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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
PubMed

Insights

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.

Keywords:
intensive carepediatricphysical therapy modalitiesphysiotherapyrespiration artificial

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