From the Research
Postural changes for pulmonary hygiene in infants with cystic fibrosis (CF) on a ventilator should be performed every 2 hours, as this frequency helps prevent secretion pooling and promotes optimal ventilation distribution throughout the lungs, although the evidence is not strong, this recommendation is based on the most recent and highest quality study available 1.
Key Considerations
- The positioning should include alternating between supine, prone (if clinically appropriate), and both right and left lateral positions to ensure all lung segments are adequately drained.
- Each position should be maintained for approximately 30 minutes before changing to the next.
- During these position changes, chest physiotherapy techniques such as percussion and vibration can be incorporated to enhance secretion clearance.
- It's essential to coordinate these postural changes with other care activities and to monitor the infant's vital signs and oxygen saturation during and after repositioning.
Rationale
- The 2-hour interval is recommended because secretions accumulate more rapidly in CF patients due to their thicker mucus, and infants on ventilators have impaired natural clearance mechanisms.
- More frequent repositioning may be necessary if the infant has copious secretions or if clinical assessment indicates deteriorating respiratory status.
- A recent study found that conventional chest physiotherapy compared to other airway clearance techniques for cystic fibrosis showed no difference in lung function or respiratory exacerbations, but the certainty of the evidence is very low 1.
- Another study suggested that positive expiratory pressure physiotherapy for airway clearance in people with cystic fibrosis may be beneficial in reducing pulmonary exacerbations when used with a mask for at least one year 2.
Clinical Implications
- The choice of airway clearance technique should be individualized based on the patient's preferences, age, and clinical status.
- Physiotherapists and people with CF may wish to try different airway clearance techniques until they find one that suits them best.
- Further research is needed to determine the most effective airway clearance technique for infants with CF on a ventilator, but until then, the recommended 2-hour interval for postural changes should be followed 1.