Prophylactic Flexible Bronchoscopy Immediately following Open Airway Reconstruction in Children

Objectives: Prophylactic flexible bronchoscopy immediately following open airway reconstruction allows for directed clearance of the distal airways, potentially reducing the rate of certain postoperative respiratory complications. In this investigation, we sought to determine if prophylactic flexible bronchoscopy at the conclusion of pediatric open airway reconstruction has any benefit over blind flexible suctioning of the trachea. Methods: A retrospective, single-center study at an urban tertiary care hospital was completed. From January 2010 to April 2013, patients underwent open airway reconstruction, immediately followed by blind flexible suctioning of the trachea for distal airway clearance. From May 2013 through December 2016, sequential patients underwent prophylactic flexible bronchoscopy immediately following airway reconstruction. Results: A total of 29 patients (age: 3.6 months-6.2 years) met inclusion criteria. Sixteen sequential patients underwent simple blind flexible suctioning and 13 sequential patients underwent directed, prophylactic flexible bronchoscopy. Demographics and comorbidities between the groups were equivalent other than slightly older age in the prophylactic bronchoscopy group. All clinical outcomes analyzed were equivalent other than faster time to room air ( P < .002) and a decrease in the number of chest physical therapy sessions ( P < .02) in a subset of patients who did not undergo prophylactic bronchoscopy. Conclusion: This investigation suggests that the use of prophylactic flexible bronchoscopy immediately following open airway reconstruction may not be superior to blind flexible suctioning of the trachea in limiting postoperative pulmonary complications. Further studies of greater power are needed to better elucidate any small differences that may exist between these two interventions.

Is Prolonged Slow Expiration a Reproducible Airway Clearance Technique?

Background Prolonged slow expiration (PSE) is a manual chest physical therapy technique routinely performed in clinical practice. However, the reliability and agreement of the technique have not been tested. Objective The objective of this study was to assess reliability and agreement between physical therapists during the application of PSE in infants with wheezing. Design This was a cross-sectional study. Methods Infants with a mean age of 59 weeks (SD = 26 weeks) were included in this study. Two physical therapists (physical therapist 1 and physical therapist 2) randomly performed 3 PSE sequences (A, B, and C). The expiratory reserve volume (ERV) was measured with a pneumotachograph connected to a face mask. ERV was used to evaluate the reproducibility of the technique between sequences and between physical therapist 1 and physical therapist 2. Results The mean ERV of the infants was 63 mL (SD = 21 mL). There was no statistically significant difference between the ERV values in the 3 sequences for physical therapist 1 (A: mean = 46.6 mL [SD = 17.8 mL]; B: mean = 45.7 mL [SD = 19.9 mL]; C: mean = 53.3 mL [SD = 26.3 mL]) and physical therapist 2 (A: mean = 43.5 mL [SD = 15.4 mL]; B: mean = 43.2 mL [SD = 18.3 mL]; C: mean = 44.8 mL [SD = 25.0 mL]). There was excellent reliability between the sequences for physical therapist 1 (ICC = 0.88 [95% CI = 0.63–0.95]) and physical therapist 2 (ICC = 0.82 [95% CI = 0.48–0.93]). Moderate agreement was observed between physical therapist 1 and physical therapist 2 (ICC = 0.67 [95% CI = 0.01–0.88]). According to Bland-Altman analysis, the mean difference between physical therapist 1 and physical therapist 2 was 4.1 mL (95% CI = −38.5 to 46.5 mL). Limitations The data were collected in infants with wheezing who were not in crisis. This decreased lung mucus; however, it also reduced evaluation risks. Conclusions PSE was a reproducible chest physical therapy technique between physical therapists.

Upper Limb Aerobic Training versus Chest Physical Therapy in Asthmatic Children Rehabilitation

With asthma, children have a significant impairment in ventilatory functions which lead to impairment in functional capacity and developing lung infections. The purpose of this study was to evaluate the effect of treadmill training versus arm ergometry on ventilatory functions in children with asthma. Children for 16 weeks of training - 40 asthmatic children of both sexes participated in this study. They were classified randomly into 2 groups of equal number. (Group A) 20 children received chest physical therapy, (Group B) 20 children received arm ergometry training. Discovery diagnostic spirometer was used to measure the ventilatory functions. Forced Vital Capacity (FVC), Forced Expiratory Volume (FEV1), Maximum voluntary ventilation (MVV) and Peak Expiratory Flow Rate (PEFR). The pre-treatment results showed that there were no significant differences in all measured parameters among both groups, The post-treatment results revealed that there was a significant improvement in both groups of the patient’s ventilatory function “FVC, FEV1 and PEFR”