Chest physiotherapy in paediatric patients hospitalised with community-acquired pneumonia: a randomised clinical trial Janice Luisa Lukrafka, 1 Sandra C Fuchs, 2 Gilberto Bueno Fischer, 3 José A Flores, 4 Jandira M Fachel, 5 Jose A Castro-Rodriguez 6 1 Department of Physiotherapy, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brasil 2 Department of Social Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil 3 Department of Pediatrics, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil 4 Department of Radiology, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil 5 Department of Statistics, Mathematics Institute, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil 6 Departments of Pediatrics and Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile Correspondence to Janice Luisa Lukrafka, Department of Physiotherapy, Universidade Federal de Ciências da Saúde de Porto Alegre, St. Sarmento Leite 245, CEP 90050-170, Porto Alegre, Rio Grande do Sul, Brasil; jllukrafka@bol.com.br Accepted 8 August 2012 Published Online First 15 September 2012 ABSTRACT Background Chest physiotherapy has been used to treat children hospitalised with pneumonia with no clear scientific evidence to support a beneficial effect. The objective of the current study was to evaluate the efficacy of chest physiotherapy as an adjuvant treatment in children hospitalised with acute community-acquired pneumonia. Methods Children (aged 1–12 years) with a clinical and confirmed radiological diagnosis of pneumonia sequentially admitted to a tertiary children hospital were eligible for this study. Participants were randomly selected to receive a standardised respiratory physiotherapy (positioning, thoracic vibration, thoracic compression, positive expiratory pressure, breathing exercises and forced exhalation with the glottis open or ‘huffing’) three times daily in the ‘intervention group’ or a non-mandatory request to breathe deeply, expectorate the sputum and maintain a lateral body position once a day in the ‘control group’. The primary outcomes were reduction in respiratory rate and severity score (respiratory rate, recession, fever, oxygen saturation and chest x-ray) from baseline to discharge. Secondary outcome was duration of hospitalisation. Results In all, 72 patients were randomly allocated to the intervention (n=35) or control (n=37) groups. There were no differences at admission on severity of pneumonia between groups. Respiratory rate and severity score significant decreased between admission to discharge within each group; however, there were no differences when comparing groups. Also, there was no significant difference in duration of hospitalisation between the control and intervention groups (6 vs 8 days, p=0.11, respectively). Conclusions This clinical trial suggests that, in children hospitalised with moderate community-acquired pneumonia, chest physiotherapy did not have clinical benefits in comparison to control group. INTRODUCTION Though chest physiotherapy is not specifically recommended for children with pneumonia, 1 it still a common practice in many treatment centres around the world. Postural drainage, percussion, deep breathing and vibration techniques together with controlled coughing are intended to improve the clearance of airway secretions from the lung. 2 However there is little evidence to support this practice. A randomised clinical trial (RCT) of 55 children with presumed viral pneumonia was performed. Comparing chest x-ray improvement and duration of fever, there was no statistical differences between the chest physiotherapy and control groups. 3 In a single-blind RCT, 171 patients (15–75 years.) with acute pneumonia admitted to the hospital were allocated either to receive physiotherapy or advised on expectoration, deep breathing and exercise (control group). There was no evidence in favour of daily physiotherapy. However, patients younger than 47 years, smokers, or patients with interstitial pneumonia had a longer fever duration and hospital stay in the chest physiotherapy group; this high- lights the importance of performing RCTs in a younger population. 4 A recent RCT performed with 98 children hospitalised with acute pneumonia failed to confirm that chest physiotherapy as an adjunct to standard treatment hastens the clinical resolution of pneumonia. 5 The aim of this study was to assess the efficacy of the use of chest physiotherapy on children hospita- lised with primary community-acquired pneumonia. METHODS Setting and participants Children (aged 1–12 years) hospitalised with a clin- ical and radiological confirmed diagnosis of acute community-acquired pneumonia were assessed for eligibility for the study. Clinical diagnosis criteria for pneumonia were: cough, tachypnoea (respiratory rate≥40 breaths/min in children aged 12–59 months and ≥30 breaths/min in children aged 5–12 years) and fever. 6 Radiological diagnosis of pneumonia was considered if the chest x-ray had lobar, segmental or bronchopneumonia, or pleural effusion within the first 48 h. 7 Patients who were severely ill, such as What is already known on this topic ▸ Guidelines suggest that chest physiotherapy is unlikely to be effective in children with acute pneumonia. ▸ Chest physiotherapy is, however, widely used throughout the world in this scenario. What this study adds Chest physiotherapy had no beneficial effect in children hospitalised with community-acquired pneumonia. Arch Dis Child 2012;97:967–971. doi:10.1136/archdischild-2012-302279 967 Original article group.bmj.com on November 7, 2012 - Published by adc.bmj.com Downloaded from