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Intermittent Positive Pressure Breathing, Incentive Spirometry, and Face-Mask Positive End-Expiratory Pressure

William L. Paul, MD; John B. Downs, MD, FCCP

Arch Surg. 1981;116(7):861-863.

Abstract
• Postoperative atelectasis has been treated with inspiratory maneuvers in an attempt to increase functional residual capacity. We compared the effect of intermittent positive pressure breathing (IPPB), incentive spirometry, and 5-cm H₂O positive end-expiratory pressure (PEEP) applied with a face mask on the transpulmonary pressure (P_L) at the end of expiration of eight patients 24 to 34 hours after aortocoronary bypass graft insertion. Intermittent positive pressure breathing and PEEP increased expiratory P_L during therapy. After IPPB, expiratory P_L fell below control values and then returned toward, but did not reach, control values. After PEEP was discontinued, expiratory P_L returned to control values within the next 30 minutes. The results suggest that face-mask PEEP will increase functional residual capacity, that incentive spirometry has little or no effect, and that IPPB may decrease lung volume after treatment.

(Arch Surg 1981;116:861-863)

Author Affiliations
From the Departments of Anesthesiology (Drs Paul and Downs) and Surgery (Dr Downs), University of Florida College of Medicine; and the Department of Anesthesia, Veterans Administration Medical Center (Dr Paul), Gainesville, Fla. Dr Downs is now with the Department of Pulmonary Medicine and Anesthesiology, Mercy Hospital, Urbana, Ill.

Footnotes
Accepted for publication Feb 2, 1981.

Read in part at the annual meeting of the American Society of Anesthesiologists, San Francisco, Oct 12, 1976.

Reprint requests to Department of Anesthesiology, Box J-254, J. Hillis Miller Health Center, University of Florida College of Medicine, Gainesville, FL 32610 (Dr Paul).

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