Ventilation à percussions intrapulmonaires : fonctionnement et modalités de réglage

Intrapulmonary Percussion Ventilation (IPV) was designed to promote airway clearance, to recruit areas of lung and to improve pulmonary gas exchange. Its principle is to administer bursts of small tidal volume at high frequency. This article describes IPV devices, especially the Phasitron®, which provides a dynamic interface between the pneumatic source of gas and the patient. Although not fully understood, the principles of action are also discussed. Finally, available settings of IPV are proposed following two strategies. In patients with obstructive respiratory disease and ventilatory autonomy, the vibrations and percussions are applied with a frequency more than 300 cycles/min and pressure in the proximal airways ranging from 10-20 cm. H2O. In patients with restrictive pulmonary disease but without ventilatory autonomy, IPV is expected to improve gas exchange. The frequency of percussion will be slower (80-200 cycles/min) but the proximal airway pressure may reach 40 cm H2O. During the sessions, the frequency may be modified to alternate from a percussive pattern (high frequencies promoting the mobilization of secretions) to a ventilatory pattern (slow frequencies encouraging alveolar ventilation and clearance of secretions).