None listed
Conditions
Brief summary
Chest physiotherapy (CPT) is regarded as an important contributor to the management, and potentially long-term outcomes, of preterm infants with lung disease. Delivering CPT in this population is not without risk, however, and the decision to undertake CPT interventions rely on effective assessment (Hough, 2008). Preterm infants present with multiple lung pathologies, (Gallacher et al, 2016) however not all of these are best treated using CPT. In preterm infants, CPT is thought to be most efficacious in treating alveolar collapse and consolidation, and not useful, or potentially harmful, in the management of interstitial lung disease (Hough, 2008). Differentiating between pathological processes using existing assessment tools such as auscultation and chest radiograph is challenging as these tools only provide subjective, non-specific and surrogate measurements of lung aeration and pathology (McAlinden et al, 2020). Physiotherapy- led lung ultrasound (LUS) has been recently proposed as a more accurate and objective way to image both regional lung aeration and lung pathology by the bedside without the potentially harmful radiation associated with other imaging techniques (Hansell et al, 2023; Hayward et al, 2021). Such imaging makes it theoretically possible to deliver individualised and targeted CPT, thereby improving effectiveness and minimising physiological burden. (Le Neindre et al, 2023) Despite its promise, physiotherapist-led LUS is considered an extended scope skill in Australia and further training and knowledge is required before it can be used safely and effectively. To date, physiotherapist-led LUS has been investigated in paediatric (Myszkowski, 2019; Shkurka & Nolann 2023) and adult cohorts (Hansell et al, 2023; Le Neindre et al, 2023) but similar research has yet to be undertaken in preterm infants. This study aims to investigate the use of LUS as a neonatal physiotherapy assessment tool to measure the effect of CPT in premature infants with lung collapse.
Interventions
Chest physiotherapy (CPT) will form the intervention that will be measured in this study. CPT will consist of a combination of techniques including positioning, cupping, expiratory flow increase techniques such as expiratory vibes and sustained expiratory manoeuvres, and endotracheal suction. Treatments will not be standardised. Instead, they will be individualised to each infant’s assessment findings and presentation to reflect clinical reality. All CPT interventions in the study will be perfor
Chest physiotherapy (CPT) will form the intervention that will be measured in this study. CPT will consist of a combination of techniques including positioning, cupping, expiratory flow increase techniques such as expiratory vibes and sustained expiratory manoeuvres, and endotracheal suction. Treatments will not be standardised. Instead, they will be individualised to each infant’s assessment findings and presentation to reflect clinical reality. All CPT interventions in the study will be performed by a paediatric physiotherapist trained to work in the NCCU. CPT will occur in the NCCU at the infant's bedside as per usual practice in our unit. The techniques, dosing and position utilised during the CPT intervention will be determined by the physiotherapist based on the presence/ type of pathology seen on chest radiograph (CXR), auscultation findings and LUS findings. This is based on current practice in the NCCU where the research project will take place. No published guidelines or practice recommendations are available in the literature due to the lack of previous research undertaken regarding CPT in the neonatal population. A single episode of CPT intervention will be measured, however infant's may be eligible to be measured on more than one occasion, ie. on multiple consecutive days, providing they meet the inclusion criteria. CPT will continue for as many days as indicated (no maximum time frame), based on the physiotherapist's clinical interpretation of assessment findings (CXR, auscultation and LUS). There is no limit on the age of infants being eligible for this research study if they meet inclusion criteria and are receiving care in the NCCU. CPT effects will be measured using Lung Ultrasound (LUS), auscultation, physiological measurements and where available CXR by comparing baseline/ pre-CPT measurements with immediately post, and 4 hours post, CPT measurements. CPT will be undertaken by the physiotherapist and documented in the infant's medical notes and details of the treatment will be documented as part of the study report form. As CPT will be undertaken only by the physiotherapist, not by any other staff members, no adherence strategies will be required.
Sponsors
Bronagh McAlinden - Mater Hospital Brisbane
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
23 Weeks to 39 Weeks
Healthy volunteers
No
Inclusion criteria
i. Neonates < 39 weeks gestational age ii. Invasively ventilated, receiving care in Mater NCCU iii. Chest radiograph in previous 24 hours of undertaking CPT and evidence of lung collapse/ consolidation diagnosed by radiographer. iv. Parent/ guardian written consent. v. Infant deemed medically safe to undergo CPT interventions.
Exclusion criteria
i. Contraindication to CPT ii. Absence of CXR within 24 hours from time of CPT assessment and treatment iii. LUS not possible (e.g. Poor skin integrity, dressings, drains etc) iv. Pending or active redirection of care
Outcome results
None listed