Structured respiratory physiotherapy protocol for resolution of atelectasis in pediatric intensive care

Abstract

Children are at higher risk of atelectasis due to their anatomical and physiological particularities. Several physiotherapy techniques are used to treat atelectasis, but only four studies cite methods in pediatric patients undergoing Invasive Mechanical Ventilation (IMV). The objective of this study was to evaluate the Structured Respiratory Physiotherapy Protocol (SRPP) for airway clearance and lung reexpansion for infants on IMV with atelectasis. This is a prospective study including 30 infants (mean ± standard deviation age 8.9 ± 8.0 months; weight 7.5 ± 3.0 kg; BMI 15.8 ± 1.6 kg/cm² and IMV duration 7.7 ± 4.3 days). The sample was randomized into a Control Group (CG), which received routine physiotherapy, and an Intervention Group (IG), submitted to SRPP (postural drainage, mechanical thoracic vibration, manual hyperinflation, stretching of the accessory respiratory muscles, and functional positioning). Both groups were evaluated before and after physiotherapy for respiratory effort using the Wood Downes Score (WD) and pulmonary aeration using lung ultrasonography (Lung Ultrasound Score ‒ LUS). The outcome of the intervention was evaluated by the magnitude of the effect by the Hedges' g test [(small (0.2 < Hedges' g < 0.5), moderate (0.5 < Hedges' g < 0.8) and large (Hedges' g > 0.8) effects]. There were large within-group effects on the reduction of WD in the CG after intervention in both the CG (Hedges' g = -1.53) and IG (Hedges' g = -2.2). There was a moderate effect on LUS reduction in the CG (Hedges' g = -0.64) and a large effect on IG (Hedges' g = -1.88). This study has shown that the SRPP appears to be safe and may be effective in improving airway clearance and lung reexpansion in children on IMV with atelectasis.

Keywords: Mechanical ventilation; Pediatrics; Pulmonary atelectasis; Respiratory physiotherapy; Ultrasound.

Fig. 1

Description of patient selection. Note: ICU, Intensive Care Unit; IMV, Invasive Mechanical Ventilation.

Fig. 2

Positioning for stretching the respiratory muscles: (A) Upper trapezius; (B) Sternocleidomastoid; (C) Pectoralis major and (D) Intercostals. Source: The author (2023).

Fig. 3

Sample selection flowchart.

Fig. 4

Magnitude of the effect (effect size) of the intervention proposed in the study (GI) on LUS (y axis), compared to the effect of routine physiotherapy (CG), shown by the differences between the medians (green bars) and the values “g” for Hedges.

Fig. 5

Magnitude of the effect (effect size) of the intervention proposed in the study (GI) on the Wood-Downes score (y-axis), compared to the effect of routine physiotherapy (CG), shown by the differences between the medians (green bars) and by Hedges’ “g” values.