Chest physiotherapy, gastro-oesophageal reflux, and arousal in infants with cystic fibrosis

Abstract

Background: Postural drainage chest physiotherapy in infants with cystic fibrosis (CF) exacerbates gastro-oesophageal reflux (GOR) and may contribute to a more rapid deterioration in lung function.

Aims: To compare standard postural drainage chest physiotherapy (SPT) and a modified physiotherapy regimen (MPT) without head-down tilt, with regard to GOR, arousal state, and cardiorespiratory function.

Methods: Twenty infants with CF underwent 30 hour oesophageal pH monitoring, during which four chest physiotherapy sessions were administered (day 1: MPT-SPT; day 2: SPT-MPT). Arousal state, heart rate, and oxygen saturation were documented for each of the physiotherapy positions (supine, prone, right lateral, and left lateral with (SPT) or without (MPT) 30 degrees head-down tilt).

Results: Significantly more reflux episodes occurred during SPT than during MPT, but there were no significant differences in median episode duration or fractional reflux time. During SPT, left lateral positioning was associated with fewer reflux episodes compared to other positions. During supine and prone positioning, more reflux episodes occurred during SPT than during MPT. Infants were significantly more likely to be awake or cry during SPT. There was a significant association between crying and reflux episodes for SPT. Non-nutritive sucking was associated with a significant reduction in reflux episodes during SPT. Oxygen saturation during SPT was significantly lower during crying and other waking, and non-nutritive sucking during SPT was associated with a significant increase in oxygen saturation.

Conclusions: SPT is associated with GOR, distressed behaviour, and lower oxygen saturation.

Figure 1

Median number of reflux episodes per hour, median duration of reflux episodes, and median fractional reflux time during chest physiotherapy in each of four positions carried out using either a standard postural drainage technique (SPT), or a modified regimen without head-down tilt (MPT). Twenty patients were studied twice in each of four positions during both physiotherapy regimens. Error bars show interquartile range. *Wilcoxon signed rank test: p < 0.05.