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The use of positive pressure devices by physiotherapists

¹ School of Physiotherapy, The University of Melbourne, Melbourne, Australia. ² Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia

CORRESPONDENCE: L. Denehy, School of Physiotherapy, The University of Melbourne, 200 Berkeley Street, 3052, Melbourne, Australia.

Keywords: continuous positive airway pressure, intermittent positive pressure breathing, physiotherapy, respiratory complications

Received: January 15, 1999
Accepted December 29, 2000

Abstract

The aim of this paper is to review the indications for use by physiotherapists, such as physiological rationale and the comparative efficacy of intermittent positive pressure breathing (IPPB) and continuous positive airway pressure (CPAP). A brief discussion of nasal intermittent positive airway pressure is also included.

The use of IPPB for post operative prophylaxis has not been supported in the literature. In patients with low lung volumes resulting from neuromuscular disease or spinal injury, IPPB may be useful in the acute phase to improve tidal volume and cough effectiveness.

The physiological benefits of CPAP to improve lung volumes are well documented in the literature. Physiotherapists use CPAP as an intermittent application in patients with low lung volumes following surgery. It is predominantly used as a second line intervention in the presence of refractory atelectasis and poor gas exchange. It may also be indicated in other patient groups with similar physiological problems.

Nasal intermittent positive airway pressure combines the beneficial effects of intermittent positive pressure breathing and continuous positive airway pressure. There have been many studies evaluating its effectiveness. These have been supportive for patients with neuromuscular disease and sleep disordered breathing, but more research is needed in patients with acute respiratory failure.

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