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Chest physiotherapy for preventing morbidity in babies being extubated from mechanical ventilationFlenady V, Gray PH
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SummaryChest physiotherapy for preventing morbidity in babies being extubated from mechanical ventilationActive 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.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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October 20. 1997 AbstractBackgroundChest physiotherapy has been used to clear secretions and help lung ventilation in newborns who have needed mechanical ventilation for respiratory problems. However concerns about the safety of some forms of chest physiotherapy have been expressed. ObjectivesTo assess the effects of active chest physiotherapy on babies being extubated from mechanical ventilation for neonatal respiratory failure. Search strategyThe 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-Jan 2005); and CINAHL (1982-Jan 2005), previous reviews including cross references, abstracts, conferences, symposia proceedings, expert informants and journal hand searching mainly in the English language. Selection criteriaAll trials utilising random or quasi-random patient allocation, in which active chest physiotherapy was compared with non-active techniques (eg positioning and suction alone) or no intervention in the peri-extubation period. Data collection and analysisAssessment of methodological quality and extraction of data for each included trial was undertaken independently by the authors. Data were extracted for the primary outcomes of postextubation lobar collapse, use of reintubation, duration of oxygen therapy, intracranial haemorrhage, cerebral cystic lesions, long term neurosensory impairment and death. 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 resultsIn this review of four trials, two of which were carried out 15 & 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 [RR 0.80 (95% CI 0.49,1.29)], though a reduction in the use of reintubation was shown in the overall analysis: RR 0.32 (95% CI 0.13,0.82); 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' conclusionsThe results of this review do not allow development of clear guidelines for clinical practice. 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. Further randomised controlled trials addressing the role of prophylactic active chest physiotherapy for neonates in the postextubation period may be unwarranted. |