Assessment of chest physiotherapy in children

Abstract: Chest physiotherapy (CPT) is used to improve the lung function and blood gas tensions in individuals with respiratory disease. The aim of this thesis was to assess and compare immediate effects of CPT with positive expiratory pressure (PEP) and oscillating PEP (OscPEP) on blood gas tensions in patients with cystic fibrosis (CF), to assess effects of CPT with PEP in severely disabled children, to describe and evaluate a new CPT method for children who cannot co-operate, and to compare obtained results with chest clapping. One additional aim was to study the reliability of transcutaneous blood gas monitoring in children.Methods: Transcutaneous oxygen tension (tcPO2), carbon dioxide tension (tcPCO2) and oxygen saturation (tcSO2) were recorded in 41 healthy children for 30 minutes on two occasions. Inter- and intra-individual differences in tcPO2, tcPCO2 and tcSO2 were studied. Fifteen patients with CF performed CPT with PEP and OscPEP at two separate occasions. Eighteen severely disabled children were treated with PEP and the reproducibility of the CPT was tested by repeating the treatments. A new CPT method, in which children with hypoxemia were rocked on a big ball, was described and compared with chest clapping. Continuous recordings of tcPO2, tcPCO2 and tcSO2 (study IV) were made before, during and after each treatment. In study IV, four-point ordinal scales were used to assess the children s acceptance of the two CPT methods.Results: In healthy children the coefficients of variation at the first and second recording were 9.3% and 9.5%, respectively, for tcPO2, 7.8% for both recordings for tcPCO2 and 1.1% and 0.8%, respectively, for tcSO2. The mean intra-individual difference in tcPO2 was 0.3 kPa (SD 1.0), tcPCO2 0.0 kPa (0.5) and tcSO2 0.1% (1.3). PEP and OscPEP affected blood gas tensions during treatment in patients with CF, OscPEP more than PEP. Immediate after PEP, a reduced tcPCO2 and immediate after OscPEP, an increased tcPO2 and reduced tcPCO2 were seen. When comparing the treatments a lower tcPCO2 was seen during and immediately after OscPEP. After PEP treatment in severely disabled children, tcPO2 increased but no difference was seen in tcPCO2. The reproducibility of the PEP treatment was good. No difference was seen in tcPO2 or tcSO2, and no clinical significance was seen in tcPCO2 in children with hypoxemia after ball treatment or after chest clapping. The children accepted both treatments well.Conclusions: Transcutaneous blood gas monitoring and pulse oximetry can be used to monitor changes in blood gas tensions and SO2 over time, and thus to evaluate immediate effects of CPT methods. PEP and OscPEP influence blood gas tensions in patients with CF. TcPO2 increased after PEP treatment in children with severe disabilities. No difference in tcPO2 or tcSO2 was seen in children with hypoxemia from before to after ball treatment or chest clapping. The children accepted both treatments well. Further studies are needed trying to detect the positive effects of ball treatment that parents, physiotherapists and hospital staff experience.