Chest physiotherapy for pneumonia in children

Pneumonia is an inflammatory lung disease and it is the greatest cause of deaths in children younger than five years of age worldwide. Accumulation of secretions in the airways due to respiratory infections contributes to the worsening of clinical symptoms making it very difficult for the child to breathe. Chest physiotherapy may contribute to patient recovery as a complementary treatment because it can help to eliminate inflammatory secretions, remove airway obstructions, reduce airway resistance and the work of breathing. Chest physiotherapy techniques combine manual percussion of the chest wall and strategic positioning of the patient for mucus drainage, with cough and breathing techniques.

We looked for evidence for the effectiveness of chest physiotherapy in children with pneumonia. We found three studies involving 255 children with pneumonia aged 29 days to 12 years. In all included studies there was a group that received some type of physiotherapy and another group that did not receive physiotherapy, called a control group. Children in both groups underwent the standard medical treatment for pneumonia. Two of the included studies found a significant improvement in respiratory rate (decrease in the number of breaths per minute) and oxygen saturation (measure of how much oxygen the blood is carrying as a percentage of the maximum it could carry), whereas one included study failed to show that standardised respiratory physiotherapy and positive expiratory pressure (maintenance of a pressure in the lungs above atmospheric pressure at the end of expiration) decreased the time to clinical resolution and the duration of hospital stay. No adverse effects related to the interventions were described. This systematic review was limited by the lack of studies and the quality of the existing data. Two of the included studies had an overall low risk of bias whereas one included study had an overall unclear risk of bias. The studies differed in some of their characteristics, such as the duration of treatment, levels of severity, types of pneumonia and the techniques used in children with pneumonia. Moreover, the included studies reported different outcomes and also had differences in their statistical presentation of data. As a result, we were not able to compare the results from these trials by meta-analysing (combining) them. There is no conclusive evidence in this review to support or refute the use of physiotherapy in children with pneumonia. The results are up to date as of May 2013.

Authors' conclusions: 

Our review does not provide conclusive evidence to justify the use of chest physiotherapy in children with pneumonia due to a lack of data. The number of included studies is small and they differed in their statistical presentation.

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Background: 

Pneumonia is an inflammatory lung disease and it is the greatest cause of deaths in children younger than five years of age worldwide. Chest physiotherapy is widely used in the treatment of pneumonia because it can help to eliminate inflammatory exudates and tracheobronchial secretions, remove airway obstructions, reduce airway resistance, enhance gas exchange and reduce the work of breathing. Thus, chest physiotherapy may contribute to patient recovery as an adjuvant treatment even though its indication remains controversial.

Objectives: 

To assess the effectiveness of chest physiotherapy in relation to time until clinical resolution in children (from birth up to 18 years old) of either gender with any type of pneumonia.

Search strategy: 

We searched CENTRAL 2013, Issue 4; MEDLINE (1946 to May week 4, 2013); EMBASE (1974 to May 2013); CINAHL (1981 to May 2013); LILACS (1982 to May 2013); Web of Science (1950 to May 2013); and PEDro (1950 to May 2013).

We consulted the ClinicalTrials.gov and the WHO ICTRP registers to identify planned, ongoing and unpublished trials. We consulted the reference lists of relevant articles found by the electronic searches for additional studies.

Selection criteria: 

We included randomised controlled trials (RCTs) that compared chest physiotherapy of any type with no chest physiotherapy in children with pneumonia.

Data collection and analysis: 

Two review authors independently selected the studies to be included in the review, assessed trial quality and extracted data.

Main results: 

Three RCTs involving 255 inpatient children are included in the review. They addressed conventional chest physiotherapy, positive expiratory pressure and continuous positive airway pressure. The following outcomes were measured: duration of hospital stay, time to clinical resolution (observing the following parameters: fever, chest indrawing, nasal flaring, tachypnoea and peripheral oxygen saturation levels), change in adventitious sounds, change in chest X-ray and duration of cough in days. Two of the included studies found a significant improvement in respiratory rate and oxygen saturation whereas the other included study failed to show that standardised respiratory physiotherapy and positive expiratory pressure decrease the time to clinical resolution and the duration of hospital stay. No adverse effects related to the interventions were described. Due to the different characteristics of the trials, such as the duration of treatment, levels of severity, types of pneumonia and the techniques used in children with pneumonia, as well as differences in their statistical presentation, we were not able to pool data. Two included studies had an overall low risk of bias whereas one included study had an overall unclear risk of bias.

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