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Keywords:

  • Infant, Newborn;
  • Mucus [*secretion];
  • Percussion [methods];
  • Pulmonary Atelectasis [*therapy];
  • Randomized Controlled Trials as Topic;
  • Respiration, Artificial [*adverse effects];
  • Respiratory Therapy [*methods];
  • Suction;
  • Vibration [therapeutic use];
  • Humans;
  • Infant

Abstract

Background

Chest physiotherapy (CPT) has been used in many neonatal nurseries around the world to improve airway clearance and treat lung collapse; however, the evidence to support its use has been conflicting. Despite the large number of studies there is very little evidence of sufficiently good quality on which to base current practice.

Objectives

To assess the effects of active CPT techniques, such as percussion and vibration followed by suction compared with suction alone, on the respiratory system in infants receiving mechanical ventilation. Additionally, differences between types of active CPT techniques were assessed.

Search strategy

Our search included The Cochrane Library (Issue 2, 2007), MEDLINE (1966 to 2007), EMBASE (1988 to 2007), CINAHL, Science Citation Index, previous reviews including cross-references, abstracts, conference proceedings and grey literature.

Selection criteria

Trials in which ventilated newborn infants up to four weeks of age were randomly or quasi-randomly assigned to receive active CPT or suction alone. Infants receiving CPT for the extubation period were excluded.

Data collection and analysis

Two review authors independently conducted quality assessments and data extraction for included trials. We analysed data for individual trial results using relative risk (RR) and mean difference (MD). Results are presented with 95% confidence intervals (CI). Due to insufficient data, we could not undertake meta-analysis.

Main results

Three trials involving 106 infants were included in this review. In one trial (n = 20) CPT was no better than standard care in clearing secretions. No increase in the risk of intraventricular haemorrhage was noted. Two trials compared different types of active CPT. One trial (n = 56) 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 to 0.57). No difference in secretion clearance or in the rate of intraventricular haemorrhage or periventricular leucomalacia was demonstrated. The other trial (n = 30) showed that the use of percussion or 'cupping' resulted in an increased incidence of hypoxaemia (RR 0.53; 95% CI 0.28 to 0.99) and increased oxygen requirements (MD -9.68; 95% CI -14.16 to -5.20) when compared with contact heel percussion. There was insufficient information to adequately assess important short and longer-term outcomes, including adverse effects.

Authors' conclusions

The results of this review do not provide sufficient evidence on which to base clinical practice. There is a need for larger randomised controlled trials to address these issues.

Plain Language Summary

Chest physiotherapy for reducing respiratory morbidity in infants requiring ventilatory support

There is not enough evidence to determine whether active chest physiotherapy is of benefit to neonates on mechanical ventilation. Babies who require mechanical ventilation are at risk of lung collapse from increased secretions. Chest physiotherapy (patting or vibrating the chest) is used to improve clearance of secretions from the airway to try to prevent lung collapse. This review found no clear overall benefit or harm from chest physiotherapy. Some individual chest physiotherapy techniques were more beneficial than others in resolving atelectasis and maintaining oxygenation. These results do not support one technique over another. Due to the limited number, poor quality and age of trials in this review, there is not enough evidence to determine whether or not chest physiotherapy is beneficial or harmful in the treatment of infants being ventilated in today's intensive care units. Further good quality trials are needed to address this issue.