Intrapulmonary percussive ventilation in the intensive care unit: a pro-con debate

Abstract

Effectiveness of intrapulmonary percussion ventilation (IPV) in the intensive care unit (ICU) remains controversial due to the lack of evidence regarding its principles and therapeutic benefits. IPV impact in medical literature targets improvement of airway clearance and gas exchange as well as recruitment of poorly ventilated lung areas, particularly in patients lacking active participation in other techniques of chest physiotherapy because of sedation, clinical instability, respiratory muscle fatigue or weakness, or due to non-compliance. IPV preventive role in patients with chronic obstructive pulmonary disease at high risk of exacerbation is relatively well described. Regular IPV use in patients with tracheal intubation or tracheostomy seems to reduce the rate of hospital-acquired pneumonia and the length of ICU stay. However, lack of bibliographic support and complexity of implementation and adequate monitoring represent a significant barrier to its routine use in the ICU. IPV seems to find a place when conventional techniques of chest physiotherapy fail.