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Manual hyperinflation in airway clearance in pediatric patients: a systematic review
Vanessa Cristina Waetge Pires de Godoy1, Nathalia Mendonça Zanetti, Cíntia Johnston
1Serviço de Fisioterapia, Hospital São Paulo, São PauloSP, Brasil.
Insights
Manual hyperinflation is a useful respiratory physical therapy technique for pediatric airway clearance. However, more research is needed to confirm its safety and effectiveness in children.
Area of Science:
- Pediatric Respiratory Care
- Physical Therapy Techniques
- Evidence-Based Medicine
Background:
- Manual hyperinflation is a respiratory physical therapy technique.
- Airway clearance is a critical aspect of pediatric respiratory care.
- Limited literature exists on manual hyperinflation in pediatric patients.
Purpose of the Study:
- To assess the available literature on manual hyperinflation for airway clearance in pediatric patients.
- To determine the efficacy and safety of manual hyperinflation in children.
- To identify research gaps in the use of manual hyperinflation for pediatric airway clearance.
Main Methods:
- A systematic literature review was conducted.
- Databases searched included Lilacs, Cochrane Library, Medline, SciELO, and PEDro (2002-2013).
- Search terms focused on physiotherapy, respiratory therapy, intensive care, and airway clearance.
Main Results:
- Three studies involving 250 pediatric patients (0-16 years) were analyzed.
- Patients had various diagnoses including acute respiratory failure, post-surgery, asthma, and airway injuries.
- Included studies had a level of evidence 2C and grade of recommendation C.
Conclusions:
- Manual hyperinflation shows potential for pediatric airway clearance.
- Current evidence is insufficient to establish definitive safety and efficacy.
- Further controlled randomized studies are necessary; the technique should only be performed by trained physical therapists.
Objective:
To perform an assessment of the available literature on manual hyperinflation as a respiratory physical therapy technique used in pediatric patients, with the main outcome of achieving airway clearance.
Methods:
We reviewed articles included in the Lilacs (Latin American and Caribbean Literature on Health Sciences/Literatura Latino Americana e do Caribe em Ciências da Saúde), Cochrane Library, Medline (via Virtual Health Library and PubMed), SciELO (Scientific Electronic Library), and PEDro (Physiotherapy Evidence Database) databases from 2002 to 2013 using the following search terms: "physiotherapy (techniques)", "respiratory therapy", "intensive care", and "airway clearance". The selected studies were classified according to the level of evidence and grades of recommendation (method of the Oxford Centre for Evidence-Based Medicine) by two examiners, while a third examiner repeated the search and analysis and checked the classification of the articles.
Results:
Three articles were included for analysis, comprising 250 children (aged 0 to 16 years). The main diagnoses were acute respiratory failure, recovery following heart congenital disease and upper abdominal surgery, bone marrow transplantation, asthma, tracheal reconstruction, brain injury, airway injury, and heterogeneous lung diseases. The studies were classified as having a level of evidence 2C and grade of recommendation C.
Conclusions:
Manual hyperinflation appeared useful for airway clearance in the investigated population, although the evidence available in the literature remains insufficient. Therefore, controlled randomized studies are needed to establish the safety and efficacy of manual hyperinflation in pediatric patients. However, manual hyperinflation must be performed by trained physical therapists only.
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