Chest physiotherapy in paediatric patients hospitalised with community-acquired pneumonia: a randomised clinical trial

Abstract

This clinical trial suggests that, in children hospitalised with moderate community-acquired pneumonia, chest physiotherapy did not have clinical benefits in comparison to control group.

Assisted autogenic drainage in infants and young children hospitalized with uncomplicated pneumonia, a pilot study

“…Duration of hospitalization in this study is in line with results reported by Paludo et al (; median of 6 days for both groups), who also included a non‐intervention control group. However, the study by Lukrafka et al (; median of 6 days in the control group and 8 days in the intervention group) and Stapleton (; mean of 7 and 9 days in the control and intervention groups respectively) showed slightly longer duration of stay for the participants receiving physiotherapy intervention. This could be due to the mixed diagnoses included in the one study (bronchiolitis, bronchitis, and pneumonia; Stapleton, ) and the inclusion of participants diagnosed with pleural effusion who were enrolled in the intervention group in the other study (Lukrafka et al, ).…”

“…Several clinical guidelines and two systematic reviews have been published, which do not support the use of airway clearance therapy for children with pneumonia (Chaves et al, 2013;Corten, Jelsma, & Morrow, 2015;Harris et al, 2011;Zar, Jeena, Argent, Gie, & Madhi, 2005). Three randomized controlled trials (RCTs) have been published in the past 10 years, with inconclusive results (Abdelbasset & Elnegamy, 2015;Lukrafka, Fuchs, & Fischer, 2012;Paludo et al, 2008). Two RCTs showed no differences in outcome measures between an intervention group receiving a combination of different airway clearance techniques and a control group receiving either no physiotherapy management (Paludo et al, 2008) or physiotherapy recommendations to perform side lying, deep breathing, and cough (Lukrafka et al, 2012).…”

Complicated pneumonia in children

“…It was historically considered to be due to alveolar deflation but evidence is now emerging that it is due to accumulation of alveolar fluid [74]. It can occur secondary to mucus plugging in CAP, suggesting that chest physiotherapy may be useful, although there is little evidence to support this [96] and a Cochrane Review is currently being undertaken. Flexible bronchoscopy, both as a diagnostic and therapeutic intervention, has been shown to be beneficial in atelectasis associated with infections in children [97].…”

Continuing to Challenge Practice to Be Evidence Based

“…Studies that supported the use of CPT to treat pneumonia did not have well-defined inclusion criteria and were published in the 1980s. Studies have not demonstrated improvement in signs and symptoms, decreased length of illness, decreased LOS, 75,76 or reduction in duration of fever. 73 Furthermore, pneumonia occurs in the peripheral airways; therefore, secretions are not located in an area where CPT could facilitate movement of secretions out of the airways.…”

“…The Cochrane review 77 concluded that the evidence is insufficient to support the use of CPT in pneumonia. In another study, 75 researchers randomized 72 hospitalized children 1 to 12 years old to receive standard respiratory care or CPT. No significant difference in severity of respiratory rate or duration of hospitalization was found between the 2 treatment groups.…”