Chest physiotherapy, gastro-oesophageal reflux, and arousal in infants with cystic fibrosis

Abstract

Background: Postural drainage chest physiotherapy in infants with cystic fibrosis (CF) exacerbates gastrooesophageal reflux (GOR) and may contribute to a more rapid deterioration in lung function. Aims: To compare standard postural drainage chest physiotherapy (SPT) and a modified physiotherapy regimen (MPT) without head-down tilt, with regard to GOR, arousal state, and cardiorespiratory function. Methods: Twenty infants with CF underwent 30 hour oesophageal pH monitoring, during which four chest physiotherapy sessions were administered (day 1: MPT-SPT; day 2: SPT-MPT). Arousal state, heart rate, and oxygen saturation were documented for each of the physiotherapy positions (supine, prone, right lateral, and left lateral with (SPT) or without (MPT) 30˚head-down tilt). Results: Significantly more reflux episodes occurred during SPT than during MPT, but there were no significant differences in median episode duration or fractional reflux time. During SPT, left lateral positioning was associated with fewer reflux episodes compared to other positions. During supine and prone positioning, more reflux episodes occurred during SPT than during MPT. Infants were significantly more likely to be awake or cry during SPT. There was a significant association between crying and reflux episodes for SPT. Non-nutritive sucking was associated with a significant reduction in reflux episodes during SPT. Oxygen saturation during SPT was significantly lower during crying and other waking, and non-nutritive sucking during SPT was associated with a significant increase in oxygen saturation. Conclusions: SPT is associated with GOR, distressed behaviour, and lower oxygen saturation.

Chest Physical Therapy in Acute Viral Bronchiolitis: An Updated Review

“…[27][28][29] No wonder that conventional CPT gives poor results and is poorly tolerated, with side effects such as esophageal reflux, tachypnea, tachycardia, hypoxemia, rib fracture, and severe central nervous system complications, especially in newborns. [30][31][32][33][34] The 2012 Cochrane review showed no significant benefit from conventional CPT on clinical score or hospital stay, and conventional CPT in acute viral bronchiolitis is no longer recommended. [35][36][37] In France, increased-exhalation technique has been widely used in various ways since the 1970s.…”

Pediatric Airway Maintenance and Clearance in the Acute Care Setting: How To Stay Out of Trouble

“…Reflux episodes, as measured with a pH probe reading of Ͻ 4, occurred most often during crying. 75 Button and colleagues reported no differences in heart rate or oxygen saturation during reflux episodes, 75 which illustrates what some call silent aspiration. pH probe monitoring cannot detect whether reflux contents reach the airways.…”

“…Modifying CPT by excluding head-down positions may decrease the number of reflux episodes. 75 During modified CPT, infants are more likely to remain calm. Keeping the infant calm can decrease intra-abdominal pressure produced by crying.…”

“…Since respiratory disease is the most common diagnosis among acute pediatric patients admitted to the hospital, 75 unnecessary airway-clearance therapies substantially increase costs to the patient and hospital. To find information on adverse effects from chest physiotherapy and postural drainage we looked as far back as the late 1970s, and found only 2 studies focused on children.…”

Influence de la kinésithérapie respiratoire sur le reflux gastro-œsophagien chez l’enfant

“…Cette dernière nécessite le recours à la kinésithérapie [4] dont certaines manoeuvres de désencombrement ont été associées au RGO même si les publications restent peu nombreuses [5][6][7][8]. Au vu de cette association possible, il est intéressant de s'assurer de l'innocuité des techniques de kinésithérapie chez ces patients.…”