Key messages

• It is unclear whether chest physiotherapy increase or decrease the length of hospitalization, severity, or the time to clinical improvement in children with pneumonia because the certainty of the evidence is very low.
• There is a high probability of future evidence changing what we know about this question.

What is the evidence.
See evidence matrix  in Epistemonikos later

We found only one systematic review [1] including two pertinent randomized controlled trials [2],[3].

What types of patients were included

The studies included hospitalized patients with pneumonia that were clinically stable for receiving chest physiotherapy.

What types of interventions were included

Different types of chest physiotherapy were used. The first study applied standardized chest physiotherapy including positioning, thoracic vibration, thoracic compression, positive expiratory pressure, breathing exercises and forced exhalation with the glottis open or ’huffing’ [2].

The other study made postural drainage, thoracic squeezing, chest percussion, vibration, cough stimulation and secretions suctioning (if necessary)[3].

What types of outcomes
were measured

Time to clinical resolution, hospital length of stay, arterial oxygen saturation, X-ray, lung auscultation, and cough duration.

To whom this evidence does and does not apply

• This evidence can be applied in children between 29 days and 12 years old with clinical diagnosis of pneumonia of variable etiology (bacterial or viral) and who are hospitalized and in stable clinical condition to receive chest physiotherapy.
• This evidence cannot be aplied to newborns or intensive care unit patients. 

• Outcomes included in this summary are those which had more information and those used in clinical guidelines. 

• We could not perform a proper risk/benefit assessment because there is uncertainty about the latter.

• Health proffesionals have a subjective perception of a positive effect of chest physiotherapy, especially in patients with bronchial hypersecretion and increased work of breathing.
• Chest physiotherapy use in non-responders does not seem to be supported by the evidence and is associated with costs. However, in settings where there are no resource constraints, some patients and doctors may be motivated to use an unproven therapy whose perception is generally positive. In these cases, it is particularly important to inform the patient about the certainty of the evidence.

• Chest physiotherapy is associated with high cost, since a trained professional is required. It is not possible to estimate the cost/benefit because there is uncertainty about the latter. 

• Chest physiotherapy is feasible in most hospitals due to proffessional presence in pediatric units. However, the insufficient relationship between number of patients and professional supply in each center must be considered.  

Differences between this summary and other sources

• Conclusions obtained in this summary are consistent with the systematic review identified and the recommendations of the main clinical guidelines [4],[5], where the application of chest physiotherapy as coadjuntive treatment in patients with pneumonia is not recommended. However, some guidelines [6],[7], mention that it could improve physiological parameters such as respiratory rate and oxygenation in patients with bronchial hypersecretion.
• Clinical and epidemiological evidence about the uses of chest physiotherapy in pediatric respiratory patients must be considered since there are worldwide differences in chest physiotherapy technique.

• The probability of evidence changing in the future is high, due to the very low certainty of the evidence.
• It is likely that a new systematic review, or an update of the existing one, would provide additional information, since at least one ongoing randomized controlled study was identified [8].