Chest physiotherapy for pneumonia in children

• Published in: Cochrane database of systematic reviews 2019-01, Vol.1 (1), p.CD010277-CD010277
• Main Authors: Chaves, Gabriela Ss, Freitas, Diana A, Santino, Thayla A, Nogueira, Patricia Angelica Ms, Fregonezi, Guilherme Af, Mendonça, Karla Mpp
• Format: Article
• Language: English
• Subjects: Child; Child health; Child, Preschool; Continuous Positive Airway Pressure - methods; Continuous Positive Airway Pressure - mortality; Drainage; Female; Humans; Infant; Infant, Newborn; Infectious disease; Length of Stay - statistics & numerical data; Lungs & airways; Male; Oxygen - blood; Pneumonia; Pneumonia - mortality; Pneumonia - therapy; Positive-Pressure Respiration - methods; Randomized Controlled Trials as Topic; Respiratory Rate; Respiratory Therapy - adverse effects; Respiratory Therapy - methods; Respiratory Therapy - mortality
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD010277.pub3

Pneumonia is a lung infection that causes more deaths in children aged under five years than any other single cause. Chest physiotherapy is widely used as adjuvant treatment for pneumonia. Physiotherapy is thought to help remove inflammatory exudates, tracheobronchial secretions, and airway obstructions, and reduce airway resistance to improve breathing and enhance gas exchange. This is an update of a review published in 2013. To assess the effectiveness of chest physiotherapy with regard to time until clinical resolution in children (from birth to 18 years) of either gender with any type of pneumonia. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1), which includes the Cochrane Acute Respiratory Infections Group Specialised Register, MEDLINE (22 February 2018), Embase (22 February 2018), CINAHL (22 February 2018), LILACS (22 February 2018), Web of Science (22 February 2018), and PEDro (22 February 2018). We also searched clinical trials registers (ClinicalTrials.gov and WHO ICTRP) to identify planned, ongoing, and unpublished trials. We included randomised controlled trials (RCTs) that compared any type of chest physiotherapy with no chest physiotherapy for children with pneumonia. We used standard Cochrane methodological procedures. The primary outcomes of interest were mortality, duration of hospital stay, and time to clinical resolution. We used Review Manager 5 software to analyse data and GRADE to assess the quality of the evidence for each outcome. We included three new RCTs for this update, for a total of six included RCTs involving 559 children aged from 29 days to 12 years with pneumonia who were treated as inpatients. Pneumonia severity was described as moderate in one trial, severe in two trials, and was not stated in three trials. The studies assessed five different interventions: effects of conventional chest physiotherapy (3 studies, 211 children), positive expiratory pressure (1 study, 72 children), continuous positive airway pressure (CPAP) (1 study, 94 children), bubble CPAP (bCPAP) (1 study, 225 children), and assisted autogenic drainage (1 studies, 29 children). The included studies were conducted in Bangladesh, Brazil, China, Egypt, and South Africa. The studies were overall at low risk of bias. Blinding of participants was not possible in most studies, but we considered that the outcomes were unlikely to be influenced by the lack of blinding.All included studies evaluated mortality. However, thre