Respiratory Physiotherapy Techniques Research Articles

Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old.

Acute bronchiolitis is the leading cause of medical emergencies during winter months in infants younger than 24 months old. Chest physiotherapy is sometimes used to assist infants in the clearance of secretions in order to decrease ventilatory effort. This is an update of a Cochrane Review first published in 2005 and updated in 2006, 2012, and 2016. To determine the efficacy of chest physiotherapy in infants younger than 24 months old with acute bronchiolitis. A secondary objective was to determine the efficacy of different techniques of chest physiotherapy (vibration and percussion, passive exhalation, or instrumental). We searched CENTRAL, MEDLINE, Embase, CINAHL, LILACS, Web of Science, PEDro (October 2011 to 20 April 2022), and two trials registers (5 April 2022). Randomised controlled trials (RCTs) in which chest physiotherapy was compared to control (conventional medical care with no physiotherapy intervention) or other respiratory physiotherapy techniques in infants younger than 24 months old with bronchiolitis. We used standard methodological procedures expected by Cochrane. Our update of the searches dated 20 April 2022 identified five new RCTs with 430 participants. We included a total of 17 RCTs (1679 participants) comparing chest physiotherapy with no intervention or comparing different types of physiotherapy. Five trials (246 participants) assessed percussion and vibration techniques plus postural drainage (conventional chest physiotherapy), and 12 trials (1433 participants) assessed different passive flow-oriented expiratory techniques, of which three trials (628 participants) assessed forced expiratory techniques, and nine trials (805 participants) assessed slow expiratory techniques. In the slow expiratory subgroup, two trials (78 participants) compared the technique with instrumental physiotherapy techniques, and two recent trials (116 participants) combined slow expiratory techniques with rhinopharyngeal retrograde technique (RRT). One trial used RRT alone as the main component of the physiotherapy intervention. Clinical severity was mild in one trial, severe in four trials, moderate in six trials, and mild to moderate in five trials. One study did not report clinical severity. Two trials were performed on non-hospitalised participants. Overall risk of bias was high in six trials, unclear in five, and low in six trials. The analyses showed no effects of conventional techniques on change in bronchiolitis severity status, respiratory parameters, hours with oxygen supplementation, or length of hospital stay (5 trials, 246 participants). Regarding instrumental techniques (2 trials, 80 participants), one trial observed similar results in bronchiolitis severity status when comparing slow expiration to instrumental techniques (mean difference 0.10, 95% confidence interval (C) -0.17 to 0.37). Forced passive expiratory techniques failed to show an effect on bronchiolitis severity in time to recovery (2 trials, 509 participants; high-certainty evidence) and time to clinical stability (1 trial, 99 participants; high-certainty evidence) in infants with severe bronchiolitis. Important adverse effects were reported with the use of forced expiratory techniques. Regarding slow expiratory techniques, a mild to moderate improvement was observed in bronchiolitis severity score (standardised mean difference -0.43, 95% CI -0.73 to -0.13; I2 = 55%; 7 trials, 434 participants; low-certainty evidence). Also, in one trial an improvement in time to recovery was observed with the use of slow expiratory techniques. No benefit was observed in length of hospital stay, except for one trial which showed a one-day reduction. No effects were shown or reported for other clinical outcomes such as duration on oxygen supplementation, use of bronchodilators, or parents' impression of physiotherapy benefit. We found low-certainty evidence that passive slow expiratory technique may result in a mild to moderate improvement in bronchiolitis severity when compared to control. This evidence comes mostly from infants with moderately acute bronchiolitis treated in hospital. The evidence was limited with regard to infants with severe bronchiolitis and those with moderately severe bronchiolitis treated in ambulatory settings. We found high-certainty evidence that conventional techniques and forced expiratory techniques result in no difference in bronchiolitis severity or any other outcome. We found high-certainty evidence that forced expiratory techniques in infants with severe bronchiolitis do not improve their health status and can lead to severe adverse effects. Currently, the evidence regarding new physiotherapy techniques such as RRT or instrumental physiotherapy is scarce, and further trials are needed to determine their effects and potential for use in infants with moderate bronchiolitis, as well as the potential additional effect of RRT when combined with slow passive expiratory techniques. Finally, the effectiveness of combining chest physiotherapy with hypertonic saline should also be investigated.

Factors Associated with the Peak Flow Variation Generated during Forced Manual Hyperinflation Technique

Manual hyperinflation is one of the most used respiratory physiotherapy techniques in critically ill patients and consists of administering a higher volume of gaseous fluid than the patient performed using a self-inflating balloon (AMBU). This technique was developed with the objective of removing bronchial secretion and re-expansion of atelectasis lung areas, thus improving pulmonary compliance and oxygenation in mechanically ventilated patients.

Effects of respiratory physiotherapy interventions on pulmonary mechanics of newborns: a protocol for a systematic review

IntroductionAlthough respiratory physiotherapy techniques may reduce respiratory load in newborns, manual contact with the ribcage may interfere with pulmonary mechanics. Therefore, this systematic review aims to evaluate the effects of...

TÉCNICAS DE FISIOTERAPIA RESPIRATÓRIA EM PACIENTES VENTILADOS MECANICAMENTE ELEITAS PELA MAIOR EFICÁCIA PELA PRÁTICA CLÍNICA E LITERATURA

Patients on Invasive Mechanical Ventilation constantly present impaired mucociliary clearance, where respiratory physiotherapy techniques are important in their care. The objective of the study was to analyze and describe the bronchial hygiene maneuvers most used in the clinical practice of physical therapists working in the Intensive Care Unit. The sample consisted of 50 physical therapists who worked in Intensive Care Units, and who answered the questionnaire applied. For the analysis of the results, an electronic database was created and descriptive analysis was used. 50 online questionnaires were answered. The most common maneuvers were: endotracheal aspiration, early mobilization, manual chest compression maneuver, vibrocompression and postural drainage. The reasons for choosing these techniques were “I see them being more effective in clinical practice” and “The literature shows them to be more effective”. It is necessary to carry out more studies to ensure the benefits and disadvantages in the practice of these maneuvers.

Association of Chartered Physiotherapists in Respiratory Care scoping review: Post-operative physiotherapy in people undergoing thoracic surgery

Introduction This scoping review was produced by the ACPRC editorial board. Following a preliminary scoping day, surgery was considered 1 of 5 key priorities for review. Surgery was subsequently separated into specialities. Objective The objective of this scoping review was to report the extent and methodological type of evidence associated with post-operative physiotherapy in people who underwent thoracic surgery. Inclusion criteria Studies with adult patients undergoing thoracic surgery and published between 2014 and 2020 were included. The thoracic procedure undertaken required post-operative physiotherapy intervention as part of the recovery process. Method Searches were undertaken in PEDro, CINAHL, EMBASE, MEDLINE, PubMed, Google Scholar and the Clinical Trials Registry. Article titles and abstracts were screened by one reviewer, and full text articles appraised by two reviewers. Quality was assessed and data was extracted using the relevant tools dependent on study methodology. Results Initially, 1809 articles were retrieved from which 28 articles were included in this scoping review, including a total of 6265 participants. Studies were randomised control trials (n = 10), observational studies (n = 7) and systematic review or meta-analysis (n = 5). The quality of the articles was good with the studies having structured protocols and blinding of subjects where appropriate, however there were some methodical flaws, including being underpowered. The variability in clinical physiotherapy practice between countries was highlighted. Included studies explored respiratory physiotherapy (n = 13), mobilisation (n = 10), combined respiratory and mobilisation (n = 3), kinesiology taping (n = 1) and outcomes (n = 1). Early and intensive mobilisation as part of an ERAS programme demonstrated statistically significant reduction in length of stay, post-operative pulmonary complications, and morbidity. The level of patients’ pre-operative mobility impacted on their post-operative outcomes and risk of developing post-operative pulmonary complications (PPC). Conclusion The scoping review included 28 studies with a range of methodologies providing evidence that supports post-operative physiotherapy intervention in people who undergo thoracic surgery. Future research should aim to clarify which respiratory physiotherapy techniques impact recovery and expand the diversity of methodologies to include more qualitative research.

Airway Clearance and Mucoactive Therapies.

The respiratory system is constantly exposed to external pathogens but has different and effective defense systems. The pathophysiology of bronchiectasis affects the defense system considerably in that alterations occur in the airway that reduce its effectiveness in mucociliary clearance and the greater presence of mucins leads to the accumulation of more adherent and viscous mucus. One of the pillars of treatment of this disease should be improvement of mucociliary clearance and a decrease in the adherence and viscosity of the mucus. To this end, the mobilization of secretions must be increased through effective respiratory physiotherapy techniques, which can be manual and/or instrumental. The properties of mucus can be modified to improve its mobilization through the use of a mucoactive agent. Despite the increase in the number and quality of studies, the evidence for these treatments remains scarce, although their application is recommended in all guidelines.

Potential Prophylactic and Therapeutic Effects of Respiratory Physiotherapy for COVID-19.

New coronavirus disease 2019 (COVID-19) has succeeded in surprising the world with infecting more than 12 million people and claiming 560,000 lives in only six months. COVID-19 is associated with a spectrum of respiratory symptoms, especially dyspnea. Patients who progress to severe or critical condition display peripheral and posterior lung lesions bilaterally. These patients require admission to the intensive care unit (ICU); therefore, they are prone to ICU-related complications during disease and after recovery. Respiratory physiotherapy techniques, in particular, active techniques, might help the improvement of airway clearance and lung capacity in addition to the reduction of breathing effort during the active disease. In parallel, it might lead to the prevention of disabilities, resulting from infection and extended hospitalization in patients who recovered from COVID-19. This supports physiotherapy both as a prophylactic and therapeutic strategy for COVID-19. (www.actabiomedica.it)

A Practical Approach to Managing Patients With Myasthenia Gravis-Opinions and a Review of the Literature.

When the diagnosis of myasthenia gravis (MG) has been secured, the aim of management should be prompt symptom control and the induction of remission or minimal manifestations. Symptom control, with acetylcholinesterase inhibitors such as pyridostigmine, is commonly employed. This may be sufficient in mild disease. There is no single universally accepted treatment regimen. Corticosteroids are the mainstay of immunosuppressive treatment in patients with more than mild MG to induce remission. Immunosuppressive therapies, such as azathioprine are prescribed in addition to but sometimes instead of corticosteroids when background comorbidities preclude or restrict the use of steroids. Rituximab has a role in refractory MG, while plasmapheresis and immunoglobulin therapy are commonly prescribed to treat MG crisis and in some cases of refractory MG. Data from the MGTX trial showed clear evidence that thymectomy is beneficial in patients with acetylcholine receptor (AChR) antibody positive generalized MG, up to the age of 65 years. Minimally invasive thymectomy surgery including robotic-assisted thymectomy surgery has further revolutionized thymectomy and the management of MG. Ocular MG is not life-threatening but can be significantly disabling when diplopia is persistent. There is evidence to support early treatment with corticosteroids when ocular motility is abnormal and fails to respond to symptomatic treatment. Treatment needs to be individualized in the older age-group depending on specific comorbidities. In the younger age-groups, particularly in women, consideration must be given to the potential teratogenicity of certain therapies. Novel therapies are being developed and trialed, including ones that inhibit complement-induced immunological pathways or interfere with antibody-recycling pathways. Fatigue is common in MG and should be duly identified from fatigable weakness and managed with a combination of physical therapy with or without psychological support. MG patients may also develop dysfunctional breathing and the necessary respiratory physiotherapy techniques need to be implemented to alleviate the patient's symptoms of dyspnoea. In this review, we discuss various facets of myasthenia management in adults with ocular and generalized disease, including some practical approaches and our personal opinions based on our experience.

Multimodality respiratory physiotherapy reduces mortality but may not prevent ventilator-associated pneumonia or reduce length of stay in the intensive care unit: a systematic review.

In intubated adult patients receiving mechanical ventilation, does multimodality respiratory physiotherapy prevent ventilator-associated pneumonia, shorten length of intensive care unit (ICU) stay, and reduce mortality? A systematic review with meta-analysis of randomised controlled trials. Intubated adult patients undergoing mechanical ventilation who were admitted to an intensive care unit. More than two respiratory physiotherapy techniques such as positioning or postural drainage, manual hyperinflation, vibration, rib springing, and suctioning. Incidence of ventilator-associated pneumonia (VAP), duration of ICU stay, and mortality. Five trials were included in the meta-analysis. Random-effects models were used to calculate pooled weighted mean difference (WMD) for length of ICU stay and pooled risk ratio (RR) for incidence of VAP, and fixed-effects model was used to calculate pooled RR for mortality. The effect on the incidence of VAP was unclear (RR 0.73 in favour of multimodality respiratory physiotherapy, 95% CI 0.38 to 1.07). The effect on length of stay was also unclear (WMD -0.33days shorter with multimodality respiratory physiotherapy, 95% CI -2.31 to 1.66). However, multimodality respiratory physiotherapy significantly reduced mortality (RR 0.75, 95% CI 0.58 to 0.92). Multimodality respiratory physiotherapy appeared to reduce mortality in ICU patients. It was unclear whether this occurred via a reduction in the incidence of VAP and/or length of stay because the available data provided very imprecise estimates of the effect of multimodality respiratory physiotherapy on these outcomes. These very imprecise estimates include the possibility of very worthwhile effects on VAP incidence and length of ICU stay; therefore, these outcomes should be the focus of further investigation in rigorous trials. PROSPERO CRD42018094202. [Pozuelo-Carrascosa DP, Torres-Costoso A, Alvarez-Bueno C, Cavero-Redondo I, López Muñoz P, Martínez-Vizcaíno V (2018) Multimodality respiratory physiotherapy reduces mortality but may not prevent ventilator-associated pneumonia or reduce length of stay in the intensive care unit: a systematic review. Journal of Physiotherapy 64: 222-228].

Gastroesophageal reflux and chest physiotherapy: review

Objective: to present scientific evidence on the impact of respiratory physiotherapy techniques (RPT) in episodes of gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) in pediatric population, as well as characteristics of the studied samples, evaluation tools, RPT applied and the results obtained. Method: Systematic review operationalized through electronic search of three databases: LILACS, MEDLINE and Science Direct, in the period February to April 2014, using the keywords: gastroesophageal reflux, gastro-oesophageal reflux, physiotherapy / physical therapy, respiratory / chest. Studies evaluating the effects of RPT (conventional and modern) in children with GER and / or diagnosed with GERD were selected. Results: 73 articles were identified on the subject, and a sequential process excluded those who did not meet the inclusion criteria previously established. At the end of the calculation we included eight articles, seven clinical trials and one report series of cases. There was a higher frequency in the assessment of the impact on the conventional RPT about GER in children with cystic fibrosis, and postural drainage, associated or not with other techniques, applied in most studies, however, the effects of the described RPT may be still controversial. More recent studies have analyzed other RPT (increased expiratory flow handlings and method thoracoabdominal rebalancing) verifying their capability of causing reflux and security in the application of handlings. Conclusions: there is lack of research on the subject, there is no consensus as to the effect of RPT on GER in the pediatric population, especially in children with cystic fibrosis. In these investigations it was found that most of the examination of images used for the identification of GER.

Tecnicas de fisioterapia respiratoria: efeito nos parametros cardiorrespiratorios e na dor do neonato estavel em UTIN

OBJETIVOS: verificar os efeitos de técnicas de fisioterapia respiratória (TFR) na dor e na função cardiorrespiratória de recém-nascidos (RN) clinicamente estáveis com prescrição de TFR, internados em unidade de terapia intensiva neonatal. MÉTODOS: ensaio clínico randomizado cego. Os RN foram alocados em três grupos: G1-controle; G2- fisioterapia convencional; G3-reequilíbrio tóracoabdominal. Neonatos do G2 e G3 receberam intervenção em atendimento único. Todos foram avaliados antes, imediatamente após e 15 minutos após o término da intervenção/repouso quanto aos parâmetros cardiorrespiratórios (saturação periférica de oxigênio/SpO2, frequências cardíaca/fc e respiratória/fr) e dor (escalas específicas: NIPS, NFCS e PIPP). Para análise dos dados foram aplicados: testes qui-quadrado, Friedman, Kruskal- Wallis e, posteriormente, análise de comparações múltiplas, com p<0,05 significativo. RESULTADOS: participaram do estudo 60 RN, dos quais 56,7% eram do sexo feminino, 68,3% prétermo/ muito baixo peso, com média de idade gestacional corrigida de 38,88 ± 2,03 semanas, idade de 13,22 ± 7,37 dias e peso de 1603,42 ± 439,16 gramas. Antes da intervenção, os grupos eram equivalentes quanto à presença de dor e parâmetros cardiorrespiratórios basais. Comparando os efeitos de cada um dos procedimentos, entre os grupos e no decorrer das três avaliações, não houve alterações significativas em nenhum dos parâmetros cardiorrespiratórios avaliados (p>0,05) e em relação à dor houve mudanças significativas nas escalas NIPS (G1 e G2, p=0,037 e p=0,011, respectivamente) e PIPP (G2, p=0,005). CONCLUSÕES: técnicas de fisioterapia respiratória não desencadearam dor, nem instabilidade cardiorrespiratória nos RN estudados.

Standardised education and training for respiratory physiotherapists

The mission of ERS is to alleviate suffering from respiratory disease and to promote lung health through research, sharing of knowledge and through medical and public education. Within this context, respiratory physiotherapy plays a fundamental role in improving ventilation, and enhancing quality of life [1] for patients with respiratory disease. Physiotherapists work with patients in a variety of settings including patients' homes, pulmonary rehabilitation programmes, wards and intensive care units. Although physiotherapy is globally recognised within the healthcare profession, some respiratory physiotherapy techniques have been clouded by a lack of scientific evidence [2] and insufficient clinical data [3] on the benefits of specific techniques in the treatment of patients suffering from respiratory disease. In recent decades, evidence (or absence thereof) has been emerging for many techniques related to exercise training, mucus transport and breathing retraining strategies. The field is rapidly evolving. In 1995 a specific group involving respiratory physiotherapists was established. This active group exists under the European Respiratory Society assembly for allied health professionals (ERS group 9.02), and gathers annually during the ERS Annual Congress, keeping an open channel of communication with physiotherapists throughout the year. Stiller [3] reported that while “some physiotherapists routinely treat most if not all ICU patients with a combination of techniques, […] other physiotherapists use such techniques selectively when they believe they are specifically indicated”, thereby highlighting the differences in treatment of patients by respiratory physiotherapists just over a decade ago. In 2009, Bott et al. [2] published guidelines with the distinct purpose of producing evidence-based recommendations for practice. In recent years, great strides have been taken in research of respiratory physiotherapy to accumulate and report on the supporting rationale and effectiveness of respiratory physiotherapy techniques and combinations of techniques used in …

Flutter valve improves respiratory mechanics and sputum production in patients with bronchiectasis

Although the application of airway clearance techniques is considered an important component in the treatment of several obstructive pulmonary diseases, there is no scientific evidence supporting the use of Flutter Valve™ in the management of patients with bronchiectasis. Moreover, the consequences of respiratory physiotherapy techniques on respiratory mechanics have not been fully studied. Therefore, we investigated the acute, short-term effects of Flutter Valve™ on respiratory mechanics and sputum production in bronchiectatic patients. EIGHT patients were evaluated in a randomized, blinded, cross-over trial. Impedance at 5 Hz (R5), resistance as a function of oscillation frequency (dR/dF), reactance at 5 Hz (X5), resonant frequency (f(0) ) and integral of reactance between 5 Hz and resonant frequency (AX) were recorded. Flutter Valve™ cleared 8.4 mL more secretions than the Sham Flutter intervention (95% confidence interval [95% CI], 3.4-13.4). There was a higher percentage decrease in R5 (-11.2%; 95% CI, -4.4 to -18.2), dR/dF (-20.8%; 95% CI, -32.4 to -9) and AX (-7.8%; 95% CI, -11.9 to -3.7) under Flutter Valve™. X5 and f(0) variation did not differ between interventions. Flutter Valve™ increases sputum removal during treatment and diminishes total and peripheral airway resistance in hypersecretive patients with bronchiectasis. Impulse oscillometry is a user-friendly tool to evaluate the effects of airway clearance techniques on respiratory mechanics.

The effect of breath physiotherapeutic maneuvers on cerebral hemodynamics: a clinical trial

To observe the repercussion of respiratory physiotherapy techniques on the mean arterial pressure (MBP), intracranial pressure (ICP), cerebral perfusion pressure (CPP), jugular venous oxygen pressure (PjvO2) and jugular venous oxygen saturation (SjvO2). The sample consisted of 20 patients with head trauma. The protocol consisted of physiotherapy techniques application of vibrocompression (VBC), expiratory flow increase (EFI) and suction. The results show the maintenance on variables of cerebral hemodynamics during the techniques of VBC and EFI. However, in relation to suction, there was an increase of MBP, ICP, with maintenance of CPP, PjvO2 and SjvO2 and return to baseline of MBP and ICP 10 minutes after the end of suction. The respiratory physiotherapy techniques (VBC, EFI) do not promote cerebral hemodynamic repercussion, unlike suction, in severe head injury patients, mechanically ventilated, sedated and paralyzed.

Neumonías de repetición y fisioterapia respiratoria: a propósito de un caso clínico

Aims To evaluate the effect of the respiratory physiotherapy techniques in a 4-year old patient who suffered recurrent pneumonia in different sites, these being the lower left lobe, middle right lobe and lower right lobe. Patient and methods The patient was referred by the pneumology department for respiratory physiotherapy treatment in a private clinic. Treatment was given for 3 weeks, performing pulmonary expansion and disobstruction maneuver techniques. Results The auscultation showed a decrease in number of whistling rales, increase in ventilation and disappearance of crepitations. The main spirometric values increased from FEF 25%-75%: 23% to 89%, FEV 1/FVC: 86, 38% to 96%. Uses of drugs decreased and the pulmonary condensations disappeared. Conclusions The respiratory physiotherapy program presented solved the clinical presented case.