P0398 / #971: CHEST PHYSIOTHERAPY FOR SLIDE TRACHEOPLASTY PATIENTS IN PAEDIATRIC INTENSIVE CARE

Abstract

Aims & Objectives: Long segment congenital tracheal stenosis is a rare, life threatening malformation, which is treated with slide tracheoplasty (STP) surgery. Chest physiotherapy (CPT) is part of postoperative ICU care for these patients, however there is minimal evidence to guide treatment. This study aims to explore current CPT practice in paediatric STP patients. Methods: Retrospective cohort study, at a single tertiary centre, over a 3 year period. Patient demographics, surgical procedures and clinical variables were recorded. Main outcome measures: Types of CPT and adjuncts Prevalence of gas trapping Focal pathology on initial postoperative chest x-ray (CXR) Results: A total of 43 children were included, all received standard CPT whilst ventilated. Mucolytics were used in two patients whilst ventilated, and four once extubated. Fourteen patients (33%) required chest wall decompression due to gas trapping and ventilation difficulties. Subgroup analysis demonstrated that these patients were smaller (median weight 5.6 vs 8 kg, p = 0.015) and younger (median age 6 vs 12 months, p = 0.006) than those who did not require decompression. Focal pathology was present on initial CXR in 54% of children, with 61% of cases involving the upper lobes. Conclusions: This experience highlights that CPT is a routine component of STP postoperative care. Additional adjuncts were used infrequently, suggesting standard CPT was sufficient. It was the smaller children who required chest wall decompression; hence physiotherapists should adopt a proactive approach with these patients. Lung pathology on CXR was most commonly seen in the upper lobes. Further research is needed including investigation into decompression techniques.