Article

Chest physiotherapy for pneumonia in adults

Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 03/2013; 2(2):CD006338. DOI: 10.1002/14651858.CD006338.pub3
Source: PubMed

ABSTRACT

Despite conflicting evidence, chest physiotherapy has been widely used as an adjunctive treatment for adults with pneumonia.
To assess the effectiveness and safety of chest physiotherapy for pneumonia in adults.
We searched CENTRAL 2012, Issue 11, MEDLINE (1966 to November week 2, 2012), EMBASE (1974 to November 2012), Physiotherapy Evidence Database (PEDro) (1929 to November 2012), CINAHL (2009 to November 2012) and CBM (1978 to November 2012).
Randomised controlled trials (RCTs) assessing the efficacy of chest physiotherapy for treating pneumonia in adults.
Two authors independently assessed trial eligibility, extracted data and appraised trial quality. Primary outcomes were mortality and cure rate. We used risk ratios (RR) and mean difference (MD) for individual trial results in the data analysis. We performed meta-analysis and measured all outcomes with 95% confidence intervals (CI).
Six RCTs (434 participants) appraised four types of chest physiotherapy (conventional chest physiotherapy; osteopathic manipulative treatment (which includes paraspinal inhibition, rib raising and myofascial release); active cycle of breathing techniques (which include active breathing control, thoracic expansion exercises and forced expiration techniques); and positive expiratory pressure).None of the physiotherapies (versus no physiotherapy or placebo) improved mortality rates of adults with pneumonia.Conventional chest physiotherapy (versus no physiotherapy), active cycle of breathing techniques (versus no physiotherapy) and osteopathic manipulative treatment (versus placebo) did not increase the cure rate or chest X-ray improvement rate.Osteopathic manipulative treatment (versus placebo) and positive expiratory pressure (versus no physiotherapy) reduced the mean duration of hospital stay by 2.0 days (mean difference (MD) -2.0 days, 95% CI -3.5 to -0.6) and 1.4 days (MD -1.4 days, 95% CI -2.8 to -0.0), respectively. Conventional chest physiotherapy and active cycle of breathing techniques did not.Positive expiratory pressure (versus no physiotherapy) reduced fever duration (MD -0.7 day, 95% CI -1.4 to -0.0). Osteopathic manipulative treatment did not.Osteopathic manipulative treatment (versus placebo) reduced the duration of intravenous (MD -2.1 days, 95% CI -3.4 to -0.9) and total antibiotic treatment (MD -1.9 days, 95% CI -3.1 to -0.7).Limitations of this review are that the studies addressing osteopathic manipulative treatment were small, and that six published studies which appear to meet the inclusion criteria are awaiting classification.
Based on current limited evidence, chest physiotherapy might not be recommended as routine additional treatment for pneumonia in adults.

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    • "À leur stade aigu de consolidation ne correspond aucune proposition physio-technique, à l'exception de quelques démonstrations exploitant le positionnement comme en réanimation néonatale. Les quelques rares études qui concernent la kinésithérapie dans les consolidations pulmonaires chez l'enfant aussi bien que chez l'adulte invalident la kinésithérapie dans ces affections [54] [55]. Cette absence de résultat découle de trois facteurs : • la solution physio-technique proposée est classiquement de type expiratoire et ne concerne donc que l'arbre trachéobronchique proximal ou moyen ; • les tests fonctionnels qui recueillent à la bouche un signal global ne rendent pas compte d'une modification locorégionale obtenue lors d'une séance de kinésithérapie ; • l'observation stéthacoustique géographiquement plus proche et plus sélective est négligée. "
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    ABSTRACT: Recent medical literature has shown that there has been renewed interest focused on the small airways deep in the lung tissue. Although there is involvement of the distal airways at an early stage in mucus secreting lung diseases, no specific chest physical therapy (CPT) manoeuver has been proposed for small airways clearance. A four-tier classification of CPT has been established with identification of its benefits at each level of a monoalveolar respiratory tract model. The usual expiratory techniques directed towards the upper and middle respiratory tract are not applicable to the small airways and new paradigm is proposed appropriate to their specific mechanical characteristics. This comprises a slow resistive inspiratory manoeuver in the lateral position. Clinical auscultation of the lung is the cornerstone of the validation and follow-up of the technique.
    Full-text · Article · Jun 2014 · Revue des Maladies Respiratoires
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    • "À leur stade aigu de consolidation ne correspond aucune proposition physio-technique, à l'exception de quelques démonstrations exploitant le positionnement comme en réanimation néonatale. Les quelques rares études qui concernent la kinésithérapie dans les consolidations pulmonaires chez l'enfant aussi bien que chez l'adulte invalident la kinésithérapie dans ces affections [54] [55]. Cette absence de résultat découle de trois facteurs : • la solution physio-technique proposée est classiquement de type expiratoire et ne concerne donc que l'arbre trachéobronchique proximal ou moyen ; • les tests fonctionnels qui recueillent à la bouche un signal global ne rendent pas compte d'une modification locorégionale obtenue lors d'une séance de kinésithérapie ; • l'observation stéthacoustique géographiquement plus proche et plus sélective est négligée. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Recent medical literature has shown that there has been renewed interest focused on the small airways deep in the lung tissue. Although there is involvement of the distal airways at an early stage in mucus secreting lung diseases, no specific chest physical therapy (CPT) manoeuver has been proposed for small airways clearance. A four-tier classification of CPT has been established with identification of its benefits at each level of a monoalveolar respiratory tract model. The usual expiratory techniques directed towards the upper and middle respiratory tract are not applicable to the small airways and new paradigm is proposed appropriate to their specific mechanical characteristics. This comprises a slow resistive inspiratory manoeuver in the lateral position. Clinical auscultation of the lung is the cornerstone of the validation and follow-up of the technique.
    Full-text · Article · Jun 2014
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    • "Chest X-ray resolution and improvements in arterial blood gas analysis (ABG) are the mainstay clinical methods to assess the effectiveness of multimodal chest physiotherapy.[13] From current survey results, it was found that the majority of the physiotherapists (91%) interpreted X-ray and ABG results in planning and assessing the improvements following treatment. "
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    ABSTRACT: Context:Neurological intensive care units (ICUs) are a rapidly developing sub-specialty of neurosciences. Chest physiotherapy techniques are of great value in neurological ICUs in preventing, halting, or reversing the impairments caused due to neurological disorder and ICU stay. However, chest physiotherapy techniques should be modified to a greater extent in the neurological ICU as compared with general ICUs.Aim:The aim of this study is to obtain data on current chest physiotherapy practices in neurological ICUs of India.Settings and Design:A tertiary care hospital in Karnataka, India, and cross-sectional survey.Subjects and Methods:A questionnaire was formulated and content validated to assess the current chest physiotherapy practices in neurological ICUs of India. The questionnaire was constructed online and a link was distributed via E-mail to 185 physiotherapists working in neurological ICUs across India.Statistical Analysis Used:Descriptive statistics.Results:The response rate was 44.3% (n = 82); 31% of the physiotherapists were specialized in cardiorespiratory physiotherapy and 30% were specialized in neurological physiotherapy. Clapping, vibration, postural drainage, aerosol therapy, humidification, and suctioning were used commonly used airway clearance (AC) techniques by the majority of physiotherapists. However, devices for AC techniques such as Flutter, Acapella, and standard positive expiratory pressure devices were used less frequently for AC. Techniques such as autogenic drainage and active cycle of breathing technique are also frequently used when appropriate for the patients. Lung expansion therapy techniques such as breathing exercises, incentive spirometry exercises, and positioning, proprioceptive neuromuscular facilitation of breathing are used by majority of physiotherapists.Conclusions:Physiotherapists in this study were using conventional chest physiotherapy techniques more frequently in comparison to the devices available for AC.
    Full-text · Article · Jun 2014 · Indian Journal of Critical Care Medicine
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