REVIEW QUESTION

Is chest physiotherapy effective as an adjunct treatment in children with pneumonia?

TYPE OF REVIEW

This is a systematic review of three randomized controlled trials (RCTs) comparing various chest physiotherapy interventions with controls.

RELEVANCE FOR NURSING

Pneumonia is common among children worldwide, with particularly high incidence and mortality rates in low-income countries. It is the greatest cause of death in children under five years old. Characterized by inflammation of the lungs, pneumonia leads to an accumulation of respiratory secretions in the airways, which contribute to worsening clinical symptoms and increased airway resistance, making it difficult for children to breathe. Chest physiotherapy is widely used as an adjunct treatment for pneumonia, and aims to help clear tracheobronchial secretions, reduce airway resistance, and enhance gas exchange.

CHARACTERISTICS OF THE EVIDENCE

The three RCTs were conducted in hospital settings, two in Brazil, and the third in China. The participants were 255 children ages 29 days to 12 years, with pneumonia (of any type) stated as moderate in one trial, severe in one trial, and not stated in the other. Different types of chest physiotherapy were investigated, including conventional chest physiotherapy, breathing exercises, and positive expiratory pressure. Interventions (chest physiotherapy plus standard treatment for pneumonia or continuous positive airway pressure plus standard treatment) were compared with standard treatment in two trials and one trial compared chest physiotherapy with a nonmandatory request to breathe deeply, expectorate sputum, and maintain a lateral body position once a day.

The primary outcomes of the review were mortality, duration of hospital stay, and time to resolution of clinical parameters (including fever, increase in respiratory work, and peripheral oxygen saturation levels). Secondary outcomes included change in adventitious sounds, change in chest X-ray, and duration in days of antibiotic therapy and cough.

No studies reported on mortality as an outcome. Conventional chest physiotherapy and positive expiratory pressure did not decrease duration of hospital stay in the two studies reporting this outcome. Some clinical parameters were improved following chest physiotherapy, including respiratory rate. One study used a severity score that included tachypnea, recession, fever, oxygen saturation, and X-ray, with statistically significant results favoring the intervention group. In another, continuous positive airway pressure significantly improved peripheral oxygen saturation levels. The third study did not find any differences between the intervention and control groups. The one study reporting on both adventitious sounds and duration of days of coughing found a statistically significantly longer median duration of rhonchi on lung auscultation and of coughing in the intervention group compared with controls. There were no changes in chest X-ray between intervention and control groups in the one study that reported this outcome.

BEST PRACTICE RECOMMENDATIONS

While there was improvement in some outcomes, such as respiratory rate and peripheral oxygen saturation following chest physiotherapy, overall there is insufficient evidence to justify the use of chest physiotherapy in children with pneumonia.

RESEARCH RECOMMENDATIONS

The lack of available evidence highlights the need for more high-quality RCTs addressing chest physiotherapy in children with pneumonia. It would be beneficial for future studies to report more thoroughly on methodologic aspects of trials, and to use appropriate sample sizes with sufficient power to detect any treatment effects.

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