Strategy nursing in children with compromised ventilation: Umbrella review
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Published on: July 14, 2023
Neuza Reis1, Luís Jorge Gaspar2, Abel Paiva3
1Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160 Lisbon, Portugal; Rehabilitation Nurse, CHULC, Portugal.
Insights
Nursing interventions like respiratory exercises and oxygen therapy can improve ventilation in children. However, evidence quality is low to moderate, requiring more robust research for definitive conclusions.
Area of Science:
- Pediatric Nursing
- Respiratory Care
- Evidence-Based Practice
Background:
- Pediatric patients often require interventions to manage impaired ventilation.
- Nursing plays a crucial role in adapting management strategies to children's needs.
Purpose of the Study:
- To systematically review the evidence for nursing interventions aimed at optimizing ventilation in children.
- To assess the effectiveness of various interventions for pediatric impaired ventilation.
Main Methods:
- A systematic literature review was conducted across multiple databases.
- Nineteen articles published between 2012 and 2022, focusing on nursing interventions for impaired ventilation in children, were included.
Main Results:
- Respiratory exercises, BiPAP (Bilevel Positive Airway Pressure), and oxygen therapy showed efficacy in 13 studies.
- Respiratory muscle-strengthening exercises were effective in seven studies, and positioning in three.
- Respiratory exercises and muscle training were the most frequently studied interventions.
Conclusions:
- Nursing interventions to optimize ventilation in children are generally effective.
- The evidence supporting these interventions is of low to moderate quality due to small, heterogeneous pediatric populations.
- Further research with robust methodology and clear focus is needed to strengthen the evidence base.
Problem:
Changes in the ventilation demand nursing interventions duly adapted to the management of said impairment and to the adaptability of the child/parents. This revision aimed to investigate the evidence behind the interventions performed on children with impaired ventilation.'
Eligibility Criteria:
Systematic reviews of literature in English, Spanish, French, and Portuguese from studies on nursing interventions related to children with impaired ventilation in all contexts of the clinical practice. The Joanna Briggs Institute recommendations were followed.
Sample:
We conducted a comprehensive search as of January 2022 and updated as of June 2023. The following electronic databases were searched: SCOPUS, Web of Science, Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, MEDLINE (via PubMed), CINAHL (via EBSCO), MedicLatina (via EBSCO), The Cochrane Database of Systematic Reviews (via EBSCO), and Database of Abstracts of Reviews of Effects (DARE). Nineteen articles published between 2012 and 2022 were included in this review.
Results:
Nineteen studies investigated the efficacy of respiratory exercises (Breathing Control - relaxed breathing, pursed lip breathing, Diaphragmatic breathing exercises, respiratory expansion exercise - deep breathing exercise, thoracic expansion exercises (with device), exercises for respiratory muscle strengthening and position to optimize ventilation. In the majority of the studies, it was not possible to evaluate the interventions separately. Thirteen studies evidenced the efficacy of respiratory exercises, BIPAP, and oxygen therapy. Seven articles demonstrated the effectiveness of respiratory muscle-strengthening exercises, and only three mentioned the efficacy of positioning regarding impaired ventilation. Interventions based on respiratory exercises and respiratory muscle training were the most common ones.
Conclusions:
The results suggest that nursing interventions to optimize ventilation are efficient. Nevertheless, the same present a low to moderate evidence degree, justified by the population characteristics (small and heterogeneous).
Implications:
There is proof of evidence for the studied interventions. However, the lack of methodological robustness points to future research to duly describe interventions, data, and comparable results, using reliable samples in which the focus of the study is clear.
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