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Chest physiotherapy and post-extubation atelectasis in infants
1Department of Pediatrics, Respiratory Care and Biostatistics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Insights
Chest physiotherapy (CPT) did not significantly prevent post-extubation atelectasis (PEA) in infants. The study found no statistical difference in PEA incidence across CPT and no-CPT groups.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Respiratory Therapy
Background:
- Post-extubation atelectasis (PEA) is a common complication in infants following mechanical ventilation.
- Preventive strategies for PEA are crucial to reduce respiratory morbidity in neonates.
Purpose of the Study:
- To evaluate the efficacy of chest physiotherapy (CPT) in preventing PEA in infants.
- To compare the incidence of PEA in infants receiving 2-hourly CPT, 4-hourly CPT, or no CPT.
Main Methods:
- A randomized controlled trial involving 63 infants in a neonatal intensive care unit.
- Infants received either 2-hourly CPT, 4-hourly CPT, or no CPT immediately after extubation.
- Chest X-rays were used to assess PEA incidence 24 hours post-extubation.
Main Results:
- No statistically significant difference in PEA incidence was observed between the three groups (P = 0.33).
- Some infants in all groups required interventions such as nasal continuous positive airway pressure or re-intubation for symptomatic atelectasis.
Conclusions:
- Chest physiotherapy, as administered in this study, was not effective in preventing post-extubation atelectasis in infants.
- Further research may be needed to explore alternative or modified CPT protocols for PEA prevention.
Abstract:
We investigated the role of chest physiotherapy (CPT) in preventing post-extubation atelectasis (PEA) in infants. Sixty-three infants who were admitted to the neonatal intensive care unit and intubated for more than 24 hours and who showed no evidence of atelectasis by chest x-ray prior to extubation were enrolled in the study. Infants were randomly assigned to 2-hourly CPT, 4-hourly CPT, or a no CPT group. Chest physiotherapy began immediately after extubation and consisted of postural drainage, bilateral chest vibration, and suctioning. A second chest x-ray was obtained on all infants 24 hours following extubation. The three groups were comparable in birth weight, gestational age, and duration of intubation. In the 24-hour period following extubation, the incidence of PEA was not statistically significant in the three groups (P = 0.33). Two infants in the 2-hourly CPT group were placed on nasal continuous positive airway pressure; two in each of the 2-hourly and the no CPT groups required re-intubation and intermittent positive pressure ventilation to treat symptomatic atelectasis. We conclude that post extubation chest physiotherapy as used in this study did not prevent atelectasis in extubated infants.