Peri-operative chest physiotherapy for paediatric cardiac patients: a systematic review and meta-analysis

Chest physiotherapy (CPT) is implemented before and after congenital heart disease (CHD) surgery in paediatrics to prevent and treat postoperative pulmonary complications (PPC). Currently, there are no systematic reviews or meta-analyses on the efficacy of CPT in this population.

To conduct a systematic review and meta-analysis to determine whether peri-operative CPT is safe and effective for paediatric patients with CHD.

A literature search was conducted on PEDro, MEDLINE, CINAHL, Informit, The Cochrane Library and Scopus in March and April 2016.

English peer-reviewed articles that utilised CPT before or after cardiac surgery for paediatric CHD. Systematic reviews were excluded.

Completed by two independent researchers using the Crowe Critical Appraisal Tool. Data were collated using a piloted data extraction tool. Mix Version 2.0.1.4 was used for meta-analysis, and data were extracted using an odds ratio (with a random effects model).

Eleven studies met the inclusion criteria for the systematic review. Variable results were found regarding the effect of CPT on peripheral oxygen saturation and pain. Meta-analysis showed that CPT did not prevent pneumonia (odds ratio (OR) 2.01; 95% confidence interval (CI) 0.80 to 5.05; P = 0.13), and did not prevent or treat atelectasis (OR 1.27; 95% CI 0.18 to 8.87; P = 0.81).

There was a lack of high-quality studies. The included studies were comprised of heterogeneous treatment, limiting external validity.

Active therapies such as mobilisation, deep breathing and incentive spirometry were more effective than passive treatment. Percussion led to oxygen desaturation, and percussion, vibration and suctioning increased the risk of developing atelectasis.

Systematic review registration number CRD42015024768.