Effect of chest physiotherapy on lung function in preterm infants.

Judith Hough (2008). Effect of chest physiotherapy on lung function in preterm infants. PhD Thesis, School of Health & Rehabilitation Sciences, The University of Queensland.

       
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Author Judith Hough
Thesis Title Effect of chest physiotherapy on lung function in preterm infants.
School, Centre or Institute School of Health & Rehabilitation Sciences
Institution The University of Queensland
Publication date 2008-12
Thesis type PhD Thesis
Supervisor Dr Leanne Johnston
Dr Sandy Brauer
Dr Paul Woodgate
Total pages 313
Total colour pages 38
Total black and white pages 275
Collection year 2009
Language eng
Subjects 320000 Medical and Health Sciences
Abstract/Summary Preterm infants are at an increased risk of lung damage due to the adverse effects of the ventilatory assistance which is required to support their respiration. Chest physiotherapy (CPT) has been proposed as one intervention which can be used to help improve ventilation by assisting in the removal of excess tracheobronchial secretions. The package of CPT used in the preterm infant consists of a variety of techniques which include postural drainage and positioning, active techniques such as percussion and vibrations, and suction. The use of these techniques, in varying combinations, has become traditional treatment for a variety of acute and chronic pulmonary conditions. There has been some attempt in the past to ascertain which techniques produced the most clinically relevant results however study results are equivocal due to the variations in techniques investigated and outcomes measured. In the absence of clear clinical guidelines, techniques used tend to depend on the experience and clinical judgement of individual clinicians. The aim of this thesis was thus to investigate how different components of CPT affect lung function in preterm infants. Two different components of CPT were studied - positioning and active techniques. In total, sixty preterm infants aged less than 32 weeks gestational age participated in five studies which investigated differences in lung function as a result of CPT intervention. The first three studies investigated the differential effects of the body positions of supine, ¼ prone, and prone on lung function in infants who were either mechanically ventilated, were on bubble CPAP, or who were spontaneously ventilating. Measurements of lung function were undertaken using a new non-invasive technique, electrical impedance tomography (EIT), which has opened up new possibilities in the visualisation and quantification of regional lung ventilation in preterm infants. Study results revealed that the previously described reverse pattern of ventilation distribution could not be confirmed in preterm infants on positive pressure ventilatory support, and that distribution of ventilation is affected by head position and body position, and mode of ventilatory support. In infants on positive pressure ventilation the pattern of ventilation was found to be distributed more centrally whereas in spontaneously ventilating infants the pattern of ventilation was directed more to the non-dependent lung. The fourth study consisted of a Cochrane review which was undertaken to determine the evidence available for the use of active CPT in infants receiving mechanical ventilation, and to determine the effects of the different types of active CPT. The results of the Cochrane review did not provide sufficient evidence on which to base clinical practice, and a large multi-centre RCT wasrecommended. However, it was apparent that before undertaking an RCT, there was a need to be clear on what measurable outcomes would be most clinically relevant. Consequently, the fifth study was undertaken as a pilot trial to asses the feasibility of the use of EIT in the assessment of lung function in a trial of active techniques of CPT. The pilot data from this study confirms that ventilation distribution can feasibly be used as an outcome measurement in the assessment of lung function in infants having active CPT. However, further trials are required to assess the risks and benefits of CPT in the treatment of respiratory diseases in ventilated infants. This research has provided new knowledge on the topic of the study of lung function in the preterm infant, in particular with regard to the effect of positioning of the head and body in different modes of ventilation. It has not only added to the knowledge base for neonatal physiotherapy by providing evidence for the efficacy of interventions but also by improving the understanding of the mechanisms which underlie the application of the different physiotherapy techniques. The findings of the reported studies have identified implications for clinical practice and further potential research directions to improve management of this complex clinical population.
Additional Notes Colour: 38,53,68,72,76,78-80,87,97-101,107-108,123-127,132-134,146-149,158-159,167,205,208,213,215,216,253 Landscape: 42-43,48,211,283-293

 
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Created: Fri, 26 Jun 2009, 18:37:49 EST by Mrs Judith Hough on behalf of Library - Information Access Service