The use of positive pressure devices by physiotherapists

The aim of this paper is to review the indications for use by physiotherapi sts, such as physiological rationale and the comparative efficacy of interm ittent positive pressure breathing (IPPB) and continuous positive airway pr essure (CPAP). A brief discussion of nasal intermittent positive airway pre ssure is also included. The use of IPPB for post operative prophylaxis has not been supported in th e literature. In patients with low lung volumes resulting from neuromuscula r disease or spinal injury, IPPB may be useful in the acute phase to improv e tidal volume and cough effectiveness. The physiological benefits of CPAP to improve lung volumes are well documen ted in the literature, Physiotherapists use CPAP as an intermittent applica tion in patients with low lung volumes following surgery, It is predominant ly used as a second line intervention in the presence of refractory atelect asis and poor gas exchange. It may also he indicated in other patient group s 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 dis ordered breathing, but more research is needed in patients with acute respi ratory failure.