Review of the status of intermittent positive pressure breathing therapy

With the advent of diagnosis related groups reimbursement schedules, the cost-effectiveness of therapies needs to be assessed. The safety and efficacy of intermittent positive pressure breathing (IPPB) has been controversial. IPPB employs the dilating effects of positive-pressure ventilation to deliver aerosolized particles to small and medium-sized bronchi of patients with obstructive airways disease. IPPB is expensive to implement and maintain. The hazards of IPPB (infection, pneumothorax, decreased cardiac output), although rare, could prolong hospital stays. Except for severely ill patients with fatigued respiratory muscles, IPPB offers no advantages over the less costly and safer compressor-nebulizer or metered-dose delivery of a beta-agonist.