Chest Physiotherapy for Mechanically Ventilated Children: A Systematic Review
Emma Shkurka1, Jo Wray2, Mark Peters3
1Physiotherapy Department, Hospital for Children NHS Foundation Trust, London, United Kingdom.
Journal of Pediatric Intensive Care
|June 26, 2024
Summary
Chest physiotherapy in mechanically ventilated children shows mixed results. While some techniques slightly alter oxygen saturation and tidal volume, evidence remains inconclusive, necessitating further high-quality research.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Therapy
- Evidence-Based Practice
Background:
- Mechanical ventilation is a critical intervention for critically ill children.
- Chest physiotherapy is frequently employed to improve respiratory outcomes in these patients.
- The effectiveness and safety of various chest physiotherapy techniques require thorough evaluation.
Purpose of the Study:
- To systematically review and appraise the effects of chest physiotherapy in pediatric patients requiring mechanical ventilation.
- To summarize evidence on the effectiveness and safety of chest physiotherapy interventions.
Main Methods:
- A systematic review was conducted using major medical databases (Medline, Embase, Cinahl Plus, PEDro, Web of Science) up to February 2021.
- Included studies focused on children (0-18 years) in pediatric intensive care units receiving mechanical ventilation and physiotherapy.
- Quality assessment used Cochrane risk of bias and Critical Appraisal Skills Program tools.
Main Results:
- Oxygen saturations showed non-clinically significant decreases with manual hyperinflations (MHI) and chest wall vibrations (CWV), and non-significant improvements with the expiratory flow increase technique.
- Expiratory tidal volume increased 30 minutes post-MHI and CWV, with no sustained change after recruitment maneuvers.
- Atelectasis scores improved with intrapulmonary percussive ventilation, MHI, and CWV, but respiratory compliance and dead-space increased post-MHI and CWV.
Conclusions:
- Current evidence supporting chest physiotherapy in mechanically ventilated children is inconclusive due to a lack of high-quality studies and heterogeneity in interventions and populations.
- Further research is needed to investigate the impact of multiple physiotherapy interventions on short- and long-term outcomes.
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