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Chest physiotherapy for pneumonia in children

Gabriela S S Chaves¹, Guilherme A F Fregonezi, Fernando A L Dias

¹Department of Physical Therapy, Federal University of Rio Grande do Norte, Avenida Senador Salgado Filho, 3000, Bairro Lagoa Nova, Natal, Rio Grande do Norte, Brazil, 59078-970.

The Cochrane Database of Systematic Reviews

|September 24, 2013

Insights

Chest physiotherapy for pediatric pneumonia lacks conclusive evidence for improving recovery time. More research is needed to determine its effectiveness and role in treating childhood pneumonia.

Area of Science:

Pediatric Pulmonology
Critical Care Medicine
Evidence-Based Medicine

Background:

Pneumonia is a leading cause of death in children globally.
Chest physiotherapy is a common adjuvant treatment for pneumonia, aiming to clear secretions and improve respiratory function.
Its clinical indication and effectiveness in pediatric pneumonia remain debated.

Purpose of the Study:

To evaluate the effectiveness of chest physiotherapy in children with pneumonia.
The primary outcome was the time to clinical resolution of pneumonia.
The study included children aged 0-18 years with any type of pneumonia.

Main Methods:

A systematic review of randomized controlled trials (RCTs) was conducted.
Searches included multiple databases (CENTRAL, MEDLINE, EMBASE, etc.) and clinical trial registries.
RCTs comparing any chest physiotherapy with no physiotherapy in children with pneumonia were included.

Main Results:

Three RCTs with 255 children were analyzed, investigating conventional chest physiotherapy, positive expiratory pressure, and continuous positive airway pressure.
Two studies showed significant improvements in respiratory rate and oxygen saturation.
One study found no significant reduction in clinical resolution time or hospital stay with standardized physiotherapy or positive expiratory pressure.

Conclusions:

Current evidence is insufficient to support the routine use of chest physiotherapy for pediatric pneumonia.
Limited data and heterogeneity among studies prevent definitive conclusions.
Further high-quality research is required to establish the role of chest physiotherapy in managing childhood pneumonia.

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Abstract

Background:

Pneumonia is an inflammatory lung disease and it is the greatest cause of deaths in children younger than five years of age worldwide. Chest physiotherapy is widely used in the treatment of pneumonia because it can help to eliminate inflammatory exudates and tracheobronchial secretions, remove airway obstructions, reduce airway resistance, enhance gas exchange and reduce the work of breathing. Thus, chest physiotherapy may contribute to patient recovery as an adjuvant treatment even though its indication remains controversial.

Objectives:

To assess the effectiveness of chest physiotherapy in relation to time until clinical resolution in children (from birth up to 18 years old) of either gender with any type of pneumonia.

Search Methods:

We searched CENTRAL 2013, Issue 4; MEDLINE (1946 to May week 4, 2013); EMBASE (1974 to May 2013); CINAHL (1981 to May 2013); LILACS (1982 to May 2013); Web of Science (1950 to May 2013); and PEDro (1950 to May 2013).We consulted the ClinicalTrials.gov and the WHO ICTRP registers to identify planned, ongoing and unpublished trials. We consulted the reference lists of relevant articles found by the electronic searches for additional studies.

Selection Criteria:

We included randomised controlled trials (RCTs) that compared chest physiotherapy of any type with no chest physiotherapy in children with pneumonia.

Data Collection And Analysis:

Two review authors independently selected the studies to be included in the review, assessed trial quality and extracted data.

Main Results:

Three RCTs involving 255 inpatient children are included in the review. They addressed conventional chest physiotherapy, positive expiratory pressure and continuous positive airway pressure. The following outcomes were measured: duration of hospital stay, time to clinical resolution (observing the following parameters: fever, chest indrawing, nasal flaring, tachypnoea and peripheral oxygen saturation levels), change in adventitious sounds, change in chest X-ray and duration of cough in days. Two of the included studies found a significant improvement in respiratory rate and oxygen saturation whereas the other included study failed to show that standardised respiratory physiotherapy and positive expiratory pressure decrease the time to clinical resolution and the duration of hospital stay. No adverse effects related to the interventions were described. Due to the different characteristics of the trials, such as the duration of treatment, levels of severity, types of pneumonia and the techniques used in children with pneumonia, as well as differences in their statistical presentation, we were not able to pool data. Two included studies had an overall low risk of bias whereas one included study had an overall unclear risk of bias.

Authors' Conclusions:

Our review does not provide conclusive evidence to justify the use of chest physiotherapy in children with pneumonia due to a lack of data. The number of included studies is small and they differed in their statistical presentation.

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