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Chest physiotherapy for preventing morbidity in babies being extubated from mechanical ventilation

  • Review
  • Intervention




Chest physiotherapy has been used to clear secretions and help lung ventilation in newborns who have needed mechanical ventilation for respiratory problems. However, there are concerns about the safety of some forms of chest physiotherapy.


To determine the effects of active chest physiotherapy on infants being extubated from mechanical ventilation for respiratory failure.

Search methods

The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of electronic databases: Oxford Database of Perinatal Trials; Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2005); MEDLINE (1966 to February 2009); CINAHL (1982 to February 2009); and EMBASE (2006 to February 2009), previous reviews including cross references, abstracts, conferences, symposia proceedings, expert informants and journal hand searching.

Selection criteria

All trials utilising random or quasi-random patient allocation, in which active chest physiotherapy was compared with non-active techniques (e.g. positioning and suction alone) or no intervention in the peri-extubation period.

Data collection and analysis

Assessment of methodological quality and extraction of data for each included trial was undertaken independently by the authors. Subgroup analysis was performed on different treatment frequencies and gestational age less than 32 weeks. Meta-analysis was conducted using a fixed effects model. Results are presented as relative risk (RR), risk difference (RD) and number needed to treat (NNT) for categorical data and mean difference (MD) for data measured on a continuous scale. All outcomes are reported with the use of 95% confidence intervals.

Main results

In this review of four trials, two of which were carried out 15 and 23 years ago, no clear benefit of peri-extubation active chest physiotherapy can be seen. Active chest physiotherapy did not significantly reduce the rate of postextubation lobar collapse [typical RR 0.80 (95% CI 0.49,1.29)], though a reduction in the use of reintubation was shown in the overall analysis [typical RR 0.32 (95% CI 0.13,0.82); typical RD -7% (95% CI-13, -2); NNT 14 (95% CI 8, 50)]. There is insufficient information to adequately assess important short and longer term outcomes, including adverse effects.

Authors' conclusions

Caution is required when interpreting the possible positive effects of chest physiotherapy of a reduction in the use of reintubation and the trend for decreased post-extubation atelectasis as the numbers of babies studied are small, the results are not consistent across trials, data on safety are insufficient, and applicability to current practice may be limited.








使用Cochrane Neonatal Review Group 的標準策略進行檢索,檢索了以下電子數據庫:Oxford Database of Perinatal Trials; Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, 2005年第1期);MEDLINE(1966年至2009年2月);以及CINAHL (1982年至2009年2月),先前回顧包括參考文獻,摘要,研討會論文集,專家訊息和對主要是英文雜誌進行手工檢索。






在本回顧的4個試驗中,有2個是在15年和23年前進行的,積極胸部物理療法在拔管前後沒有明確好處。積極胸部物理療法無統計學顯著性減少拔管後肺葉塌陷的發生率[RR 0.80 (95% CI 0.49,1.29)],但在整體分析中發現再插管率減少:RR 0.32 (95% CI 0.13,0.820);RD −7%(95% CI −13,−2);NNT 14(95% CI 8,50)。沒有資料足以適當評估短期和長期結果,包括不良反應。





此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。



Plain language summary

Chest physiotherapy for preventing morbidity in babies being extubated from mechanical ventilation

Active chest physiotherapy may not be helpful for all babies being taken off mechanical breathing support. Mechanical ventilation (machine-assisted breathing) increases a baby's lung secretions. Chest physiotherapy (tapping or vibrating on the chest) is thought to clear the baby's lungs, and is often done when taking the baby off the ventilator (extubation). Although this review found a benefit for physiotherapy in terms of less babies needing to go back on the ventilator, no other benefits were shown. Also, this benefit was mainly due to the results of studies conducted a long time ago before advances such as better humidification systems to moisten the air the baby breaths and the drug surfactant. These advances may have reduced the risk of complications around the time of extubation so these results may not apply to babies in today's neonatal nurseries. This review did not show any evidence of harm for babies receiving a short course of chest physiotherapy following extubation.

Laienverständliche Zusammenfassung

Vorbeugende Atemphysiotherapie, bei Säuglingen, die künstlich beatmet werden mussten

Aktive Atemphysiotherapie ist möglicherweise nicht für alle Babys hilfreich, die von der künstlichen Beatmung entwöhnt werden. Wird ein Säugling künstlich beatmet (maschinelle Beatmung) so bildet sich Schleim in seiner Lunge. Man geht davon aus, dass Atemphysiotherapie (d.h. Beklopfen und Vibrationsmassage des Brustkorbs) die Lunge von Schleim befreit. Daher wird sie häufig eingesetzt, wenn ein Säugling von der künstlichen Beatmung entwöhnt wird (sog. Extubation). Dieser Review zeigt einen Nutzen der Physiotherapie, dadurch dass weniger Säuglinge erneut künstliche Beatmung benötigten. Es wurden aber keine anderen Vorteile gefunden. Zudem zeigte sich dieser Nutzen vor allem in Studien, die vor langer Zeit durchgeführt wurden, d.h. vor wesentlichen Verbesserungen bei der künstlichen Beatmung, wie z.B. verbesserter Befeuchtung der Atemluft und Einsatz von Surfactant. Diese Fortschritte haben das Risiko für Komplikation zum Zeitpunkt der Extubation möglicherweise verringert. Daher könnte diese Ergebnisse für Säuglinge auf heutigen Neugeborenenstationen eventuell nicht mehr zutreffen. Dieser Review zeigt keine Evidenz dafür, dass eine kurzfristige Physiotherapie nach der Extubation für den Säugling schädlich ist.

Anmerkungen zur Übersetzung

Koordination durch Cochrane Schweiz

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