PubMed · 9228399
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G Ntoumenopoulos. 1997. Questioning chest physiotherapy.. https://doi.org/10.1378/chest.112.1.292-a
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In the context of excess bronchial secretions respiratory physiotherapy too often involves treatment by the therapist alone for the bronchial secretions. A more detailed analysis of the causes of the secretions often show evidence of the incapacity of the patient to manage autonomous bronchial drainage. Education thus becomes a priority in an attempt to improve the quality of life, and to slow the alteration of respiratory function linked to chronic hypersecretion and perhaps to reduce the consumption of medication and care. Such an outcome does not exclude regular supervision of respiratory prescriptions and treatment; maintenance of the learning process is also required to assist the patient when autonomy becomes too difficult to cope with.
We investigated the role of chest physiotherapy (CPT) in preventing post-extubation atelectasis (PEA) in infants. Sixty-three infants who were admitted to the neonatal intensive care unit and intubated for more than 24 hours and who showed no evidence of atelectasis by chest x-ray prior to extubation were enrolled in the study. Infants were randomly assigned to 2-hourly CPT, 4-hourly CPT, or a no CPT group. Chest physiotherapy began immediately after extubation and consisted of postural drainage, bilateral chest vibration, and suctioning. A second chest x-ray was obtained on all infants 24 hours following extubation. The three groups were comparable in birth weight, gestational age, and duration of intubation. In the 24-hour period following extubation, the incidence of PEA was not statistically significant in the three groups (P = 0.33). Two infants in the 2-hourly CPT group were placed on nasal continuous positive airway pressure; two in each of the 2-hourly and the no CPT groups required re-intubation and intermittent positive pressure ventilation to treat symptomatic atelectasis. We conclude that post extubation chest physiotherapy as used in this study did not prevent atelectasis in extubated infants.