Peri-operative chest physiotherapy for paediatric cardiac patients: a systematic review and meta-analysis

Area of Science:

• Pediatric Cardiology
• Respiratory Therapy
• Evidence-Based Medicine

Background:

• Chest physiotherapy (CPT) is a common intervention for pediatric patients with congenital heart disease (CHD) to manage postoperative pulmonary complications (PPCs).
• Existing literature lacks systematic reviews or meta-analyses evaluating the efficacy of CPT in this specific population.

Purpose of the Study:

• To systematically review and meta-analyze the available evidence on the safety and effectiveness of peri-operative CPT in pediatric patients undergoing CHD surgery.
• To identify optimal CPT strategies for preventing and treating PPCs in this vulnerable group.

Main Methods:

• A comprehensive literature search was performed across multiple databases (PEDro, MEDLINE, CINAHL, Informit, Cochrane Library, Scopus) in March-April 2016.
• English peer-reviewed studies on CPT before or after cardiac surgery for pediatric CHD were included, excluding systematic reviews.
• Data extraction and meta-analysis were conducted using standardized tools and a random effects model.

Main Results:

• Eleven studies met the inclusion criteria, revealing variable effects of CPT on peripheral oxygen saturation and pain.
• Meta-analysis indicated that CPT did not significantly prevent pneumonia (OR 2.01; P=0.13) or treat atelectasis (OR 1.27; P=0.81).
• Active therapies (mobilization, deep breathing, incentive spirometry) showed greater efficacy than passive CPT methods.

Conclusions:

• The current evidence base for CPT in pediatric CHD is limited by a lack of high-quality, heterogeneous studies.
• Passive CPT techniques like percussion and vibration may increase the risk of adverse events such as oxygen desaturation and atelectasis.
• Further high-quality research is needed to establish definitive guidelines for CPT in pediatric CHD patients.