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. 2000;2002(2):CD000283.
doi: 10.1002/14651858.CD000283.

Chest physiotherapy for preventing morbidity in babies being extubated from mechanical ventilation

V J Flenady  1 , P H Gray
Affiliations

Chest physiotherapy for preventing morbidity in babies being extubated from mechanical ventilation

V J Flenady et al. Cochrane Database Syst Rev. 2000.

Update in

Abstract

Background: This section is under preparation and will be included in the next issue.

Objectives: To assess the effects of active chest physiotherapy on babies being extubated from mechanical ventilation for neonatal respiratory failure.

Search strategy: The standard search strategy for the Neonatal Review Group was used as outlined in the Cochrane Handbook in the Cochrane Library.

Selection criteria: All 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 periextubation period. The methodological quality of each trial was assessed by two independent authors.

Data collection and analysis: Data were extracted independently by two authors. The data were analysed from 3 trials. Subgroup analysis was performed on different treatment frequencies.

Main results: In this review of 3 small trials, 2 of which were carried out 10 & 20 years ago, no clear benefit of periextubation active chest physiotherapy can be seen. Active chest physiotherapy did not significantly reduce the rate of postextubation lobar collapse (RR 0.69;0.33,1.45), though a reduction in the use of reintubation was shown in the overall analysis (RR 0.24;0.08,0.75). Subgroup analysis of different treatment frequencies showed the same effect with more frequent treatment (1 & 2 hourly) but showed a trend to increased lobar collapse, and no reduction in the use of reintubation, with less frequent treatment (4 hourly). There is insufficient information to assess other important short and long term outcomes, including adverse effects.

Reviewer's conclusions: The 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.

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Conflict of interest statement

The authors were investigators on the trial Bagley 2005.

Figures

1.1
1.1. Analysis
Comparison 1 Active chest physiotherapy vs no active chest physiotherapy, Outcome 1 Postextubation lobar collapse.
1.2
1.2. Analysis
Comparison 1 Active chest physiotherapy vs no active chest physiotherapy, Outcome 2 Reintubation within 24hrs.
1.3
1.3. Analysis
Comparison 1 Active chest physiotherapy vs no active chest physiotherapy, Outcome 3 Pneumonia.
1.4
1.4. Analysis
Comparison 1 Active chest physiotherapy vs no active chest physiotherapy, Outcome 4 Bradycardia.
1.5
1.5. Analysis
Comparison 1 Active chest physiotherapy vs no active chest physiotherapy, Outcome 5 Intraventricular haemorrhage‐all grades.
1.6
1.6. Analysis
Comparison 1 Active chest physiotherapy vs no active chest physiotherapy, Outcome 6 Intraventricular haemorrhage ‐ Grades 3 and 4.
1.7
1.7. Analysis
Comparison 1 Active chest physiotherapy vs no active chest physiotherapy, Outcome 7 Death prior to discharge.
1.8
1.8. Analysis
Comparison 1 Active chest physiotherapy vs no active chest physiotherapy, Outcome 8 Duration of mechanical ventilation (days).
1.9
1.9. Analysis
Comparison 1 Active chest physiotherapy vs no active chest physiotherapy, Outcome 9 Duration of nasopharyngeal CPAP( days).
1.10
1.10. Analysis
Comparison 1 Active chest physiotherapy vs no active chest physiotherapy, Outcome 10 Duration of supplemental oxygen (days).
1.11
1.11. Analysis
Comparison 1 Active chest physiotherapy vs no active chest physiotherapy, Outcome 11 Duration of neonatal intensive care stay (days).
2.1
2.1. Analysis
Comparison 2 Active chest physiotherapy vs no active physiotherapy ‐ <32 wks gestation, Outcome 1 Postextubation lobar collapse.
2.2
2.2. Analysis
Comparison 2 Active chest physiotherapy vs no active physiotherapy ‐ <32 wks gestation, Outcome 2 Reintubation within 24hrs.
2.3
2.3. Analysis
Comparison 2 Active chest physiotherapy vs no active physiotherapy ‐ <32 wks gestation, Outcome 3 Bradycardia.
2.4
2.4. Analysis
Comparison 2 Active chest physiotherapy vs no active physiotherapy ‐ <32 wks gestation, Outcome 4 Intraventricular haemorrhage ‐ all grades.
2.5
2.5. Analysis
Comparison 2 Active chest physiotherapy vs no active physiotherapy ‐ <32 wks gestation, Outcome 5 Intraventricular haemorrhage ‐ Grades 3 and 4.
2.6
2.6. Analysis
Comparison 2 Active chest physiotherapy vs no active physiotherapy ‐ <32 wks gestation, Outcome 6 Death prior to discharge.
2.7
2.7. Analysis
Comparison 2 Active chest physiotherapy vs no active physiotherapy ‐ <32 wks gestation, Outcome 7 Duration of mechanical ventilation (days).
2.8
2.8. Analysis
Comparison 2 Active chest physiotherapy vs no active physiotherapy ‐ <32 wks gestation, Outcome 8 Duration of nasopharyngeal CPAP( days).
2.9
2.9. Analysis
Comparison 2 Active chest physiotherapy vs no active physiotherapy ‐ <32 wks gestation, Outcome 9 Duration of supplemental oxygen (days).
2.10
2.10. Analysis
Comparison 2 Active chest physiotherapy vs no active physiotherapy ‐ <32 wks gestation, Outcome 10 Duration of neonatal intensive care stay (days).
3.1
3.1. Analysis
Comparison 3 Active chest physiotherapy vs no active chest physiotherapy (subgrouped by frequency), Outcome 1 Post extubation lobar collapse.
3.2
3.2. Analysis
Comparison 3 Active chest physiotherapy vs no active chest physiotherapy (subgrouped by frequency), Outcome 2 Reintubation within 24 hours.
3.3
3.3. Analysis
Comparison 3 Active chest physiotherapy vs no active chest physiotherapy (subgrouped by frequency), Outcome 3 Pneumonia.
3.4
3.4. Analysis
Comparison 3 Active chest physiotherapy vs no active chest physiotherapy (subgrouped by frequency), Outcome 4 Bradycardia.
3.5
3.5. Analysis
Comparison 3 Active chest physiotherapy vs no active chest physiotherapy (subgrouped by frequency), Outcome 5 Intraventricular haemorrhage‐ all grades.
3.6
3.6. Analysis
Comparison 3 Active chest physiotherapy vs no active chest physiotherapy (subgrouped by frequency), Outcome 6 Intraventricular haemorrhage ‐ Grades 3 and 4.
3.7
3.7. Analysis
Comparison 3 Active chest physiotherapy vs no active chest physiotherapy (subgrouped by frequency), Outcome 7 Death prior to discharge.
3.8
3.8. Analysis
Comparison 3 Active chest physiotherapy vs no active chest physiotherapy (subgrouped by frequency), Outcome 8 Duration of mechanical ventilation (days).
3.9
3.9. Analysis
Comparison 3 Active chest physiotherapy vs no active chest physiotherapy (subgrouped by frequency), Outcome 9 Duration of nasopharyngeal CPAP( days).
3.10
3.10. Analysis
Comparison 3 Active chest physiotherapy vs no active chest physiotherapy (subgrouped by frequency), Outcome 10 Duration of supplemental oxygen (days).
3.11
3.11. Analysis
Comparison 3 Active chest physiotherapy vs no active chest physiotherapy (subgrouped by frequency), Outcome 11 Duration of neonatal intensive care stay (days).
See this image and copyright information in PMC

References

References to studies included in this review

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Bagley 2005 {published data only}
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    1. Bagley CE, Gray PH, Tudehope DI, Flenady V, Shearman AD, Lamont A. Routine neonatal postextubation chest physiotherapy: a randomized controlled trial. Journal of Paediatrics and Child Health 2005;41(11):592‐7. - PubMed
Finer 1979 {published data only}
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References to other published versions of this review

Flenady 1998
    1. Flenady VJ, Gray PH. Chest physiotherapy for preventing morbidity in babies being extubated from mechanical ventilation. Cochrane Database of Systematic Reviews 1998, Issue 1. [DOI: 10.1002/14651858.CD000283] - DOI - PMC - PubMed
Flenady 2002
    1. Flenady VJ, Gray PH. Chest physiotherapy for preventing morbidity in babies being extubated from mechanical ventilation. Cochrane Database of Systematic Reviews 2002, Issue 2. [DOI: 10.1002/14651858.CD000283] - DOI - PMC - PubMed

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