Early respiratory therapy reduces postoperative atelectasis in children undergoing lung resection

• Published in: Respiratory care 2013-05, Vol.58 (5), p.805-809
• Main Authors: Kaminski, Patrícia Nerys, Forgiarini, Jr, Luiz Alberto, Andrade, Cristiano Feijó
• Format: Article
• Language: English
• Subjects: Arm - physiology; Atelectasis; Bronchoscopy; Care and treatment; Child; Child, Preschool; Children; Cough; Diseases; Drainage; Female; Humans; Infant; Length of Stay; Lungs; Male; Movement - physiology; Patient outcomes; Physical Therapy Modalities; Pneumonectomy - adverse effects; Positive-Pressure Respiration; Postoperative Care; Pulmonary Atelectasis - etiology; Pulmonary Atelectasis - prevention & control; Respiratory Therapy; Risk factors; Surgery; Time Factors; Walking - physiology
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.01870

Early physiotherapy reduces pulmonary complications after lung resection in adult patients. However, the effectiveness and the techniques used in postoperative physiotherapy in children undergoing lung resection have not been well described. Therefore, the standardization of a physiotherapeutic attendance after lung resection in children is necessary. This was a retrospective and prospective, interventional, descriptive, and quantitative study. We evaluated 123 pediatric subjects undergoing lung resection. Fifty-two children were prospectively submitted to a standardized physiotherapy protocol that included a mask with a positive expiratory pressure of 10 cm H2O, expiratory rib cage compression, coughing, lifting the upper limbs, and ambulation, starting within the first 4 hours after surgery and continuing 3 times each day. A historical control group of 71 subjects received physiotherapeutic techniques without specific standardization and with variability in the start date and number of days attended. We recorded the presence of postoperative complications, prolonged air leak, postoperative bronchoscopy, the time of chest tube removal, and hospital stay following surgery. The group that received a standardized protocol of physiotherapy had fewer instances of atelectasis than the control group (15.4% vs 7.6%, P = .01). Subjects in the control group were more likely than those in the intervention group to require fiberoptic bronchoscopy for bronchial toilet (n = 14 [19.7%] vs n = 5 [9.6%], P ≤ .001). There was no difference in the time of drainage or hospital stay between the groups. Implementation of a standardized physiotherapeutic protocol after lung resection in children decreases atelectasis but does not reduce the time of chest tube removal or the duration of hospital stay.