Main, Eleanor; (2001) The effect of physiotherapy on respiratory function in ventilated children. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: Chest physiotherapy to clear secretions is routine in many intensive care units, although there is little evidence to substantiate its use above routine suction procedures. Until recently evaluation of such treatments has been limited by a lack of objective measures of respiratory function. This study aimed to evaluate the performance of a new respiratory function monitor in assessing the effects of therapeutic interventions such as physiotherapy. In addition the study aimed to establish whether physiotherapy offered an advantage over routine suction procedures with respect to selected indices of respiratory function. Subjects: Consent was obtained for 101 muscle relaxed, fully ventilated children recruited to the study between April 1998 and March 2000. Of these, 56 had a primary cardiac diagnosis and 45 had primary or secondary respiratory problems and all required physiotherapy treatment. Methodology and equipment: Validation and pilot studies were undertaken to assess the accuracy of the "CO2SMO Plus" Subjects were randomly allocated to receive either physiotherapy or nursing suction in the morning and the alternative intervention in the afternoon. Arterial blood gases, tidal volume, respiratory mechanics, CO2 parameters and deadspace values were recorded before and after both interventions. Group and individual responses to treatment were evaluated and compared. Results: Validation studies demonstrated that the "CO2SMO Plus" could provide accurate and reproducible data, provided that tracheal tube leak was <20%. Data from 89 children (tracheal tube leak <20%) were analysed, 81 of whom had both physiotherapy and nursing suction performed on the same day. Physiotherapy treatments were significantly longer than nursing suction, involved greater saline instillations and more suction catheters (p<0.005). Physiotherapy resulted in increased alveolar and physiological deadspace (p<0.01) and reductions in Rrs, HCO3-, base excess, O2 saturation and PeCO2 (p<0.05). Following nursing suction, VTE and Crs were reduced (p<0.05). There was considerable individual variation in response to both physiotherapy and suction. Conclusions: The "CO2SMO Plus" was accurate and useful for investigating the effect of clinical interventions in muscle relaxed patients, provided that tracheal tube leak was <20%. The demonstrable differences between the physiological effects of physiotherapy and nursing suction could be attributable to the longer, more vigorous physiotherapy treatments which included chest wall vibrations.

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