Intermittent Positive Pressure Breathing

An overview of IPPB, one of the primary inhalation therapy modalities from the 1940s until the mid-1970s.

Intermittent positive pressure breathing (IPPB), a hyperinflation therapy modality, was one of the primary treatment modalities administered by inhalation therapists in the 1950s, 1960s, and 1970s.

IPPB is primarily prescribed to prevent atelectasis, to assist in clearance of secretions, and to deliver medications when other forms of therapy were unsuccessful.

IPPB delivers a prescribed gas at a positive pressure (usually 10-15 cm H20) for a specified time (usually 15 minutes.) Medications, such as bronchodilators, diluents, mucolytics, and antibiotics can be delivered via a nebulizer built into the breathing circuit. IPPB can be used on patients of all ages.

IPPB is most commonly delivered via a simple mouthpiece but flanged mouthpieces, shields/seals, oronasal masks, and 15 mm trach tube adapters can also be used, as applicable. Following the Sugarloaf Conference in 1974 where the scientific basis for IPPB was questioned, the use of IPPB significantly declined as other therapeutic techniques were substituted.

V. Ray Bennett worked with the military during WWII to improve the demand oxygen systems for aviators flying at high altitudes. Bennett’s valve improved the demand system to be breathed intermittently.

In May 1945, V. Ray Bennett filed for a patent for an “Oxygen Valve” for use in high altitude aircraft and for “administering oxygen and other gases in the therapeutic treatment of bronchial asthma, pulmonary edema, coronary thrombosis, coronary sclerosis, pneumonia, and numerous other physical ailments which have been found to be benefited by inhalational therapy.” The patent was granted October 4, 1949.

The Bennett was incorporated into the TV2P, PR-1, PR-2, AP-4, and AP-5 units.

This apparatus was used by Hrley Motley and his associates to deliver IPPB to patients in respiratory failure.
A - corrugated rubber hose, B-Bendix Pressure Demand Regulator, C - Bennett Clinical Research Model X-2 Respirator, D- Bennett Face Mask

In December 1947, Dr. Andre Cournand, Dr. Hurley Motley, Dr.Lars Werko, and Dr, Dickinson Richards submitted their research on the effects of IPPB on cardiac output on human volunteers to the American Journal of Physiology.

PHYSIOLOGICAL STUDIES OF THE EFFECTS OF INTERMITTENT POSITIVE PRESSURE BREATHING ON CARDIAC OUTPUT IN MAN
Andre Cournand, Hurley L. Motley, Lars Werko, Dickinson W. Richards
American Journal of Physiology -- Legacy ContentDec 1947,152(1)162-174;

In May 1948, V. Ray Bennett applied for a patent for his “Respiratory Facial Mask”. In his patent application, he indicated that “the need for a comfortable, and yet tightly fitting mask is particularly pressing in cases involving pressure breathing, such as encountered in resuscitation, high altitude flying, and in positive and intermittent positive pressure breathing now being used clinically in oxygen therapy and in the treatment of pulmonary edema, asthma, cardiac conditions, and other types of respiratory depression or failure.”
The patent was granted on February 6, 1951.

First prototype of Dr. Bird’s magnetic respirator with manually selectable positive pressure developed in 1950.

In March 1952, J.H. Emerson filed a patent application for his invention of "Breathing Assistor Valve". Upon the patient's initiation of inhalation, the device would "assure the enforced delivery of life sustaining gas at a predetermined pressure and in predetermined volume to fill the patient's lungs without requiring any further effort on the patients part and without injury to his lungs and which when the period of artificial inhalation has terminated will permit normal exhalation by the patient." In addition, the device would operate "auxiliary equipment, as for example, an atomizer for administering medicine to the patient."

The patent was granted December 18, 1956.

Mine Safety Appliances Company Compressor Model for IPPB

In November 1956, V. Ray Bennett filed a patent for a “Respiratory Mouthpiece”. This shield provided a better seal than a simple mouthpiece and was better tolerated by many patients than face masks. The patent was granted on October 28, 1958.

This announcement of the introduction of the Bird Mark 7 Respirator appeared in the June 1958 issue of the INHALATION THERAPY journal.

In January 1956, William H. Haverland filed a patent application for “Respirator Control Systems”. The unit became known as the Monaghan VENTALUNG™. The patent was granted on April 14, 1959.

The housing of the Monaghan Ventalung is removed to show the internal components.

This 1958 ad shows the Thompson Portable Medi-Breather. The portable IPPB device was contained in a luggage "train case".

This ad for the Mine Safety Appliances Company's Pulmonary Ventilator appeared in the December 1959 issue of the Inhalation Therapy journal. The device was designed to operate from an oxygen cylinder of piped system to deliver "IPPBI Therapy".

In February 1958, Forrest M. Bird and Henry l. Pohndorf filed a patent for a “Fluid Control Device.” The patent for the respirator was granted on December 18, 1962.

This early Bennett unit was cylinder-mounted.Image from Gene Gantt

The Ohio/Dotco Pressure Balanced Respirator claimed to provide improved flexibility and adjustment for all IPPB procedures in this late 1950s ad from the Inhalation Therapy journal.

The Emerson Exhalator with IPPB is shown in this ad that appeared in the June 1959 issue of the Inhalation Therapy journal. The device provided gentle abdominal pressure to aid exhalation.

This ad for the Bennett Flow-Sensitive Valve appeared in the September 1958 issue of the Inhalation Therapy journal.

In April 1959, Richard Brush filed a patent application for the “Respirator Control Valve Casing” for the ornamental housing for the Monaghan Pediatric VENTALUNG. The patent was granted on May 2, 1961.

The “eyes” on the face of the clown moved as the child breathed on the unit.

TV-2P Video

This 1960 ad states that the Monaghan Pediatric VENTALUNG was “the first I.P.P.B. breathing apparatus designed for therapy of children” and “makes therapy fun.”

In November 1960, H. L. Gage, Jr. filed a patent application for a “Respiration Apparatus” which became known as the Bennett PR-1. The patent was granted on August 9, 1966.

Often mistaken for a "TV-2P", the only difference is that the PV-3P is pedestal-mounted and uses piped in oxygen or air while a TV2P is "tank" (cylinder) mounted.

In October 1961, N.F. Beasley applied for a patent for “Pressure Breathing Therapy Unit”. The device which contained a compressor and was designed to be portable and later would be known as the Bennett AP-4. The patent was granted on December 7, 1965.

This ad from the June 1962 issue of Inhalation Therapy shows the Air-Shields' Pressure Breathing Assistor (PBA).

This ad for the NCG IPPB apparatus appeared in the June 1962 issue of INHALATION THERAPY journal.

This Bird Mark 7 respirator circa 1961 has an aluminum housing. It is owned by Felix Khusid.

This 1965 IPPB training manual was from the Hospital of Good Samaritan Medical Center, Los Angeles, California.

In this 1969 photo, an inhalation therapist holds a face mask to administer an IPPB treatment.

This ad for the MSA Fluidic Breathing Assistor for IPPB appeared in the December 1970 issue of the INHALATION THERAPY journal.

Many departments offered multi-patient treatment rooms in the 1960s and 1970s where ambulatory inpatients and outpatients could receive IPPB treatments concurrently. These rooms were sometimes nicknamed "puffing parlors". This slide shows one patient receiving an IPPB treatment from the row of wall-mounted Birds.

Preparing for the next round of IPPB treatments in 1970.

Prior to the availability of portable units for transport and home care, this suitcase was modified to house a Bird Mark 7 ventilator and compressor.

In July 1971, a patent application was filed for a "portable respirator" for prescribed IPPB or topical pulmonary chemotherapy. The patent was awarded to Forrest M. Bird et al on December 26, 1972.

The Porta-Bird enclosed in its carrying case.

The National Heart and Lung Institute and the American Thoracic Society convened scientists to review the efficacy of respiratory therapy modalities. The Sugarloaf Conference findings on IPPB, were published in the December 1974 issue of the American Review of Respiratory Disease. John F. Murray's conference summary identified the misuse of IPPB, one of the primary clinical modalities of respiratory therapy practitioners at that time.