BackgroundApplication of CPT in mechanically ventilated adults has shown to improve lung/thoracic compliance (Mackenzie and Shin, 1985). CPT has been used in many neonatal nurseries around the world to improve airway clearance and treat lung collapse. However, there is conflicting data regarding the effect of CPT on the respiratory status and other short-term outcomes of ventilated neonates and there is concern that CPT could lead to serious adverse outcomes in neonates (Raval, 1987).
ParticipantsPreterm and term newborn infants receiving mechanical ventilation for underlying pulmonary disorder including respiratory distress syndrome (RDS), aspiration, infection or Chronic Lung Disease (CLD) with or without atelectasis.
InterventionProphylactic or therapeutic Active Chest Physiotherapy Techniques with percussion or vibration followed by suction with frequencies between every 2 to 3 h to twice a day.
ComparisonControl with suction (with or without positioning).
Outcome(s)Potential benefits:
 • Duration of mechanical ventilation (days)
 • Duration of supplemental oxygen after intervention (days)
 • Duration of hospital stay (days)
 • Incidence of atelectasis or consolidation (for prophylactic group)
 • Resolution or extension of atelectasis or consolidation (for treatment group)
 Potential harms:
 • Incidence of hypoxemia (SaO2 < 90% or TcPO2 < 50 mmHg) during a single intervention
 • Percent change PaCO2 and PaO2 pre- and post- a single intervention
 • Percent change inspired oxygen received (FiO2) pre- and post- a single intervention
 • Intraventricular hemorrhage (IVH) (any IVH, grade 3 and 4)
 • Periventricular leukomalacia (PVL) [any grade, and severe (grades 3 and 4)]
 • Bradycardia (change in heart rate < 30% of baseline or < 100 beats per min) during intervention
StudiesCross-over trials, randomized and quasi-randomized controlled trials that met inclusion criteria and reported at least one outcome included.
Study description and settingOne cross-over trial and two quasi-randomized controlled trials with newborn infant with respiratory problems requiring mechanical ventilation and receiving different types of chest physiotherapy were included in the review of Hough and coworkers (Hough 2008).
ResultsOne trial showed no significant difference between CPT and standard care in secretions weight and volume and no adverse affects. Two trials compared different types of active CPT. One trial showed that non-resolved atelectasis was reduced in more neonates receiving the lung squeezing technique (LST) when compared to postural drainage, percussion and vibration (PDPV) (RR 0.25; 95% CI 0.11, 0.57 NNT 2(2–3)). The other trial showed that the use of percussion or ‘cupping’ resulted in an increased incidence of hypoxemia (RR 1.62 (1.01–2.59) NNH 4(2–33)) and increased oxygen requirements (MD −9.68 FiO2 points; 95% CI −14.16, −5.20) when compared with contact heel percussion. No difference in secretion clearance or in the rate of intraventricular hemorrhage or periventricular leukomalacia was demonstrated.
Confidence in resultsOnly one trial was considered to be of relatively high methodological quality (Wong and Fok, 2003). Allocation concealment was unclear in the other trials.
Key figure(s)
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Figure captionChest physiotherapy techniques and non-resolution of atelectasis (above). Chest physiotherapy techniques and IVH grade 3 or 4 (below).
Search for eligible studiesCENTRAL, MEDLINE, EMBASE. CINAHL. PEDro and Web of Science. Relevant literature including identified trials and review articles searched through June 2007.
ConclusionThere is insufficient information to adequately assess the important short- and longer-term outcomes of chest physiotherapy, including adverse effects is available.
CitationHough JL, Flenady V, Johnston L, Woodgate PG. Chest physiotherapy for reducing respiratory morbidity in infants requiring ventilatory support. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD006445. DOI: 10.1002/14 651 858.CD006445.pub2.
Date completed18 February 2010
People who helped prepare this Cochrane PICO:Henriette van Laerhoven, Fellow Neonatology, Emma Children's Hospital AMC, Amsterdam, The Netherlands.


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  2. References
  • Mackenzie CF, Shin B. Cardiorespiratory function before and after chest physiotherapy in mechanically ventilated patients with post-traumatic respiratory failure. Crit Care Med 1985; 13: 483486.
  • Raval D, Yeh TF, Mora A, Cuevas D, Pyati S, Pildes RS. Chest physiotherapy in preterm infants with RDS in the first 24 hours of life. J Perinatol 1987; 7: 301304.