What is the role of the physiotherapist in paediatric intensive care units? A systematic review of the evidence for respiratory and rehabilitation interventions for mechanically ventilated patients

Abstract

BackgroundPhysiotherapy in intensive care units (ICU) has traditionally focussed on the respiratory management of mechanically ventilated patients. Gradually, focus has shifted to include rehabilitation in adult ICUs, though evidence of a similar shift in the paediatric ICU (PICU) is limited. ObjectivesReview the evidence to determine the role of physiotherapists in the management of mechanically ventilated patients in PICU. Data sourcesA search was conducted of: PEDro, CINAHL, Medline, PubMed and the Cochrane Library. Eligibility criteriaStudies involving PICU patients who received physiotherapy while invasively ventilated were included in this review. Those involving neonatal or adult ICU patients, or patients on non-invasive or long-term ventilation, were not included in the study. Study appraisalAll articles were critically appraised by two reviewers and results were analysed descriptively. ResultsSix studies on chest physiotherapy (CPT) met the selection criteria. Results support the use of the expiratory flow increase technique and CPT, especially manual hyperinflation and vibrations, for secretion clearance. Evidence does not support the routine use of either CPT or suction alone. No studies investigating rehabilitation in PICU met selection criteria. LimitationsA lack of high level evidence was available to inform this review. ConclusionEvidence indicates that CPT is still the focus of physiotherapy intervention in PICU for mechanically ventilated patients, and supports its use for secretion clearance in this setting.PROSPERO register for systematic reviews (registration no. CRD42014009582).