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Morrow BM. Airway clearance therapy in acute paediatric respiratory illness: A state-of-the-art review. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2019; 75:1295. [PMID: 31309166 PMCID: PMC6620562 DOI: 10.4102/sajp.v75i1.1295] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/19/2019] [Indexed: 11/01/2022] Open
Abstract
Background Despite unclear evidence of effectiveness or safety, airway clearance therapy (ACT) is frequently performed in infants and children with acute pulmonary disease. Objectives The aim of this review was to critically synthesise published evidence, expert opinion and pathophysiological principles to describe the indications, effects, precautions and application of commonly used ACT modalities for managing infants and children with acute pulmonary disease. Method A comprehensive narrative review of published literature was conducted. Articles describing paediatric populations were prioritised, but adult and animal studies were also considered where appropriate. Results There is a dearth of high-level evidence supporting the use of ACT in acutely ill infants and children. Conversely, studies have highlighted the lack of effect of different modalities for a variety of conditions, and in some cases serious associated complications have been reported.Airway clearance therapy may be considered when there is retention of pulmonary secretions, and the consequential airway obstruction impacts either acutely on respiratory mechanics and gaseous exchange and/or has the potential for long-term adverse sequelae [a condition that is the consequence of a previous disease or injury]. However, it should not be considered a routine intervention. Conclusion Airway clearance therapy should not be performed routinely in children admitted to hospital with acute respiratory conditions. Patients should be clinically assessed and treatment planned according to individual presentation, in those with signs and symptoms that are potentially amenable to ACT. Clinical implications This review can serve as a guide for physiotherapists in the respiratory management of children with acute respiratory illness, as well as identifying areas for clinical research.
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Affiliation(s)
- Brenda M Morrow
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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Gomes GR, Donadio MVF. Effects of the use of respiratory physiotherapy in children admitted with acute viral bronchiolitis. Arch Pediatr 2018; 25:394-398. [PMID: 30064712 DOI: 10.1016/j.arcped.2018.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 05/16/2018] [Accepted: 06/24/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the effects of the use of respiratory physiotherapy in children admitted with acute viral bronchiolitis (AVB). METHODS A literature review was done searching the Pubmed, LILACS, PEDro, and Scielo databases. The following key words were used: bronchiolitis, physiotherapy, techniques, physical therapy, and chest physiotherapy. Both controlled and uncontrolled clinical trials, without limits as to date, were selected. RESULTS Fifteen articles were included and the use of different techniques of respiratory physiotherapy showed positive results in eight studies. Most (11) were controlled clinical trials, and only two had a double-blind design. Of the 14 studies with a control group, in six this group was submitted to nasopharyngeal aspiration. The most widely used techniques were manual vibration and postural drainage (eight studies), and then tapping/percussion (seven studied). The maneuvers considered as current, e.g., prolonged slow expiration, expiratory flow acceleration, and rhinopharyngeal retrograde clearance, were used in four, four, and two studies, respectively. CONCLUSIONS The use of respiratory physiotherapy in children with AVB remains controversial. The heterogeneity of techniques evaluated in the studies limits the interpretation of efficacy, although its use was considered safe. Recent findings indicating a reduction in the length of the hospital stay remain to be confirmed.
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Affiliation(s)
- G R Gomes
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - M V F Donadio
- Centro Infant, Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
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Morrow BM. Chest Physiotherapy in the Pediatric Intensive Care Unit. J Pediatr Intensive Care 2015; 4:174-181. [PMID: 31110870 DOI: 10.1055/s-0035-1563385] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/31/2014] [Indexed: 10/23/2022] Open
Abstract
Despite widespread practice, there is very little, high-level evidence supporting the indications for and effectiveness of cardiopulmonary/chest physiotherapy (CPT) in critically ill infants and children. Conversely, most studies highlight the detrimental effects or lack of effect of different manual modalities. Conventional CPT should not be a routine intervention in the pediatric intensive care unit, but can be considered when obstructive secretions are present which impact on lung mechanics and/or gaseous exchange and/or where there is the potential for long-term complications. Techniques such as positioning, early mobilization, and rehabilitation have been shown to be beneficial in adult intensive care patients; however, little attention has been paid to this important area of practice in pediatric intensive care units. This article presents a narrative review of chest physiotherapy in pediatric critical illness, including effects, indications, precautions, and specific treatment modalities and techniques.
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Affiliation(s)
- Brenda M Morrow
- Department of Pediatrics and Child Health, University of Cape Town, Rondebosch, Cape Town, South Africa
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What is the role of the physiotherapist in paediatric intensive care units? A systematic review of the evidence for respiratory and rehabilitation interventions for mechanically ventilated patients. Physiotherapy 2015; 101:303-9. [PMID: 26051847 DOI: 10.1016/j.physio.2015.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 04/05/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Physiotherapy in intensive care units (ICU) has traditionally focussed on the respiratory management of mechanically ventilated patients. Gradually, focus has shifted to include rehabilitation in adult ICUs, though evidence of a similar shift in the paediatric ICU (PICU) is limited. OBJECTIVES Review the evidence to determine the role of physiotherapists in the management of mechanically ventilated patients in PICU. DATA SOURCES A search was conducted of: PEDro, CINAHL, Medline, PubMed and the Cochrane Library. ELIGIBILITY CRITERIA Studies involving PICU patients who received physiotherapy while invasively ventilated were included in this review. Those involving neonatal or adult ICU patients, or patients on non-invasive or long-term ventilation, were not included in the study. STUDY APPRAISAL All articles were critically appraised by two reviewers and results were analysed descriptively. RESULTS Six studies on chest physiotherapy (CPT) met the selection criteria. Results support the use of the expiratory flow increase technique and CPT, especially manual hyperinflation and vibrations, for secretion clearance. Evidence does not support the routine use of either CPT or suction alone. No studies investigating rehabilitation in PICU met selection criteria. LIMITATIONS A lack of high level evidence was available to inform this review. CONCLUSION Evidence indicates that CPT is still the focus of physiotherapy intervention in PICU for mechanically ventilated patients, and supports its use for secretion clearance in this setting. PROSPERO register for systematic reviews (registration no. CRD42014009582).
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de Abreu LC, Valenti VE, de Oliveira AG, Leone C, Siqueira AAF, Herreiro D, Wajnsztejn R, Manhabusque KV, Júnior HM, de Mello Monteiro CB, Fernandes LL, Saldiva PHN. Chest associated to motor physiotherapy improves cardiovascular variables in newborns with respiratory distress syndrome. Int Arch Med 2011; 4:37. [PMID: 22029840 PMCID: PMC3219586 DOI: 10.1186/1755-7682-4-37] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 10/26/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We aimed to evaluate the effects of chest and motor physiotherapy treatment on hemodynamic variables in preterm newborns with respiratory distress syndrome. METHODS We evaluated heart rate (HR), respiratory rate (RR), systolic (SAP), mean (MAP) and diastolic arterial pressure (DAP), temperature and oxygen saturation (SO2%) in 44 newborns with respiratory distress syndrome. We compared all variables between before physiotherapy treatment vs. after the last physiotherapy treatment. Newborns were treated during 11 days. Variables were measured 2 minutes before and 5 minutes after each physiotherapy treatment. We applied paired Student t test to compare variables between the two periods. RESULTS HR (148.5 ± 8.5 bpm vs. 137.1 ± 6.8 bpm - p < 0.001), SAP (72.3 ± 11.3 mmHg vs. 63.6 ± 6.7 mmHg - p = 0.001) and MAP (57.5 ± 12 mmHg vs. 47.7 ± 5.8 mmHg - p = 0.001) were significantly reduced after 11 days of physiotherapy treatment compared to before the first session. There were no significant changes regarding RR, temperature, DAP and SO2%. CONCLUSIONS Chest and motor physiotherapy improved cardiovascular parameters in respiratory distress syndrome newborns.
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Affiliation(s)
- Luiz Carlos de Abreu
- Departamento de Saúde Materno-infantil, Universidade de São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP. 01246-904, Brazil
- Laboratório de Escrita Científica. Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Santo André, SP. 09060-650, Brazil
| | - Vitor E Valenti
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo (USP), Av. Dr. Arnaldo, 455, São Paulo, SP. 01246903, Brazil
- Laboratório de Escrita Científica. Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Santo André, SP. 09060-650, Brazil
| | - Adriana G de Oliveira
- Departamento de Saúde Materno-infantil, Universidade de São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP. 01246-904, Brazil
| | - Claudio Leone
- Departamento de Saúde Materno-infantil, Universidade de São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP. 01246-904, Brazil
| | - Arnaldo AF Siqueira
- Departamento de Saúde Materno-infantil, Universidade de São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP. 01246-904, Brazil
| | - Dafne Herreiro
- Departamento de Saúde Materno-infantil, Universidade de São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP. 01246-904, Brazil
| | - Rubens Wajnsztejn
- Laboratório de Escrita Científica. Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Santo André, SP. 09060-650, Brazil
| | - Katia V Manhabusque
- Laboratório de Escrita Científica. Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Santo André, SP. 09060-650, Brazil
| | - Hugo Macedo Júnior
- Laboratório de Escrita Científica. Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Santo André, SP. 09060-650, Brazil
| | - Carlos B de Mello Monteiro
- Escola de Artes, Ciência e Humanidades da Universidade de São Paulo (USP), Rua Arlindo Béttio, 1000, São Paulo, SP. 03828-000, Brazil
| | - Laís L Fernandes
- Laboratório de Escrita Científica. Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Santo André, SP. 09060-650, Brazil
| | - Paulo HN Saldiva
- Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo (USP), Av. Dr. Arnaldo, 455, São Paulo, SP. 01246903, Brazil
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Gupta P, Tobias JD, Goyal S, Kuperstock JE, Hashmi SF, Shin J, Hartnick CJ, Noviski N. Perioperative care following complex laryngotracheal reconstruction in infants and children. Saudi J Anaesth 2011; 4:186-96. [PMID: 21189858 PMCID: PMC2980667 DOI: 10.4103/1658-354x.71577] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Laryngotracheal reconstruction (LTR) involves surgical correction of a stenotic airway with cartilage interpositional grafting, followed by either placement of a tracheostomy and an intraluminal stent (two-stage LTR) or placement of an endotracheal tube with postoperative sedation and mechanical ventilation for an extended period of time (singlestage LTR). With single-stage repair, there may be several perioperative challenges including the provision of adequate sedation, avoidance of the development of tolerance to sedative and analgesia agents, the need to use neuromuscular blocking agents, the maintenance of adequate pulmonary toilet to avoid perioperative nosocomial infections, and optimization of postoperative respiratory function to facilitate successful tracheal extubation. We review the perioperative management of these patients, discuss the challenges during the postoperative period, and propose recommendations for the prevention of reversible causes of extubation failure in this article. Optimization to ensure a timely tracheal extubation and successful weaning of mechanical ventilator, remains the primary key to success in these surgeries as extubation failure or the need for prolonged postoperative mechanical ventilation can lead to failure of the graft site, the need for prolonged Pediatric Intensive Care Unit care, and in some cases, the need for a tracheostomy to maintain an adequate airway.
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Affiliation(s)
- Punkaj Gupta
- Division of Pediatric Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Andrews P, Azoulay E, Antonelli M, Brochard L, Brun-Buisson C, Dobb G, Fagon JY, Gerlach H, Groeneveld J, Mancebo J, Metnitz P, Nava S, Pugin J, Pinsky M, Radermacher P, Richard C, Tasker R, Vallet B. Year in review in intensive care medicine, 2004. III. Outcome, ICU organisation, scoring, quality of life, ethics, psychological problems and communication in the ICU, immunity and hemodynamics during sepsis, pediatric and neonatal critical care, experimental studies. Intensive Care Med 2005; 31:356-72. [PMID: 15719149 DOI: 10.1007/s00134-005-2573-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 01/24/2005] [Indexed: 11/24/2022]
Affiliation(s)
- Peter Andrews
- Intensive Care Medicine Unit, Western General Hospital, Edinburgh, UK
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