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J Pediatr Intensive Care 2015; 04(04): 174-181
DOI: 10.1055/s-0035-1563385
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Chest Physiotherapy in the Pediatric Intensive Care Unit

Brenda M. Morrow
1   Department of Pediatrics and Child Health, University of Cape Town, Rondebosch, Cape Town, South Africa
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Further Information

Publication History

03 October 2014

31 October 2014

Publication Date:
12 August 2015 (online)

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Abstract

Despite widespread practice, there is very little, high-level evidence supporting the indications for and effectiveness of cardiopulmonary/chest physiotherapy (CPT) in critically ill infants and children. Conversely, most studies highlight the detrimental effects or lack of effect of different manual modalities. Conventional CPT should not be a routine intervention in the pediatric intensive care unit, but can be considered when obstructive secretions are present which impact on lung mechanics and/or gaseous exchange and/or where there is the potential for long-term complications. Techniques such as positioning, early mobilization, and rehabilitation have been shown to be beneficial in adult intensive care patients; however, little attention has been paid to this important area of practice in pediatric intensive care units. This article presents a narrative review of chest physiotherapy in pediatric critical illness, including effects, indications, precautions, and specific treatment modalities and techniques.

Keywords

chest physiotherapy - intensive care - rehabilitation - pediatric - physiotherapy
 

  • References

  • 1 Krause MF, Hoehn T. Chest physiotherapy in mechanically ventilated children: a review. Crit Care Med 2000; 28 (5) 1648-1651
    CrossrefPubMedGoogle Scholar
  • 2 Stiller K. Physiotherapy in intensive care: towards an evidence-based practice. Chest 2000; 118 (6) 1801-1813
    CrossrefPubMedGoogle Scholar
  • 3 Bailey C, Kattwinkel J, Teja K, Buckley T. Shallow versus deep endotracheal suctioning in young rabbits: pathologic effects on the tracheobronchial wall. Pediatrics 1988; 82 (5) 746-751
    PubMedGoogle Scholar
  • 4 Fisher BJ, Carlo WA, Doershuk CF. Fetus, newborn, child, adolescent. In: Scarpelli EM, ed. Pulmonary Physiology. 2nd ed. Philadelphia, PA: Lea & Febiger; 1990: 422-428
    Google Scholar
  • 5 Young J. To help or hinder. Endotracheal suction and the intubated neonate. J Neonatal Nurs 1995; 1: 23-28
    PubMedGoogle Scholar
  • 6 Guglielminotti J, Alzieu M, Maury E, Guidet B, Offenstadt G. Bedside detection of retained tracheobronchial secretions in patients receiving mechanical ventilation: is it time for tracheal suctioning?. Chest 2000; 118 (4) 1095-1099
    CrossrefPubMedGoogle Scholar
  • 7 Main E, Castle R, Newham D, Stocks J. Respiratory physiotherapy vs. suction: the effects on respiratory function in ventilated infants and children. Intensive Care Med 2004; 30 (6) 1144-1151
    CrossrefPubMedGoogle Scholar
  • 8 Ntoumenopoulos G. Questioning chest physiotherapy. Chest 1997; 112 (1) 292-293
    PubMedGoogle Scholar
  • 9 Oberwaldner B. Physiotherapy for airway clearance in paediatrics. Eur Respir J 2000; 15 (1) 196-204
    CrossrefPubMedGoogle Scholar
  • 10 Wallis C, Prasad A. Who needs chest physiotherapy? Moving from anecdote to evidence. Arch Dis Child 1999; 80 (4) 393-397
    CrossrefPubMedGoogle Scholar
  • 11 Ciesla ND. Chest physical therapy for patients in the intensive care unit. Phys Ther 1996; 76 (6) 609-625
    PubMedGoogle Scholar
  • 12 Weissman C, Kemper M, Damask MC, Askanazi J, Hyman AI, Kinney JM. Effect of routine intensive care interactions on metabolic rate. Chest 1984; 86 (6) 815-818
    CrossrefPubMedGoogle Scholar
  • 13 Chalumeau M, Foix-L'Helias L, Scheinmann P, Zuani P, Gendrel D, Ducou-le-Pointe H. Rib fractures after chest physiotherapy for bronchiolitis or pneumonia in infants. Pediatr Radiol 2002; 32 (9) 644-647
    CrossrefPubMedGoogle Scholar
  • 14 Chanelière C, Moreux N, Pracros JP, Bellon G, Reix P. Rib fractures after chest physiotherapy: a report of 2 cases [in French]. Arch Pediatr 2006; 13 (11) 1410-1412
    CrossrefPubMedGoogle Scholar
  • 15 Harding JE, Miles FK, Becroft DM, Allen BC, Knight DB. Chest physiotherapy may be associated with brain damage in extremely premature infants. J Pediatr 1998; 132 (3, Pt 1) 440-444
    CrossrefPubMedGoogle Scholar
  • 16 Button BM, Heine RG, Catto-Smith AG, Phelan PD, Olinsky A. Postural drainage and gastro-oesophageal reflux in infants with cystic fibrosis. Arch Dis Child 1997; 76 (2) 148-150
    CrossrefPubMedGoogle Scholar
  • 17 Button BM, Heine RG, Catto-Smith AG, Phelan PD, Olinsky A. Chest physiotherapy, gastro-oesophageal reflux, and arousal in infants with cystic fibrosis. Arch Dis Child 2004; 89 (5) 435-439
    CrossrefPubMedGoogle Scholar
  • 18 Reines HD, Sade RM, Bradford BF, Marshall J. Chest physiotherapy fails to prevent postoperative atelectasis in children after cardiac surgery. Ann Surg 1982; 195 (4) 451-455
    CrossrefPubMedGoogle Scholar
  • 19 Zidulka A, Chrome JF, Wight DW, Burnett S, Bonnier L, Fraser R. Clapping or percussion causes atelectasis in dogs and influences gas exchange. J Appl Physiol (1985) 1989; 66 (6) 2833-2838
    PubMedGoogle Scholar
  • 20 Roqué i Figuls M, Giné-Garriga M, Granados Rugeles C, Perrotta C. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database Syst Rev 2012; 2: CD004873
    PubMedGoogle Scholar
  • 21 Fox WW, Schwartz JG, Shaffer TH. Pulmonary physiotherapy in neonates: physiologic changes and respiratory management. J Pediatr 1978; 92 (6) 977-981
    CrossrefPubMedGoogle Scholar
  • 22 Gray PH, Flenady VJ, Blackwell L. Potential risks of chest physiotherapy in preterm infants. J Pediatr 1999; 135 (1) 131 , author reply 132
    PubMedGoogle Scholar
  • 23 Vandenplas Y, Diericx A, Blecker U, Lanciers S, Deneyer M. Esophageal pH monitoring data during chest physiotherapy. J Pediatr Gastroenterol Nutr 1991; 13 (1) 23-26
    CrossrefPubMedGoogle Scholar
  • 24 Argent AC, Morrow BM. What does chest physiotherapy do to sick infants and children?. Intensive Care Med 2004; 30 (6) 1014-1016
    CrossrefPubMedGoogle Scholar
  • 25 Asher MI, Douglas C, Airy M, Andrews D, Trenholme A. Effects of chest physical therapy on lung function in children recovering from acute severe asthma. Pediatr Pulmonol 1990; 9 (3) 146-151
    CrossrefPubMedGoogle Scholar
  • 26 Raval D, Yeh TF, Mora A, Cuevas D, Pyati S, Pildes RS. Chest physiotherapy in preterm infants with RDS in the first 24 hours of life. J Perinatol 1987; 7 (4) 301-304
    PubMedGoogle Scholar
  • 27 Schechter MS. Airway clearance applications in infants and children. Respir Care 2007; 52 (10) 1382-1390 , discussion 1390–1391
    PubMedGoogle Scholar
  • 28 Morrow BM, Argent AC, Jeena PM, Green RJ. Guideline for the diagnosis, prevention and treatment of paediatric ventilator-associated pneumonia. S Afr Med J 2009; 99 (4, Pt 2) 255-267
    PubMedGoogle Scholar
  • 29 Clini E, Ambrosino N. Early physiotherapy in the respiratory intensive care unit. Respir Med 2005; 99 (9) 1096-1104
    CrossrefPubMedGoogle Scholar
  • 30 Main E, Stocks J. The influence of physiotherapy and suction on respiratory deadspace in ventilated children. Intensive Care Med 2004; 30 (6) 1152-1159
    CrossrefPubMedGoogle Scholar
  • 31 Walsh BK, Hood K, Merritt G. Pediatric airway maintenance and clearance in the acute care setting: how to stay out of trouble. Respir Care 2011; 56 (9) 1424-1440 , discussion 1440–1444
    CrossrefPubMedGoogle Scholar
  • 32 Peroni DG, Boner AL. Atelectasis: mechanisms, diagnosis and management. Paediatr Respir Rev 2000; 1 (3) 274-278
    PubMedGoogle Scholar
  • 33 Bilan N, Galehgolab BA, Shoaran M. Medical treatment of lung collapse in children. Pak J Biol Sci 2009; 12 (5) 467-469
    CrossrefPubMedGoogle Scholar
  • 34 Galvis AG, Reyes G, Nelson WB. Bedside management of lung collapse in children on mechanical ventilation: saline lavage—simulated cough technique proves simple, effective. Pediatr Pulmonol 1994; 17 (5) 326-330
    Google Scholar
  • 35 Branson RD. Secretion management in the mechanically ventilated patient. Respir Care 2007; 52 (10) 1328-1342 , discussion 1342–1347
    PubMedGoogle Scholar
  • 36 Hondras MA, Linde K, Jones AP. Manual therapy for asthma. Cochrane Database Syst Rev 2005; (2) CD001002
    PubMedGoogle Scholar
  • 37 Paludo C, Zhang L, Lincho CS, Lemos DV, Real GG, Bergamin JA. Chest physical therapy for children hospitalised with acute pneumonia: a randomised controlled trial. Thorax 2008; 63 (9) 791-794
    CrossrefPubMedGoogle Scholar
  • 38 Lukrafka JL, Fuchs SC, Fischer GB, Flores JA, Fachel JM, Castro-Rodriguez JA. Chest physiotherapy in paediatric patients hospitalised with community-acquired pneumonia: a randomised clinical trial. Arch Dis Child 2012; 97 (11) 967-971
    CrossrefPubMedGoogle Scholar
  • 39 De Boeck K, Vermeulen F, Vreys M, Moens M, Proesmans M. Airway clearance techniques to treat acute respiratory disorders in previously healthy children: where is the evidence?. Eur J Pediatr 2008; 167 (6) 607-612
    CrossrefPubMedGoogle Scholar
  • 40 Crane LD, Zombek M, Krauss AN, Auld PAM. 1173 Comparison of chest physiotherapy techniques in infants with HMD. Pediatr Res 1978; 12: 559
    PubMedGoogle Scholar
  • 41 Button BM, Heine RG, Catto-Smith AG , et al. Chest physiotherapy in infants with cystic fibrosis: to tip or not? A five-year study. Pediatr Pulmonol 2003; 35 (3) 208-213
    CrossrefPubMedGoogle Scholar
  • 42 Emery JR, Peabody JL. Head position affects intracranial pressure in newborn infants. J Pediatr 1983; 103 (6) 950-953
    CrossrefPubMedGoogle Scholar
  • 43 Vivian-Beresford A, King C, MaCauley H. Neonatal post-extubation complications: the preventative role of physiotherapy. Physiother Can 1987; 39: 184-190
    PubMedGoogle Scholar
  • 44 Stark AR, Waggener TB, Frantz III ID, Cohlan BA, Feldman HA, Kosch PC. Effect on ventilation of change to the upright posture in newborn infants. J Appl Physiol 1984; 56 (1) 64-71
    PubMedGoogle Scholar
  • 45 Dellagrammaticas HD, Kapetanakis J, Papadimitriou M, Kourakis G. Effect of body tilting on physiological functions in stable very low birthweight neonates. Arch Dis Child 1991; 66 (4 Spec No) 429-432
    CrossrefPubMedGoogle Scholar
  • 46 Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogué S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 1999; 354 (9193) 1851-1858
    CrossrefPubMedGoogle Scholar
  • 47 Nunn JF. Nunn's Applied Respiratory Physiology. 4th ed. Oxford: Butterworth-Heinemann Ltd; 1993
    Google Scholar
  • 48 Curley MA, Hibberd PL, Fineman LD , et al. Effect of prone positioning on clinical outcomes in children with acute lung injury: a randomized controlled trial. JAMA 2005; 294 (2) 229-237
    CrossrefPubMedGoogle Scholar
  • 49 Casado-Flores J, Martínez de Azagra A, Ruiz-López MJ, Ruiz M, Serrano A. Pediatric ARDS: effect of supine-prone postural changes on oxygenation. Intensive Care Med 2002; 28 (12) 1792-1796
    CrossrefPubMedGoogle Scholar
  • 50 Dupont H, Mentec H, Cheval C, Moine P, Fierobe L, Timsit JF. Short-term effect of inhaled nitric oxide and prone positioning on gas exchange in patients with severe acute respiratory distress syndrome. Crit Care Med 2000; 28 (2) 304-308
    CrossrefPubMedGoogle Scholar
  • 51 Jolliet P, Bulpa P, Chevrolet JC. Effects of the prone position on gas exchange and hemodynamics in severe acute respiratory distress syndrome. Crit Care Med 1998; 26 (12) 1977-1985
    CrossrefPubMedGoogle Scholar
  • 52 Kornecki A, Frndova H, Coates AL, Shemie SD. 4A randomized trial of prolonged prone positioning in children with acute respiratory failure. Chest 2001; 119 (1) 211-218
    CrossrefPubMedGoogle Scholar
  • 53 Pelosi P, Tubiolo D, Mascheroni D , et al. Effects of the prone position on respiratory mechanics and gas exchange during acute lung injury. Am J Respir Crit Care Med 1998; 157 (2) 387-393
    CrossrefPubMedGoogle Scholar
  • 54 Pelosi P, Brazzi L, Gattinoni L. Prone position in acute respiratory distress syndrome. Eur Respir J 2002; 20 (4) 1017-1028
    CrossrefPubMedGoogle Scholar
  • 55 Matthews BD, Noviski N. Management of oxygenation in pediatric acute hypoxemic respiratory failure. Pediatr Pulmonol 2001; 32 (6) 459-470
    CrossrefPubMedGoogle Scholar
  • 56 Marraro GA. Innovative practices of ventilatory support with pediatric patients. Pediatr Crit Care Med 2003; 4 (1) 8-20
    CrossrefPubMedGoogle Scholar
  • 57 Riedel T, Richards T, Schibler A. The value of electrical impedance tomography in assessing the effect of body position and positive airway pressures on regional lung ventilation in spontaneously breathing subjects. Intensive Care Med 2005; 31 (11) 1522-1528
    CrossrefPubMedGoogle Scholar
  • 58 Bhuyan U, Peters AM, Gordon I, Davies H, Helms P. Effects of posture on the distribution of pulmonary ventilation and perfusion in children and adults. Thorax 1989; 44 (6) 480-484
    CrossrefPubMedGoogle Scholar
  • 59 Benumof JL, Alfery DD. Anesthesia for Thoracic Surgery. In: Miller RD, , ed. Anesthesia. 5th ed. Philadelphia, PA: Churchill Livingstone; 2000
    Google Scholar
  • 60 Davies H, Helms P, Gordon I. Effect of posture on regional ventilation in children. Pediatr Pulmonol 1992; 12 (4) 227-232
    CrossrefPubMedGoogle Scholar
  • 61 Heaf DP, Helms P, Gordon I, Turner HM. Postural effects on gas exchange in infants. N Engl J Med 1983; 308 (25) 1505-1508
    CrossrefPubMedGoogle Scholar
  • 62 Senol G, Kirakli C, Halilçolar H. In vitro antibacterial activities of oral care products against ventilator-associated pneumonia pathogens. Am J Infect Control 2007; 35 (8) 531-535
    CrossrefPubMedGoogle Scholar
  • 63 Li Z, Kosorok MR, Farrell PM , et al. Longitudinal development of mucoid Pseudomonas aeruginosa infection and lung disease progression in children with cystic fibrosis. JAMA 2005; 293 (5) 581-588
    CrossrefPubMedGoogle Scholar
  • 64 Ren CL, Brucker JL, Rovitelli AK, Bordeaux KA. Changes in lung function measured by spirometry and the forced oscillation technique in cystic fibrosis patients undergoing treatment for respiratory tract exacerbation. Pediatr Pulmonol 2006; 41 (4) 345-349
    CrossrefPubMedGoogle Scholar
  • 65 Pham TM, Yuill M, Dakin C, Schibler A. Regional ventilation distribution in the first 6 months of life. Eur Respir J 2011; 37 (4) 919-924
    CrossrefPubMedGoogle Scholar
  • 66 Hough JL, Johnston L, Brauer S, Woodgate P, Schibler A. Effect of body position on ventilation distribution in ventilated preterm infants. Pediatr Crit Care Med 2013; 14 (2) 171-177
    CrossrefPubMedGoogle Scholar
  • 67 Lupton-Smith AR, Argent AC, Rimensberger PC, Morrow BM. Challenging a paradigm: positional changes in ventilation distribution are highly variable in healthy infants and children. Pediatr Pulmonol 2014; 49 (8) 764-771
    CrossrefPubMedGoogle Scholar
  • 68 Desai SV, Law TJ, Needham DM. Long-term complications of critical care. Crit Care Med 2011; 39 (2) 371-379
    CrossrefPubMedGoogle Scholar
  • 69 Zafiropoulos B, Alison JA, McCarren B. Physiological responses to the early mobilisation of the intubated, ventilated abdominal surgery patient. Aust J Physiother 2004; 50 (2) 95-100
    CrossrefPubMedGoogle Scholar
  • 70 Bailey P, Thomsen GE, Spuhler VJ , et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med 2007; 35 (1) 139-145
    CrossrefPubMedGoogle Scholar
  • 71 Li Z, Peng X, Zhu B, Zhang Y, Xi X. Active mobilization for mechanically ventilated patients: a systematic review. Arch Phys Med Rehabil 2013; 94 (3) 551-561
    CrossrefPubMedGoogle Scholar
  • 72 Kayambu G, Boots R, Paratz J. Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis. Crit Care Med 2013; 41 (6) 1543-1554
    CrossrefPubMedGoogle Scholar
  • 73 Choong K, Foster G, Fraser DD , et al; Canadian Critical Care Trials Group. Acute rehabilitation practices in critically ill children: a multicenter study. Pediatr Crit Care Med 2014; 15 (6) e270-e279
    CrossrefPubMedGoogle Scholar
  • 74 McCarren B, Alison JA, Herbert RD. Vibration and its effect on the respiratory system. Aust J Physiother 2006; 52 (1) 39-43
    CrossrefPubMedGoogle Scholar
  • 75 McCarren B, Alison JA, Herbert RD. Manual vibration increases expiratory flow rate via increased intrapleural pressure in healthy adults: an experimental study. Aust J Physiother 2006; 52 (4) 267-271
    CrossrefPubMedGoogle Scholar
  • 76 Gregson RK, Shannon H, Stocks J, Cole TJ, Peters MJ, Main E. The unique contribution of manual chest compression-vibrations to airflow during physiotherapy in sedated, fully ventilated children. Pediatr Crit Care Med 2012; 13 (2) e97-e102
    Google Scholar
  • 77 Kirilloff LH, Owens GR, Rogers RM, Mazzocco MC. Does chest physical therapy work?. Chest 1985; 88 (3) 436-444
    CrossrefPubMedGoogle Scholar
  • 78 van der Schans CP, Postma DS, Koëter GH, Rubin BK. Physiotherapy and bronchial mucus transport. Eur Respir J 1999; 13 (6) 1477-1486
    CrossrefPubMedGoogle Scholar
  • 79 Patman S, Jenkins S, Stiller K. Manual hyperinflation—effects on respiratory parameters. Physiother Res Int 2000; 5 (3) 157-171
    CrossrefPubMedGoogle Scholar
  • 80 McCarren B, Chow CM. Manual hyperinflation: a description of the technique. Aust J Physiother 1996; 42 (3) 203-208
    CrossrefPubMedGoogle Scholar
  • 81 McCord J, Krull N, Kraiker J , et al. Cardiopulmonary physical therapy practice in the paediatric intensive care unit. Physiother Can 2013; 65 (4) 374-377
    CrossrefPubMedGoogle Scholar
  • 82 de Godoy VC, Zanetti NM, Johnston C. Manual hyperinflation in airway clearance in pediatric patients: a systematic review. Rev Bras Ter Intensiva 2013; 25 (3) 258-262
    PubMedGoogle Scholar
  • 83 O'Donnell CP, Davis PG, Morley CJ. Resuscitation of premature infants: what are we doing wrong and can we do better?. Biol Neonate 2003; 84 (1) 76-82
    CrossrefPubMedGoogle Scholar
  • 84 Choi JS, Jones AY. Effects of manual hyperinflation and suctioning in respiratory mechanics in mechanically ventilated patients with ventilator-associated pneumonia. Aust J Physiother 2005; 51 (1) 25-30
    CrossrefPubMedGoogle Scholar
  • 85 Stiller K, Geake T, Taylor J, Grant R, Hall B. Acute lobar atelectasis. A comparison of two chest physiotherapy regimens. Chest 1990; 98 (6) 1336-1340
    CrossrefPubMedGoogle Scholar
  • 86 Barker M, Adams S. An evaluation of a single chest physiotherapy treatment on mechanically ventilated patients with acute lung injury. Physiother Res Int 2002; 7 (3) 157-169
    CrossrefPubMedGoogle Scholar
  • 87 Gregson RK, Stocks J, Petley GW , et al. Simultaneous measurement of force and respiratory profiles during chest physiotherapy in ventilated children. Physiol Meas 2007; 28 (9) 1017-1028
    CrossrefPubMedGoogle Scholar
  • 88 Brochard L, Roudot-Thoraval F, Roupie E , et al. Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. The Multicenter Trail Group on Tidal Volume reduction in ARDS. Am J Respir Crit Care Med 1998; 158 (6) 1831-1838
    CrossrefPubMedGoogle Scholar
  • 89 Dreyfuss D, Saumon G. Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med 1998; 157 (1) 294-323
    CrossrefPubMedGoogle Scholar
  • 90 Carpenter T. Novel approaches in conventional mechanical ventilation for paediatric acute lung injury. Paediatr Respir Rev 2004; 5 (3) 231-237
    CrossrefPubMedGoogle Scholar
  • 91 Bradley JM, Moran FM, Elborn JS. Evidence for physical therapies (airway clearance and physical training) in cystic fibrosis: an overview of five Cochrane systematic reviews. Respir Med 2006; 100 (2) 191-201
    CrossrefPubMedGoogle Scholar
  • 92 de Boeck C, Zinman R. Cough versus chest physiotherapy. A comparison of the acute effects on pulmonary function in patients with cystic fibrosis. Am Rev Respir Dis 1984; 129 (1) 182-184
    PubMedGoogle Scholar
  • 93 Boothroyd AE, Murthy BV, Darbyshire A, Petros AJ. Endotracheal suctioning causes right upper lobe collapse in intubated children. Acta Paediatr 1996; 85 (12) 1422-1425
    CrossrefPubMedGoogle Scholar
  • 94 American Association for Respiratory Care. AARC clinical practice guideline. Endotracheal suctioning of mechanically ventilated adults and children with artificial airways. Respir Care 1993; 38 (5) 500-504
    PubMedGoogle Scholar
  • 95 Runton N. Suctioning artificial airways in children: appropriate technique. Pediatr Nurs 1992; 18 (2) 115-118
    PubMedGoogle Scholar
  • 96 Morrow BM, Argent AC. A comprehensive review of pediatric endotracheal suctioning: Effects, indications, and clinical practice. Pediatr Crit Care Med 2008; 9 (5) 465-477
    Google Scholar
  • 97 Hodge D. Endotracheal suctioning and the infant: a nursing care protocol to decrease complications. Neonatal Netw 1991; 9 (5) 7-15
    PubMedGoogle Scholar
  • 98 Young CS. Recommended guide lines for suction. Physiotherapy 1984; 70 (3) 106-108
    PubMedGoogle Scholar
  • 99 Tolles CL, Stone KS. National survey of neonatal endotracheal suctioning practices. Neonatal Netw 1990; 9 (2) 7-14
    PubMedGoogle Scholar
  • 100 Copnell B, Fergusson D. Endotracheal suctioning: time-worn ritual or timely intervention?. Am J Crit Care 1995; 4 (2) 100-105
    PubMedGoogle Scholar
  • 101 Kelleher S, Andrews T. An observational study on the open-system endotracheal suctioning practices of critical care nurses. J Clin Nurs 2008; 17 (3) 360-369
    CrossrefPubMedGoogle Scholar
  • 102 Kerem E, Yatsiv I, Goitein KJ. Effect of endotracheal suctioning on arterial blood gases in children. Intensive Care Med 1990; 16 (2) 95-99
    CrossrefPubMedGoogle Scholar
  • 103 Singh NC, Kissoon N, Frewen T, Tiffin N. Physiological responses to endotracheal and oral suctioning in paediatric patients: the influence of endotracheal tube sizes and suction pressures. Clin Intensive Care 1991; 2 (6) 345-350
    PubMedGoogle Scholar
  • 104 Loubser MD, Mahoney PJ, Milligan DW. Hazards of routine endotracheal suction in the neonatal unit. Lancet 1989; 1 (8652) 1444-1445
    PubMedGoogle Scholar
  • 105 Anderson KD, Chandra R. Pneumothorax secondary to perforation of sequential bronchi by suction catheters. J Pediatr Surg 1976; 11 (5) 687-693
    CrossrefPubMedGoogle Scholar
  • 106 Kuzenski BM. Effect of negative pressure on tracheobronchial trauma. Nurs Res 1978; 27 (4) 260-263
    CrossrefPubMedGoogle Scholar
  • 107 Nagaraj HS, Shott R, Fellows R, Yacoub U. Recurrent lobar atelectasis due to acquired bronchial stenosis in neonates. J Pediatr Surg 1980; 15 (4) 411-415
    CrossrefPubMedGoogle Scholar
  • 108 Choong K, Chatrkaw P, Frndova H, Cox PN. Comparison of loss in lung volume with open versus in-line catheter endotracheal suctioning. Pediatr Crit Care Med 2003; 4 (1) 69-73
    CrossrefPubMedGoogle Scholar
  • 109 Morrow B, Futter M, Argent A. Effect of endotracheal suction on lung dynamics in mechanically-ventilated paediatric patients. Aust J Physiother 2006; 52 (2) 121-126
    CrossrefPubMedGoogle Scholar
  • 110 Ehrhart IC, Hofman WF, Loveland SR. Effects of endotracheal suction versus apnea during interruption of intermittent or continuous positive pressure ventilation. Crit Care Med 1981; 9 (6) 464-468
    CrossrefPubMedGoogle Scholar
  • 111 Hoellering AB, Copnell B, Dargaville PA, Mills JF, Morley CJ, Tingay DG. Lung volume and cardiorespiratory changes during open and closed endotracheal suction in ventilated newborn infants. Arch Dis Child Fetal Neonatal Ed 2008; 93 (6) F436-F441
    CrossrefPubMedGoogle Scholar
  • 112 Kohlhauser C, Bernert G, Hermon M, Popow C, Seidl R, Pollak A. Effects of endotracheal suctioning in high-frequency oscillatory and conventionally ventilated low birth weight neonates on cerebral hemodynamics observed by near infrared spectroscopy (NIRS). Pediatr Pulmonol 2000; 29 (4) 270-275
    Google Scholar
  • 113 Simbruner G, Coradello H, Fodor M, Havelec L, Lubec G, Pollak A. Effect of tracheal suction on oxygenation, circulation, and lung mechanics in newborn infants. Arch Dis Child 1981; 56 (5) 326-330
    CrossrefPubMedGoogle Scholar
  • 114 Zmora E, Merritt TA. Use of side-hole endotracheal tube adapter for tracheal aspiration. A controlled study. Am J Dis Child 1980; 134 (3) 250-254
    CrossrefPubMedGoogle Scholar
  • 115 Cabal L, Devaskar S, Siassi B , et al. New endotracheal tube adaptor reducing cardiopulmonary effects of suctioning. Crit Care Med 1979; 7 (12) 552-555
    CrossrefPubMedGoogle Scholar
  • 116 Fanconi S, Duc G. Intratracheal suctioning in sick preterm infants: prevention of intracranial hypertension and cerebral hypoperfusion by muscle paralysis. Pediatrics 1987; 79 (4) 538-543
    PubMedGoogle Scholar
  • 117 Tume L, Jinks A. Endotracheal suctioning in children with severe traumatic brain injury: a literature review. Nurs Crit Care 2008; 13 (5) 232-240
    CrossrefPubMedGoogle Scholar
  • 118 Kerr ME, Rudy EB, Weber BB , et al. Effect of short-duration hyperventilation during endotracheal suctioning on intracranial pressure in severe head-injured adults. Nurs Res 1997; 46 (4) 195-201
    CrossrefPubMedGoogle Scholar
  • 119 Kerr ME, Sereika SM, Orndoff P , et al. Effect of neuromuscular blockers and opiates on the cerebrovascular response to endotracheal suctioning in adults with severe head injuries. Am J Crit Care 1998; 7 (3) 205-217
    PubMedGoogle Scholar
  • 120 Evans JC, Vogelpohl DG, Bourguignon CM, Morcott CS. Pain behaviors in LBW infants accompany some “nonpainful” caregiving procedures. Neonatal Netw 1997; 16 (3) 33-40
    PubMedGoogle Scholar
  • 121 Cignacco E, Hamers JP, van Lingen RA , et al. Pain relief in ventilated preterms during endotracheal suctioning: a randomized controlled trial. Swiss Med Wkly 2008; 138 (43–44) 635-645
    PubMedGoogle Scholar
  • 122 Puntillo KA. Dimensions of procedural pain and its analgesic management in critically ill surgical patients. Am J Crit Care 1994; 3 (2) 116-122
    PubMedGoogle Scholar
  • 123 Payen JF, Bru O, Bosson JL , et al. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med 2001; 29 (12) 2258-2263
    Google Scholar
  • 124 Van de Leur JP, Zwaveling JH, Loef BG, Van der Schans CP. Patient recollection of airway suctioning in the ICU: routine versus a minimally invasive procedure. Intensive Care Med 2003; 29 (3) 433-436
    CrossrefPubMedGoogle Scholar
  • 125 Durand M, Sangha B, Cabal LA, Hoppenbrouwers T, Hodgman JE. Cardiopulmonary and intracranial pressure changes related to endotracheal suctioning in preterm infants. Crit Care Med 1989; 17 (6) 506-510
    CrossrefPubMedGoogle Scholar
  • 126 Pang WW, Chang DP, Lin CH, Huang MH. Negative pressure pulmonary oedema induced by direct suctioning of endotracheal tube adapter. Can J Anaesth 1998; 45 (8) 785-788
    CrossrefPubMedGoogle Scholar
  • 127 Demers RR. Complications of endotracheal suctioning procedures. Respir Care 1982; 27: 453-457
    PubMedGoogle Scholar
  • 128 Copnell B, Tingay DG, Kiraly NJ , et al. A comparison of the effectiveness of open and closed endotracheal suction. Intensive Care Med 2007; 33 (9) 1655-1662
    CrossrefPubMedGoogle Scholar
  • 129 Cordero L, Sananes M, Ayers LW. Comparison of a closed (Trach Care MAC) with an open endotracheal suction system in small premature infants. J Perinatol 2000; 20 (3) 151-156
    CrossrefPubMedGoogle Scholar
  • 130 Morrow BM, Mowzer R, Pitcher R, Argent AC. Investigation into the effect of closed-system suctioning on the frequency of pediatric ventilator-associated pneumonia in a developing country. Pediatr Crit Care Med 2012; 13 (1) e25-e32
    CrossrefPubMedGoogle Scholar
  • 131 Morrow BM. Closed-system suctioning: why is the debate still open?. Indian J Med Sci 2007; 61 (4) 177-178
    CrossrefPubMedGoogle Scholar