From the Guidelines
Pediatric chest physical therapy should be individualized and taught by pediatric-trained chest physiotherapists, with treatment reviewed at least biannually, to ensure safety and effectiveness in children with bronchiectasis. The European Respiratory Society guidelines recommend airway clearance techniques (ACT) as a key intervention for children and adolescents with bronchiectasis, despite low evidence, due to the potential benefits of improved mucociliary clearance and ventilation 1.
Key Considerations
- Individualized therapy is crucial, considering the child's developmental stage and cognitive abilities, to ensure effective treatment and minimize undesirable effects.
- Treatment should be reviewed at least biannually to adjust techniques as needed and ensure ongoing effectiveness.
- Airway clearance techniques, such as percussion, vibration, and postural drainage, can be beneficial in enhancing secretion clearance during exacerbations.
- Parental education and involvement are essential for home management, with proper technique demonstration and regular follow-up to ensure effectiveness.
Indications and Contraindications
- Pediatric chest physical therapy is indicated for conditions with excessive secretions, such as cystic fibrosis, bronchiectasis, and pneumonia with secretion retention.
- Contraindications include pulmonary hemorrhage, unstable cardiac status, increased intracranial pressure, and rib fractures.
- Monitoring of oxygen saturation, respiratory rate, and heart rate during treatment is crucial, and therapy should be stopped immediately if the child shows signs of distress.
Technique and Duration
- For infants and young children, gentle techniques with a cupped hand or soft percussion device are recommended, while older children can tolerate firmer techniques.
- Treatment typically lasts 20-30 minutes and is performed 2-4 times daily, depending on the child's condition.
- Positioning of the child is critical, with modifications for infants to avoid increased intracranial pressure risk.
The most recent and highest-quality study, published in the European Respiratory Journal in 2021, supports the use of individualized airway clearance techniques as a key intervention for children and adolescents with bronchiectasis 1.
From the Research
Pediatric Chest Physical Therapy Guidelines
- The use of chest physiotherapy (CPT) in pediatric practice is considered a separate and specialized treatment modality that should be rendered only by a physiotherapist 2.
- Despite its widespread practice, there is little high-level evidence supporting the indications for and effectiveness of CPT in critically ill infants and children 3.
- Conventional CPT should not be a routine intervention in the pediatric intensive care unit, but can be considered when obstructive secretions are present which impact on lung mechanics and/or gaseous exchange and/or where there is the potential for long-term complications 3.
Techniques and Modalities
- Techniques such as positioning, early mobilization, and rehabilitation have been shown to be beneficial in adult intensive care patients, but little attention has been paid to this area of practice in pediatric intensive care units 3.
- Airway clearance techniques, including postural drainage combined with percussion and vibration (PD&P), Active cycle of breathing technique, and Autogenic drainage, have been used in the treatment of cystic fibrosis 4.
- Exercise can be used in addition to an airway clearance technique to enhance secretion removal and overall benefit to the patient, but it is not recommended as a replacement for airway clearance techniques 4.
Effectiveness and Safety
- Studies have shown that CPT can be irritating to patients and may lead to short-term decreases in oxygen, partial pressure in the blood, and major fluctuations in cardiac output 5.
- The use of CPT in mechanically ventilated children may not be considered a standard therapy, and controlled studies are needed to examine its impact on the duration of mechanical ventilatory support, critical illness, and hospital stay 5.
- A systematic review found that the current evidence does not provide conclusive evidence to justify the use of chest physiotherapy in children with pneumonia due to a lack of data 6.