COCHRANE CORNER
Editor’s note: This is a summary of a nursing care–related systematic
review from the Cochrane Library.
Chest Physiotherapy for Pneumonia
in Children
REVIEW QUESTION
Is chest physiotherapy effective as an adjunct treat-
ment 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 chil-
dren to breathe. Chest physiotherapy is widely used as
an adjunct treatment for pneumonia, and aims to help
clear tracheobronchial secretions, reduce airway re-
sistance, 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 investi-
gated, including conventional chest physiotherapy,
breathing exercises, and positive expiratory pressure.
Interventions (chest physiotherapy plus standard treat-
ment for pneumonia or continuous positive airway
pressure plus standard treatment) were compared with
standard treatment in two trials and one trial com-
pared chest physiotherapy with a nonmandatory re-
quest to breathe deeply, expectorate sputum, and
maintain a lateral body position once a day.
The primary outcomes of the review were mor-
tality, duration of hospital stay, and time to resolu-
tion of clinical parameters (including fever, increase
in respiratory work, and peripheral oxygen satura-
tion levels). Secondary outcomes included change
in adventitious sounds, change in chest X-ray, and
duration in days of antibiotic therapy and cough.
16 AJN ▼ May 2014 ▼ Vol. 114, No. 5 ajnonline.com
By Karolina Lisy, PhD, BSc (Hons)
No studies reported on mortality as an outcome.
Conventional chest physiotherapy and positive expi-
ratory 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, reces-
sion, fever, oxygen saturation, and X-ray, with sta-
tistically 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 be-
tween the intervention and control groups. The one
study reporting on both adventitious sounds and du-
ration of days of coughing found a statistically signifi-
cantly 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 satu-
ration following chest physiotherapy, overall there is
insufficient evidence to justify the use of chest phys-
iotherapy in children with pneumonia.
RESEARCH RECOMMENDATIONS
The lack of available evidence highlights the need for
more high-quality RCTs addressing chest physiother-
apy in children with pneumonia. It would be benefi-
cial for future studies to report more thoroughly on
methodologic aspects of trials, and to use appropri-
ate sample sizes with sufficient power to detect any
treatment effects. ▼
Karolina Lisy is a research fellow at the Joanna Briggs Institute
in the School of Translational Health Science, University of Ad-
elaide, South Australia, and a member of the Cochrane Nursing
Care Field.
SOURCE DOCUMENT
Chaves GSS, et al. Chest physiotherapy for pneumonia in
children. Cochrane Database Syst Rev 2013;9:CD010277.