Chest Physiotherapy in the Pediatric Intensive Care Unit

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Therapy
• Pediatric Intensive Care

Background:

• Cardiopulmonary physiotherapy (CPT) is commonly used in pediatric intensive care units (PICUs).
• High-level evidence supporting CPT's indications and effectiveness in critically ill infants and children is scarce.
• Existing studies often report detrimental effects or lack of efficacy for manual CPT techniques.

Purpose of the Study:

• To review the current evidence on chest physiotherapy in pediatric critical illness.
• To discuss the effects, indications, precautions, and techniques of CPT in PICUs.
• To highlight the limited evidence for routine CPT and the potential benefits of alternative strategies.

Main Methods:

• Narrative review of existing literature on CPT in pediatric critical illness.
• Analysis of studies on manual physiotherapy techniques, positioning, early mobilization, and rehabilitation.
• Examination of evidence regarding the impact of CPT on lung mechanics and gas exchange.

Main Results:

• Limited high-level evidence supports routine CPT in PICUs.
• Detrimental effects or lack of effectiveness are noted for many manual CPT modalities.
• Obstructive secretions impacting lung function are a key indication for considering CPT.
• Positioning, early mobilization, and rehabilitation show promise but are underutilized in pediatric critical care.

Conclusions:

• Conventional CPT should not be a routine intervention in the pediatric intensive care unit.
• CPT may be considered for specific indications like obstructive secretions affecting respiratory parameters.
• Further research and attention are needed for beneficial techniques like early mobilization and rehabilitation in pediatric critical care.