Intermittent Positive Pressure Breathing

About IPPBAbout IPPB
About IPPB
An overview of IPPB, one of the primary inhalation therapy modalities from the 1940s until the mid-1970s.
What is IPPB?What is IPPB?
What is IPPB?
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.
1940s1940s
1940s
1945 Bennett's Oxygen Valve1945 Bennett's Oxygen Valve
1945 Bennett's Oxygen Valve
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.
Bennettx2Bennettx2
Mid 1940s Bennett Clinical Research X-2 Respirator
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
1947 IPPB Effects on Hemodynamics1947 IPPB Effects on Hemodynamics
1947 IPPB Effects on Hemodynamics
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;
1948 Bennett's "Respiratory Facial Mask"1948 Bennett's "Respiratory Facial Mask"
1948 Bennett's "Respiratory Facial Mask"
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.
Late 1940s Bennett TV2PLate 1940s Bennett TV2P
Late 1940s Bennett TV2P
Image from Dennis Glover
1950s1950s
1950s
1950 Prototype of BIRD Respirator1950 Prototype of BIRD Respirator
1950 Prototype of BIRD Respirator
First prototype of Dr. Bird’s magnetic respirator with manually selectable positive pressure developed in 1950.
Image from Felix Khusid
1951 Second Prototype of BIRD Respirator1951 Second Prototype of BIRD Respirator
1951 Second Prototype of BIRD Respirator
Image from Felix Khusid
1952 Emerson's "Breathing Assistor Valve"1952 Emerson's "Breathing Assistor Valve"
1952 Emerson's "Breathing Assistor Valve"
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.
1950s Emerson Respiration Assistor1950s Emerson Respiration Assistor
1950s Emerson Respiration Assistor
Image from Joseph Sullivan
1950s IPPB with Bennett TV2P1950s IPPB with Bennett TV2P
1950s IPPB with Bennett TV2P
Inhalation Therapy journal
1950s M-S-A Compressor Model1950s M-S-A Compressor Model
1950s M-S-A Compressor Model
Mine Safety Appliances Company Compressor Model for IPPB
1956 Bennett's "Respiratory Mouthpiece"1956 Bennett's "Respiratory Mouthpiece"
1956 Bennett's "Respiratory Mouthpiece"
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.
1958 BIRD Mark 7 Released1958 BIRD Mark 7 Released
1958 BIRD Mark 7 Released
Image from Felix Khusid
1958 Bird Mark 71958 Bird Mark 7
1958 Bird Mark 7
This announcement of the introduction of the Bird Mark 7 Respirator appeared in the June 1958 issue of the INHALATION THERAPY journal.
1956 "Respirator Control Systems"1956 "Respirator Control Systems"
1956 "Respirator Control Systems"
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.
1950s Monaghan Ventalung1950s Monaghan Ventalung
1950s Monaghan Ventalung
Image from Dennis Glover
Interior of VentALungInterior of VentALung
Interior of VentALung<
The housing of the Monaghan Ventalung is removed to show the internal components.
Image from Felix Khusid
Thompson Medi-BreatherThompson Medi-Breather
Thompson Medi-Breather
This 1958 ad shows the Thompson Portable Medi-Breather. The portable IPPB device was contained in a luggage "train case".
MSA Pulmonary VentilatorMSA Pulmonary Ventilator
MSA Pulmonary Ventilator
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".
1958 Bird et al "Fluid Control Device"1958 Bird et al "Fluid Control Device"
1958 Bird et al "Fluid Control Device"
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.
1959 Bird Mark 8 Introduced1959 Bird Mark 8 Introduced
1959 Bird Mark 8 Introduced
Image from Felix Khusid
Ohio DotcoOhio Dotco
Ohio Dotco
This early Bennett unit was cylinder-mounted.Image from Gene Gantt
Ohio/Dotco RespiratorOhio/Dotco Respirator
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.
Emerson Exhalator with IPPBEmerson Exhalator with IPPB
Emerson Exhalator with IPPB
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.
Bennett ValveBennett Valve
Bennett Valve
This ad for the Bennett Flow-Sensitive Valve appeared in the September 1958 issue of the Inhalation Therapy journal.
1959 VENTALUNG Casing1959 VENTALUNG Casing
1959 VENTALUNG Casing
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.
Late 1950s Pediatric VENTALUNGLate 1950s Pediatric VENTALUNG
Late 1950s Pediatric VENTALUNG
The “eyes” on the face of the clown moved as the child breathed on the unit.
Image from Steve and Mary DeGenaro
1960s1960s
1960s
TV-2P Video
1960 Monaghan VENTALUNG Ad1960 Monaghan VENTALUNG Ad
1960 Monaghan VENTALUNG Ad
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.”
1960 "Respiration Apparatus"1960 "Respiration Apparatus"
1960 "Respiration Apparatus"
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.
1960s Bennett PR-11960s Bennett PR-1
1960s Bennett PR-1
Image from Doug Pursley
Early 1960s Bennett AdEarly 1960s Bennett Ad
Early 1960s Bennett Ad
1960s Bennett TV-2P1960s Bennett TV-2P
1960s Bennett TV-2P
Image from Jim Ciolek
1960s IPPB with Bennett PV-3P1960s IPPB with Bennett PV-3P
1960s IPPB with Bennett PV-3P
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.
Image from Doug Pursley
1961 Pressure Breathing Therapy Unit1961 Pressure Breathing Therapy Unit
1961 Pressure Breathing Therapy Unit
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.
1960s Bennett AP-41960s Bennett AP-4
1960s Bennett AP-4
1960s Bennett AP-5 with Cascade Humidifier1960s Bennett AP-5 with Cascade Humidifier
1960s Bennett AP-5 with Cascade Humidifier
1960s Bennett AP-51960s Bennett AP-5
1960s Bennett AP-5
Image from Lindsay Fox
Bennett AP-5Bennett AP-5
Bennett AP-5
Image from William LeTourneau
Air-Shields PBAAir-Shields PBA
Air-Shields PBA
This ad from the June 1962 issue of Inhalation Therapy shows the Air-Shields' Pressure Breathing Assistor (PBA).
NCG IPPBNCG IPPB
NCG IPPB
This ad for the NCG IPPB apparatus appeared in the June 1962 issue of INHALATION THERAPY journal.
1963 Bennett PR-21963 Bennett PR-2
1963 Bennett PR-2
Illinois Central College Archives, 1999
Bird Mark 7 – Aluminum HousingBird Mark 7 – Aluminum Housing
Bird Mark 7 – Aluminum Housing
This Bird Mark 7 respirator circa 1961 has an aluminum housing. It is owned by Felix Khusid.
Image from Felix Khusid
1964 BIRD Mark 7 Transparent Case Introduced1964 BIRD Mark 7 Transparent Case Introduced
1964 BIRD Mark 7 Transparent Case Introduced
Image from Glenn Tammen
1965 IPPB Training Manual1965 IPPB Training Manual
1965 IPPB Training Manual
This 1965 IPPB training manual was from the Hospital of Good Samaritan Medical Center, Los Angeles, California.
Image from Steve and Mary DeGenaro
Late 1960s Monaghan M510 IPPBLate 1960s Monaghan M510 IPPB
Late 1960s Monaghan M510 IPPB
Image from James Sullivan
1969 IPPB1969 IPPB
1969 IPPB
In this 1969 photo, an inhalation therapist holds a face mask to administer an IPPB treatment.
Image from Aubrey Patterson
1970s1970s
1970s
1970 MSA Fluidic Breathing Assistor1970 MSA Fluidic Breathing Assistor
1970 MSA Fluidic Breathing Assistor
This ad for the MSA Fluidic Breathing Assistor for IPPB appeared in the December 1970 issue of the INHALATION THERAPY journal.
IPPB Treatment RoomIPPB Treatment Room
IPPB Treatment Room
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.
Image from Aubrey Patterson
Checking Out the BirdsChecking Out the Birds
Checking Out the Birds
Preparing for the next round of IPPB treatments in 1970.
Image from Aubrey Patterson
Homemade "Porta-Bird"Homemade "Porta-Bird"
Homemade "Porta-Bird"
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.
Image from Kevin Christenson
1972 PortaBird Patent1972 PortaBird Patent
1972 PortaBird Patent
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.
Porta BirdPorta Bird
Porta Bird
Image from Felix Khusid
Porta BirdPorta Bird
Porta Bird<
Image from Felix Khusid
Porta Bird CasePorta Bird Case
Porta Bird Case
The Porta-Bird enclosed in its carrying case.
Image from Felix Khusid
Early 1970s BIRD Mark 8Early 1970s BIRD Mark 8
Early 1970s BIRD Mark 8
Image from Steve and Mary DeGenaro
1970s Monaghan M520 IPPB1970s Monaghan M520 IPPB
1970s Monaghan M520 IPPB
Image from Jim Ciolek
1970s IPPB Treatment via a Bennett PR-21970s IPPB Treatment via a Bennett PR-2
1970s IPPB Treatment via a Bennett PR-2
Image from Steve and Mary DeGenaro
1974 Sugarloaf Conference1974 Sugarloaf Conference
1974 Sugarloaf Conference
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.
Image from Gayle Carr
1980s1980s
1980s
Monaghan Medical CorporationMonaghan Medical Corporation
1981 Monaghan 515
Monaghan Medical Corporation
1980s IPPB1980s IPPB
Image from Steve and Mary DeGenaro
1990s and Beyond1990s and Beyond
1990s and Beyond
1993 – IPPB CPG Released1993 – IPPB CPG Released
1993 – IPPB CPG Released
2003 IPPB Update2003 IPPB Update
2003 IPPB Update
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