Intermittent positive pressure breathing is contraindicated in?

AIIMS Raipur NO - 2019 (Shift-2)

Medical Surgical Nursing

Hard

Appeared in: AIIMS Raipur NO - 2019 (Shift-2)

Explanation

A tracheoesophageal fistula (TEF) is an abnormal connection between the trachea and the esophagus.
Using IPPB forces air under positive pressure through this fistula directly into the stomach.
This causes massive gastric distention, increasing the risk of regurgitation and aspiration of gastric contents into the lungs.
Due to this high risk of severe complications, TEF is considered an absolute contraindication for IPPB unless the airway is secured distal to the fistula (e.g., with an endotracheal tube).

Option A: A comatose patient has an inability to protect their airway, which makes IPPB risky due to the potential for aspiration. However, it is a relative, not absolute, contraindication.
Option B: Pulmonary edema is a primary indication for positive pressure ventilation (like CPAP or BiPAP), not a contraindication. The pressure helps to open up the alveoli and push fluid out of the airspaces.
Option C: Asthma, particularly severe asthma, is an indication for IPPB. It can be used to deliver bronchodilator medications deep into the lungs and help reduce the patient's work of breathing.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Contraindications for Intermittent Positive Pressure Breathing (IPPB) as background academic context rather than a clinical decision trigger.
A nurse must always verify indications and contraindications before administering any respiratory therapy to prevent serious harm.
In a patient with a known or suspected TEF, a nurse should immediately question any order for non-invasive positive pressure ventilation and clarify with the physician.
What if? If the patient with a TEF was already intubated with the endotracheal tube cuff positioned below the fistula, IPPB or mechanical ventilation could be safely administered because the artificial airway would bypass the abnormal connection, directing air only to the lungs.

How to Approach the Question

First, understand the function of Intermittent Positive Pressure Breathing (IPPB): it delivers air into the lungs under positive pressure.
Next, analyze the term 'contraindicated,' which means a condition where a specific treatment should not be used because it may be harmful.
Evaluate each option based on the mechanism of IPPB.
Consider 'Pulmonary oedema' and 'Asthma.' Recall that positive pressure is often used to treat these conditions by improving oxygenation and reducing the work of breathing. This makes them indications, not contraindications.
Consider 'Comatose patient.' A comatose patient cannot protect their airway, which is a significant risk. This is a valid contraindication, but consider if it's absolute.
Finally, evaluate 'Tracheoesophageal fistula.' A fistula is an abnormal connection. Positive pressure would force air into the stomach, a direct and dangerous complication. This represents an absolute contraindication.

Concept Tested & Keywords

Concept Tested: Contraindications for Intermittent Positive Pressure Breathing (IPPB)
Stem keywords: Intermittent positive pressure breathing, IPPB, contraindicated
Lead-in keywords: BEST, MOST RELEVANT CLUE

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