 2.1L, respectively. Patients were subjected to 12-minutelong IPV sessions up to a total of 8 to 12 sessions administered every other day in an outpatient setting.

  • Door Han Franssen
  • In ARDS
  • 2016-01-30 10:42:43

Effect of intrapulmonary percussive ventilation on expiratory flow limitation in chronic obstructive pulmonary disease patients.

The aims of this prospective study were (1) to select, after weaning and extubation, chronic obstructive pulmonary disease (COPD) patients with expiratory flow limitation (EFL) measured by the negative expiratory pressure method and (2) to assess, in these patients, the short-term (30 minutes) physiologic effect of a session of intrapulmonary percussive ventilation (IPV).
All COPD patients who were intubated and needed weaning from mechanical ventilation were screened after extubation. The patients were placed in half-sitting position and breathed spontaneously. The EFL and the airway occlusion pressure after 0.1 second (P0.1) were measured at the first hour after extubation. In COPD patients with EFL, an IPV session of 30 minutes was promptly performed by a physiotherapist accustomed to the technique. Expiratory flow limitation, gas exchange, and P0.1 were recorded at the end of the IPV session.

  • Door Han Franssen
  • In ARDS
  • 2016-01-30 10:41:44

Intrapulmonary percussive ventilation superimposed on conventional ventilation: bench study of humidity and ventilator behaviour

Intrapulmonary percussive ventilation (IPV) is a form of high-frequency ventilation that can be superimposed on spontaneous breathing or conventional ventilation. Drawbacks include difficulties achieving adequate airway humidification and an inability to monitor delivered volumes and pressures, which may vary with patient characteristics. The objectives of this study were to assess various humidification set-ups, to measure intrapulmonary pressures and volumes resulting from IPV superimposed on a conventional driving ventilator (DV) and to test several ventilators regarding their ability to accept added IPV.
Bench study in a test-lung set-up was used to measure humidification and the effects of adding IPV to a DV under various conditions of compliance, resistance, plateau and positive end-expiratory pressures. Then, five ventilators were tested in combination with IPV.

  • Door Han Franssen
  • In ARDS
  • 2016-01-30 10:40:49

Intra-pulmonary Percussive Ventilation - Brief Review of Clinical and Physiological Studies

Department of Medical Intensive Care, Pellegrin Hospital, Bordeaux; 2. Medical Intensive Care Unit, L’Archet Hospital, Nice

The intra-pulmonary percussive ventilation (IPV) device, designed to improve mucus clearance, was developed by Forrest M Bird in 1979. IPV is a form of high-frequency ventilation that delivers small bursts of high-flow respiratory gas with frequency higher than 1Hz (usually 4–10Hz). This causes airway pressure to oscillate between 5 and 35cm H2O, and the airway walls vibrate in synchrony with these oscillations.1 Unique to IPV is the Phasitron®, which employs a sliding flow regulator based on the Venturi effect. As found with other high-frequency ventilatory modes (high-frequency oscillation [HFO], high-frequency jet ventilation, etc.), inspiration during IPV is active using small tidal volumes. In contrast to HFO, expiration is passive. This technique maybe associated with nebulisation and has the potential to improve secretion clearance.2–4 This device is positioned at the patient’s proximal airway. During the percussive bursts of air into the lungs, a continued pressure is maintained, while a high-velocity percussive inflow opens airways and enhances intra-bronchial secretion mobilisation. We will briefly present the clinical and physiological studies concerning IPV in order to demonstrate its usefulness in successfully managing intensive care unit (ICU) patients.

  • Door Han Franssen
  • In ARDS
  • 2016-01-30 10:38:51

Intrapulmonary percussive ventilation in tracheostomized patients: a randomized controlled trial

OBJECTIVE: To investigate whether the addition of intrapulmonary percussive ventilation to the usual chest physiotherapy improves gas exchange and lung mechanics in tracheostomized patients. 
DESIGN AND SETTING: Randomized multicenter trial in two weaning
centers in northern Italy. 
PATIENTS AND PARTICIPANTS: 46 tracheostomized patients (age 70 ± 7 years, 28 men, arterial blood pH 7.436 ± 0.06, PaO2/FIO2 238 ± 46) weaned from mechanical ventilation.
INTERVENTIONS: Patients were assigned to two treatment groups performing chest physiotherapy (control), or percussive ventilation (IMP2 Breas, Sweden)

  • Door Han Franssen
  • In ARDS
  • 2016-01-30 10:37:24

Intrapulmonary percussive ventilation and noninvasive positive pressure ventilation in patients with chronic obstructive pulmonary disease: Strength through unity?

The originality and the most important clinical message of the study by Dr. Antonaglia and colleagues  are that a bimodal therapy combining NPPV and noninvasive IPV can be useful to manage successfully patients with acute exacerbation of COPD. Even if that is not demonstrated, one can think that IPV will benefit more particularly the patients with very excessive secretions and a frequent need to remove them. Indeed, patients with a repeated need to remove secretions may be difficult to treat with NPPV. This therapy is right not only for patients presenting with acute exacerbation of COPD. The technique should be evaluated in other types of acute respiratory failure including respiratory distress after extubation, where the interest of NPPV is challenged and where the excess of secretions is a frequent cause of extubation failure. Further studies are needed to confirm the advantage of adding IPV sessions to the strongly recommended practice of NPPV and to improve the selection of the patients likely to benefit from IPV, before being able to adopt “strength through unity for the noninvasive challenges.”

  • Door Han Franssen
  • In ARDS
  • 2016-01-30 10:34:19

Physiological response to intrapulmonary percussive ventilation in stable COPD patients

Respiratory Intensive Care Unit, Fondazione S.Maugeri, IRCCS, Istituto Scientifico di Pavia, Via Ferrata 8, 27100 Pavia, Italy.

Intrapulmonary percussive ventilation (IPV) is a ventilatory technique that delivers bursts of high-flow respiratory gas into the lung at high rates, intended for treating acute respiratory failure and for mobilization of secretions. We performed a study, aimed at assessing the physiological response to IPV, on patients' breathing pattern, inspiratory effort, lung mechanics and tolerance to ventilation. 10 COPD patients underwent randomized trials of IPV through a face mask at different pressure/frequency combinations (1.2 bar/250 cycles/min; 1.8/250; 1.2/350; 1.8/350), separated by return to baseline (SB), using the IMP2 ventilator. In 5 patients we have also compared the physiological changes of IPV with those obtained during pressure support ventilation (PSV). Minute ventilation did not vary among the trials, but tidal volumes (VT) were significantly greater during 1.2/250, 1.2/350 and 1.8/350 compared to SB. The
pressure time product of the diaphragm per minute (PTPdi/min) estimate of the diaphragm oxygen expenditure was also significantly reduced during 1.2/250 and 1.8/250 (209 cmH2O x s/min for SB vs. 143 and 125 for 1.2/250 and 1.8/250, respectively P < 0.05), as well as dynamic intrinsic end-expiratory pressure (PEEPi,dyn). Similar reduction in PTPdi/min were obtained also during PSV. Tolerance to
ventilation and oxygen saturation were satisfactory and did not change during the different trials. In 5 normal subjects a prolonged apnea trial lasting > 2 min was also performed, without any significant decrease in SaO2 or subjective discomfort.  Conclusion: IPV was able to guarantee an adequate ventilation, while inducing a significant unloading of the diaphragm during the "low-frequency" trials.

  • Door Han Franssen
  • In ARDS
  • 2016-01-30 10:33:20

Efficacy and safety of intrapulmonary percussive ventilation superimposed on conventional ventilation in obese patients with compression atelectasis.

OUbe, Yamaguchi 755-8505, Japan. ryosanygc@ umin.ac.jp

PURPOSE: To investigate the efficacy and safety of intrapulmonary percussive functions during IPV superimposed on conventional ventilation. 
MATERIALS AND METHODS: Ten obese patients with acute respiratory failure due to compression atelectasis who had not improved by conventional ventilation were treated
with IPV. Hemodynamic parameters, ventilator settings, and intracranial pressure (n = 1) were recorded every hour. Arterial blood gas was analyzed every 3 hours. The efficacy and safety of IPV was assessed at the start of weaning. 
RESULTS: Before IPV, PaO2/FiO2 ratio remained low (189 +/- 63 mm Hg), which significantly increased to 243 +/- 67 mm Hg at 3 hours from the initiation of IPV 
(P <.01). Furthermore, it continuously increased to 280 +/- 50 mm Hg at 24 hours 
(P < .01). Intrapulmonary percussive ventilation induced significant increase in dynamic compliance from control value of 30 +/- 8 mL/cm H20  at 0 hours to 35 +/- 9 mL/cm at 12 H2O (P < .05) and to 38 +/- 8 mL/cm H2O at 24 hours (P < .01). Heart rate and mean arterial pressure were not significantly changed during IPV. Improvement of compression atelectasis was confirmed by their chest computed tomographic scans. Adverse effects such as pneumothorax and intracranial hypertension were not seen.