Chest Physiotherapy in the Pediatric Intensive Care Unit

Morrow, Brenda

doi:10.1055/s-0035-1563385

Cited by 13 publications

(22 citation statements)

References 120 publications

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“…Current evidence is insufficient to provide strong recommendations for chest physiotherapy in the PICU. [156,157] Summary: High care and intensive care of children with pneumonia…”

Section: Physiotherapymentioning

confidence: 99%

Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines

Zar

Moore

Andronikou

et al. 2020

Afr J Thorac Crit Care Med

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Background. Pneumonia remains a major cause of morbidity and mortality amongst South African children. More comprehensive immunisation regimens, strengthening of HIV programmes, improvement in socioeconomic conditions and new preventive strategies have impacted on the epidemiology of pneumonia. Furthermore, sensitive diagnostic tests and better sampling methods in young children improve aetiological diagnosis. Objective. To produce revised guidelines for pneumonia in South African children under 5 years of age. Methods. The Paediatric Assembly of the South African Thoracic Society and the National Institute for Communicable Diseases established seven expert subgroups to revise existing South African guidelines focusing on: (i) epidemiology; (ii) aetiology; (iii) diagnosis; (iv) antibiotic management and supportive therapy; (v) management in intensive care; (vi) prevention; and (vii) considerations in HIV-infected or HIVexposed, uninfected (HEU) children. Each subgroup reviewed the published evidence in their area; in the absence of evidence, expert opinion was accepted. Evidence was graded using the British Thoracic Society (BTS) grading system. Sections were synthesized into an overall guideline which underwent peer review and revision. Recommendations. Recommendations include a diagnostic approach, investigations, management and preventive strategies. Specific recommendations for HIV infected and HEU children are provided. Validation. The guideline is based on available published evidence supplemented by the consensus opinion of SA paediatric experts. Recommendations are consistent with those in published international guidelines.

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“…Current evidence is insufficient to provide strong recommendations for chest physiotherapy in the PICU. [156,157] Summary: High care and intensive care of children with pneumonia…”

Section: Physiotherapymentioning

confidence: 99%

Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines

Zar

Moore

Andronikou

et al. 2020

Afr J Thorac Crit Care Med

View full text Add to dashboard Cite

show abstract

“…Current evidence is insufficient to provide strong recommendations for chest physiotherapy in the PICU. [66,67] Summary: High care and intensive care of children with pneumonia…”

Section: Physiotherapymentioning

confidence: 99%

Management of community-acquired pneumonia in children: South African oracic Society guidelines (part 3)

et al. 2020

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Changes in the epidemiology and aetiology of childhood pneumonia have necessitated a revision of management strategies. Pneumococcal and Haemophilus influenzae type b (Hib) conjugate vaccines have resulted in a shift in bacterial aetiology, with non-typable H. influen zae and Staphylococcus aureus causing a greater proportion of radiologically confirmed severe pneumonia in hospitalised children. Improvements in diagnostic methods have further contributed to recognising causative pathogens. Furthermore, management This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

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“…In addition to facilitating secretion clearance, mobilisation and active exercise aim to improve thoracic mobility; increase lung volume; improve or maintain cardiovascular fitness, exercise tolerance and muscle strength; prevent postural deformities; improve bone ossification, bladder and bowel function; maintain skin integrity and confer psychological benefits (Button & Button 2013; Morrow 2015:174–181). Mobilisation techniques and exercise prescription should be selected according to the individual patients’ general condition, chronological (or corrected) age and developmental level (Morrow 2015:174–181). The term ‘mobilisation’ includes a range of active, passive or assisted techniques, including limb exercises, bed mobility, sitting out of bed, standing, crawling and walking.…”

Section: Airway Clearance Techniquesmentioning

confidence: 99%

“…In critically ill adults, percussion has been associated with cardiac arrhythmia and a decrease in pulmonary compliance (Stiller 2000:1801–1813), and it has been suggested that both percussion and vibrations may cause or exacerbate bronchospasm (Kirilloff et al 1985:436–444). In acutely ill children, any potential benefits of intervention must be carefully balanced against risk of harm before they are implemented (Morrow 2015:174–181). From personal experience, some children enjoy percussion and tolerate it well, while in others there may be a perception of the perpetuation of physical abuse (hitting), a problem that is rife in our community.…”

Section: Airway Clearance Techniquesmentioning

confidence: 99%

Airway clearance therapy in acute paediatric respiratory illness: A state-of-the-art review

Morrow

2019

South African Journal of Physiotherapy

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Background Despite unclear evidence of effectiveness or safety, airway clearance therapy (ACT) is frequently performed in infants and children with acute pulmonary disease. Objectives The aim of this review was to critically synthesise published evidence, expert opinion and pathophysiological principles to describe the indications, effects, precautions and application of commonly used ACT modalities for managing infants and children with acute pulmonary disease. Method A comprehensive narrative review of published literature was conducted. Articles describing paediatric populations were prioritised, but adult and animal studies were also considered where appropriate. Results There is a dearth of high-level evidence supporting the use of ACT in acutely ill infants and children. Conversely, studies have highlighted the lack of effect of different modalities for a variety of conditions, and in some cases serious associated complications have been reported. Airway clearance therapy may be considered when there is retention of pulmonary secretions, and the consequential airway obstruction impacts either acutely on respiratory mechanics and gaseous exchange and/or has the potential for long-term adverse sequelae [a condition that is the consequence of a previous disease or injury]. However, it should not be considered a routine intervention. Conclusion Airway clearance therapy should not be performed routinely in children admitted to hospital with acute respiratory conditions. Patients should be clinically assessed and treatment planned according to individual presentation, in those with signs and symptoms that are potentially amenable to ACT. Clinical implications This review can serve as a guide for physiotherapists in the respiratory management of children with acute respiratory illness, as well as identifying areas for clinical research.

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Chest Physiotherapy in the Pediatric Intensive Care Unit

Cited by 13 publications

References 120 publications

Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines

Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines

Management of community-acquired pneumonia in children: South African oracic Society guidelines (part 3)

Airway clearance therapy in acute paediatric respiratory illness: A state-of-the-art review

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