Esophageal pH Monitoring Data During Chest Physiotherapy

Vandenplas, Yvan; Diericx, Ann; Blecker, Uwe; Lanciers, S; Deneyer, Michel

doi:10.1097/00005176-199107000-00004

Cited by 52 publications

(37 citation statements)

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“…It is very important to emphasize that the forced expiratory technique should be avoided in children under 24 months of age due to high compliance tracheal and chest, because the rapid chest compression promotes an interruption of expiratory flow 26 thus demonstrating the importance of creating a modulated flow so that there is an appropriate extension of the expiratory phase and a subsequent clearance of the distal airways. Therefore, maneuvers such as tapping and postural drainage may not have been effective in pulmonary clearance of these infants because these techniques did not create a sufficient flow and forced expiratory technique for interrupting the expiratory flow, and they may increase the risk of vomiting and gastro esophageal reflux disease (GERD) [27][28][29] . These techniques may not have influenced the reduction in hyperinflation and respiratory distress in the studies cited.…”

Section: Discussionmentioning

confidence: 99%

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial

Gomes¹,

Postiaux²,

Medeiros³

et al. 2012

Rev. bras. fisioter.

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Objective: To evaluate the effectiveness of chest physical therapy (CP) in reducing the clinical score in infants with acute viral bronchiolitis (AVB). Methods: Randomized controlled trial of 30 previously healthy infants (mean age 4.08 SD 3.0 months) with AVB and positive for respiratory syncytial virus (RSV), evaluated at three moments: at admission, then at 48 and 72 hours after admission. The procedures were conducted by blinded assessors to each of three groups: G1 -new Chest Physical therapy-nCPT (Prolonged slow expiration -PSE and Clearance rhinopharyngeal retrograde -CRR), G2 -conventional Chest Physical therapy-cCPT (modified postural drainage, expiratory compression, vibration and percussion) and G3 -aspiration of the upper airways. The outcomes of interest were the Wang's clinical score (CS) and its components: Retractions (RE), Respiratory Rate (RR), Wheezing (WH) and General Conditions (GC). Results:The CS on admission was reduced in G1 (7.0-4.0) and G2 (7.5-5.5) but was unchanged in G3 (7.5-7.0). We observed a change 48 hours after hospitalization in G1 (5.5-3.0) and G2 (4.0-2.0) and in 72 hours, there was a change in G1 (2.0-1.0). Conclusion: The CP was effective in reducing the CS in infants with AVB compared with upper airway suction only. After 48 hours of admission, both techniques were effective and nCPT techniques were also effective in the 72 hours after hospitalization compared with cCPT techniques.Trial Registration NCT00884429-www.clinicaltrials.gov.Keywords: respiratory suncytial virus; bronchiolitis; physical therapy. ResumoObjetivo: Avaliar a efetividade da fisioterapia respiratória na redução do escore clínico em lactentes com bronquiolite viral aguda (BVA). Métodos: Ensaio controlado randomizado de 30 lactentes (média de idade 4,08±3,12 meses) com BVA, previamente hígidos, com vírus sincicial respiratório (VSR) positivo, avaliados em três momentos: admissão, 48 e 72 horas, antes e após os procedimentos por avaliadores cegos, em três grupos: G1 -técnicas atuais de fisioterapia (expiração lenta e prolongada e desobstrução rinofaríngea retrógrada), G2 -técnicas convencionais de fisioterapia (drenagem postural modificada, compressão expiratória, vibração e percussão) e G3 -aspiração de vias aéreas superiores por meio do escore clínico de Wang e seus componentes: retrações (RE), frequência respiratória (RR), sibilos (WH) e condições gerais (GC). Resultados: O escore clínico de Wang (CS) no momento admissão, no G1, reduziu de 7,0-4,0; no G2, de 7,5-5,5 e no G3 de 7,5-7,0, não apresentando alteração. No momento 48 horas, também houve alteração tanto no G1 (5,5-3,0) quanto no G2 (4,0-2,0) e, em 72 horas, apenas no G1 (2,0-1,0). Conclusão: A fisioterapia respiratória foi efetiva na redução do escore clínico em lactentes com BVA quando comparada com a aspiração isolada das vias aéreas na admissão. No momento 48 horas, ambas as técnicas foram efetivas, sendo que as técnicas atuais foram efetivas também nas 72 horas após a internação, comparada às técnicas convencionais.Registro de Ensa...

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Section: Discussionmentioning

confidence: 99%

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial

Gomes¹,

Postiaux²,

Medeiros³

et al. 2012

Rev. bras. fisioter.

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“…A recent study claimed that modified head-up positioning for physiotherapy caused less reflux than treatment in tipped positions [2] but this has been disputed [3]. In three previous studies reporting GOR as a consequence of chest physiotherapy, it is unclear whether the headdownward tipped positions were investigated, but the physiotherapy described would not be considered orthodox since it also consisted of the use of abdominal thrusts, routine tracheal rubs and nasopharyngeal suction [4][5][6]. This study was, therefore, designed to determine whether established current physiotherapy practice for infants causes or exacerbates GOR.…”

Section: Aamentioning

confidence: 99%

Holding the baby: head downwards positioning for physiotherapy does not cause gastro-oesophageal reflux

Phillips

Pike²,

Rosenthal³

et al. 1998

Eur Respir J

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The head-downwards tipped position for physiotherapy has been claimed to exacerbate gastro-oesophageal reflux (GOR) in infants with cystic fibrosis (CF). This was investigated using lower oesophageal pH monitoring during physiotherapy. Twenty-one infants (age range 1-27 months) with respiratory disorders (CF=11), undergoing lower oesophageal pH monitoring were recruited. Subjects received two physiotherapy episodes in random order, A/B or B/A, 12 h apart. A began the gravity-assisted positioning head downward tip for: right lower lobe, middle lobe, left lower lobe and lingula; then supine with no tip for anterior segments of the upper lobes followed by apical segments of upper lobes in a sitting position. B was in the reverse order. Intermittent chest clapping was carried out for 4 min in each position by a physiotherapist blinded to the pH data. During episode A, the median change in pH from baseline was -0.32 (range -2.07 to +1.0) in non-CF subjects (NS) and -0.52 (range -2.7 to +0.52) in CF subjects (p<0.02). During episode B, the median change in non-CF subjects was -0.1 (NS; range - 1.7 to -0.15) and in CF subjects was -0.05 (NS; range -0.67 to +0.5). There was no order effect for positioning. In the CF subjects the sitting position was twice as likely to have the lowest pH measurement during physiotherapy than the other positions (p<0.04). In conclusion, the head-downward tipped positioning for physiotherapy treatment neither induces nor aggravates gastro-oesophageal reflux. There is no justification for routinely changing the way in which infant physiotherapy is carried out.

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“…CPT increases intrathoracic pressure and can significantly increase abdominal pressure, possibly leading to episodes of gastroesophageal reflux, by compressing the stomach. 74 The infant's natural defense mechanisms against gastroesophageal reflux are weakened during CPT. Repeat episodes of acid reflux causes esophageal-tissue inflammation, with associated dampening of vagal reflexes.…”

Section: Gastroesophageal Refluxmentioning

confidence: 99%

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

2011

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1424RESPIRATORY CARE • SEPTEMBER 2011 VOL 56 NO 9Traditional airway maintenance and clearance therapy and principles of application are similar for neonates, children, and adults. Yet there are distinct differences in physiology and pathology between children and adults that limit the routine application of adult-derived airway-clearance techniques in children. This paper focuses on airway-clearance techniques and airway maintenance in the pediatric patient with acute respiratory disease, specifically, those used in the hospital environment, prevailing lung characteristics that may arise during exacerbations, and the differences in physiologic processes unique to infants and children. One of the staples of respiratory care has been chest physiotherapy and postural drainage. Many new airway clearance and maintenance techniques have evolved, but few have demonstrated true efficacy in the pediatric patient population. Much of this is probably due to the limited ability to assess outcome and/or choose a proper disease-specific or age-specific modality. Airway-clearance techniques consume a substantial amount of time and equipment. Available disease-specific evidence of airway-clearance techniques and airway maintenance will be discussed whenever possible. Unfortunately, more questions than answers remain.

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Esophageal pH Monitoring Data During Chest Physiotherapy

Cited by 52 publications

References 0 publications

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial

Holding the baby: head downwards positioning for physiotherapy does not cause gastro-oesophageal reflux

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

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