Pediatric airway maintenance and clearance in the acute care setting: How to stay out of trouble

Respiratory Care

Volumn 56, Issue 9, 2011, Pages 1424-1444

  Walsh, Brian K ^a   Hood, Kristen ^a   Merritt, Greg ^a  

^a CHILDREN S MEDICAL CENTER   (United States)

Author keywords

Airway clearance; Chest physiotherapy; Cystic fibrosis; Pediatric; Respiratory

Indexed keywords

BICARBONATE; GLYCINE; HELIOX; SODIUM CHLORIDE; BRONCHODILATING AGENT;

ACUTE RESPIRATORY TRACT DISEASE; AIRWAY MAINTENANCE AND CLEARANCE THERAPY; AIRWAY SUCTIONING; ARTICLE; ASTHMA; BREATHING EXERCISE; BRONCHIOLITIS; DISEASE EXACERBATION; DRUG INSTILLATION; EMERGENCY CARE; EQUIPMENT; HOSPITAL PATIENT; HUMAN; HUMIDIFIER; LUNG CLEARANCE; LUNG DISEASE; LUNG FUNCTION; NEUROMUSCULAR DISEASE; OUTCOME ASSESSMENT; PATIENT POSITIONING; PHYSIOLOGICAL PROCESS; POSTURAL DRAINAGE; RESPIRATORY CARE; SUCTION; THERAPY; TIME; TRACHEOBRONCHIAL TOILET; TREATMENT INDICATION; ACUTE LUNG INJURY; ARTIFICIAL VENTILATION; CHILD; HUMIDITY; METHODOLOGY; NEWBORN; PATHOLOGY; PERCUSSION; PREMATURITY; REVIEW;

ACUTE LUNG INJURY; ASTHMA; BRONCHODILATOR AGENTS; CHILD; DRAINAGE, POSTURAL; HUMANS; HUMIDITY; INFANT, NEWBORN; INFANT, PREMATURE; PERCUSSION; RESPIRATORY THERAPY; SUCTION;

EID: 82255196414     PISSN: 00201324     EISSN: 19433654     Source Type: Journal    
DOI: 10.4187/respcare.01323     Document Type: Article

References (113)

1. Hess DR. Airway clearance: physiology, pharmacology, techniques, and practice. Respir Care 2007;52(10):1392-1396.
2. Gaskell D, Webber BA. The Brompton Hospital guide to chest physiotherapy. Oxford: Blackwell Scientific; 1973.
3. Hough A. Physiotherapy in respiratory care: a problem solving approach. London: Chapman & Hall; 1991.
4. Mellins R. Pulmonary physiotherapy in the pediatric age group. Am Rev Respir Dis 1974;110(2):137-142.
5. Faling L. Chest physical therapy. Philadelphia: Lippincott; 1991: 625-654.
6. Sutton P. Assessment of percussion, vibratory shaking, and breathing exercises in chest physiotherapy. Eur J Respir Dis 1985;66(2): 147-152.
7. Sutton P. Assessment of the forced expiratory technique, postural drainage and directed cough in chest physiotherapy. Eur J Respir Dis 1983;64(1):62-68.
8. Murphy MB CD, FitzGerald M. Chest percussion: help or hindrance to postural drainage. Int Med J 1983;76:189-190.
9. van der Schans C. Effect of manual percussion in tracheobronchial clearance in patients with chronic obstruction and excessive tracheobronchial secretion. Thorax 1986;41:448-452.
10. Rogers DF. Pulmonary mucus: pediatric perspective. Pediatr Pulmonol 2003;36(3):178-188.
11. Jeffrey PK. The development of large and small airways. Am J Respir Crit Care Med 1998;157(5 Pt 2):S174-S180.
12. Montuschi P. Indirect monitoring of lung inflammation. Nat Rev 2002;1(3):238-242.
13. Ricciardolo FL, Gaston B, Hunt J. Acid stress in the pathology of asthma. J Allergy Clin Immunol 2004;113(4):610-619.
14. Paget-Brown AO, Hunt JF, Gaston B. Tracheal aspirate pH is alkaline in pre-term human infants. Eur Respir J 2007;30(5):840-842.
15. Hunt JF, Fang K, Malik R, Snyder A, Malhotra N, Platts-Mills TA, et al. Endogenous airway acidification. Implications for asthma pathophysiology. Am J Respir Crit Care Med 2000;161(3 Pt 1): 694-699.
16. Tate S, MacGregor G, Davis M, Innes JA, Greening AP. Airways in cystic fibrosis are acidified: detection by exhaled breath condensate. Thorax 2002;57(11):926-929.
17. Kostikas K, Papatheodorou G, Ganas K, Psathakis K, Panagou P, Loukides S. pH in expired breath condensate of patients with inflammatory airway diseases. Am J Respir Crit Care Med 2002; 165(10):1364-1370.
18. Gessner C, Hammerschmidt S, Kuhn H, Seyfarth HJ, Sack U, Engelmann L, et al. Exhaled breath condensate acidification in acute lung injury. Respir Med 2003;97(11):1188-1194.
19. Gaston B, Hunt JF. How acidopneic is my patient? A new question in the pulmonary laboratory. Am J Respir Crit Care Med 2002; 165(10):1349-1350.
20. Hunt J. Exhaled breath condensate: an evolving tool for noninvasive evaluation of lung disease. J Allergy Clin Immunol 2002;110(1):28-34.
21. Pugin J, Dunn-Siegrist I, Dufour J, Tissieres P, Charles PE, Comte R. Cyclic stretch of human lung cells induces an acidification and promotes bacterial growth. Am J Respir Cell Mol Biol 2008;38(3):362-370.
22. Gaston B. Expired nitric oxide in pediatric asthma: emissions testing for children? J Pediatr 1997;131(3):343-344.
23. Ricciardolo FLM, Rado V, Fabbri LM, Sterk PJ, Di Maria GU, Geppetti P. Bronchoconstriction induced by citric acid inhalation in guinea pigs: role of tachykinins, bradykinin, and nitric oxide. Am J Respir Crit Care Med 1999;159(2):557-562.
24. Bevan S, Geppetti P. Protons: small stimulants of capsaicin-sensitive sensory nerves. Trends Neurosci 1994;17(12):509-512.
25. Holma B, Lindegren M, Andersen JM. pH effects on ciliomotility and morphology of respiratory mucosa. Arch Environ Health 1977; 32(5):216-226.
26. Low PM, Luk CK, Dulfano MJ, Finch PJ. Ciliary beat frequency of human respiratory tract by different sampling techniques. Am Rev Respir Dis 1984;130(3):497-498.
27. Holma B, Hegg PO. pH- and protein-dependent buffer capacity and viscosity of respiratory mucus. Their interrelationships and influence on health. Sci Total Environ 1989;84:71-82.
28. Holma B. Effects of inhaled acids on airway mucus and its consequences for health. Environ Health Perspect 1989;79:109-113.
29. Nakayama K, Jia YX, Hirai H, Shinkawa M, Yamaya M, Sekizawa K, Sasaki H. Acid stimulation reduces bactericidal activity of surface liquid in cultured human airway epithelial cells. Am J Respir Cell Mol Biol 2002;26(1):105-113.
30. Zelenina M, Bondar AA, Zelenin S, Aperia A. Nickel and extracellular acidification inhibit the water permeability of human aquaporin-3 in lung epithelial cells. J Biol Chem 2003;278(32):30037-30043.
31. Horvath G, Schmid N, Fragoso MA, Schmid A, Conner GE, Salathe M, et al. Epithelial organic cation transporters ensure pH-dependent drug absorption in the airway. Am J Respir Cell Mol Biol 2007;36(1): 53-60.
32. Luk CK, Dulfano MJ. Effect of pH, viscosity and ionic-strength changes on ciliary beating frequency of human bronchial explants. Clin Sci 1983;64(4):449-451.
33. Hammerschmidt S, Kuhn H, Grasenack T, Gessner C, Wirtz H. Apoptosis and necrosis induced by
34. Oberwaldner B. Physiotherapy for airway clearance in paediatrics. Eur Respir J 2000;15(1):196-204.
35. Papastamelos C, Panitch HB, England SE, Allen JL. Developmental changes in chest wall compliance in infancy and early childhood. J Appl Physiol 1995;78(1):179-184.
36. Lai-Fook SJ, Hyatt RE. Effects of age on elastic moduli of human lungs. J Appl Physiol 2000;89(1):163-168.
37. Penn RB, Wolfson MR, Shaffer TH. Developmental differences in tracheal cartilage mechanics. Pediatr Res 1989;26(5):429-433.
38. Hall GL, Hantos Z, Wildhaber JH, Sly PD. Contribution of nasal pathways to low frequency respiratory impedance in infants. Thorax 2002;57(5):396-399.
39. McKiernan C, Chua LC, Visintainer PF, Allen H. High flow nasal cannulae therapy in infants with bronchiolitis. J Pediatr 2010;156(4): 634-638.
40. United States Department of Labor, OSHA Directorate of Technical Support and Emergency Management. Anesthetic gases: guidelines for workplace exposures. July 20, 1999. Revised May 18, 2000. http://www.osha.gov/dts/osta/anestheticgases/index.html. Accessed July 12, 2011.
41. J. Relative air humidity in hospital wards - user perception and technical consequences. Indoor Build Environ 2006(15):93-97.
42. Chatburn RL, Lough MD, Klinger JD. An in-hospital evaluation of the sonic mist ultrasonic room humidifier. Respir Care 1984;29(9): 893-899.
43. Zuravleff JJ, Yu VL, Shonnard JW, Rihs JD, Best M. Legionella pneumophila contamination of a hospital humidifier. Demonstration of aerosol transmission and subsequent subclinical infection in exposed guinea pigs. Am Rev Respir Dis 1983;128(4):657-661.
44. Naftali S, Schroter RC, Shiner RJ, Elad D. Transport phenomena in the human nasal cavity: a computational model. Ann Biomed Eng 1998;26(5):831-839.
45. Williams R, Rankin N, Smith T, Galler D, Seakins P. Relationship between the humidity and temperature of inspired gas and the function of the airway mucosa. Crit Care Med 1996;24(11):1920-1929.
46. Kilgour E, Rankin N, Ryan S, Pack R. Mucociliary function deteriorates in the clinical range of inspired air temperature and humidity. Intensive Care Med 2004;30(7):1491-1494.
47. Todd DA, Boyd J, Lloyd J, John E. Inspired gas humidity during mechanical ventilation: effects of humidification chamber, airway temperature probe position and environmental conditions. J Paediatr Child Health 2001;37(5):489-494.
48. Solomita M, Palmer LB, Daroowalla F, Liu J, Miller D, LeBlanc DS, et al. Humidification and secretion volume in mechanically ventilated patients. Respir Care 2009;54(10):1329-1335.
49. Kelly M, Gillies D, Todd DA, Lockwood C. Heated humidification versus heat and moisture exchangers for ventilated adults and children. Cochrane Database Syst Rev 2010;(4):CD004711.
50. Argent AC. Endotracheal suctioning is basic intensive care or is it? Pediatr Res 2009;66(4):364-367.
51. Gardner DL, Shirland L. Evidence-based guideline for suctioning the intubated neonate and infant. Neonatal Netw 2009;28(5):281-302.
52. Kiraly NJ, Tingay DG, Mills JF, Morley CJ, Dargaville PA, Copnell B. The effects of closed endotracheal suction on ventilation during conventional and high-frequency oscillatory ventilation. Pediatr Res 2009;66(4):400-404.
53. Argent AC, Morrow BM. What does chest physiotherapy do to sick infants and children? Intensive Care Med 2004;30(6):1014-1016.
54. Hoellering AB, Copnell B, Dargaville PA, Mills JF, Morley CJ, Tingay DG. Lung volume and cardiorespiratory changes during open and closed endotracheal suction in ventilated newborn infants. Arch Dis Child Fetal Neonatal Ed 2008;93(6):F436-F441.
55. Kiraly NJ, Tingay DG, Mills JF, Dargaville PA, Copnell B. Volume not guaranteed: closed endotracheal suction compromises ventilation in volume-targeted mode. Neonatology 2011;99(1):78-82.
56. Copnell B, Dargaville PA, Ryan EM, Kiraly NJ, Chin LO, Mills JF, et al. The effect of suction method, catheter size, and suction pressure on lung volume changes during endotracheal suction in piglets. Pediatr Res 2009;66(4):405-410.
57. Kalyn A, Blatz S, Sandra F, Paes B, Bautista C. Closed suctioning of intubated neonates maintains better physiologic stability: a randomized trial. J Perinatol 2003;23(3):218-222.
58. van Veenendaal MB, Miedema M, de Jongh FH, van der Lee JH, Frerichs I, van Kaam AH. Effect of closed endotracheal suction in high-frequency ventilated premature infants measured with electrical impedance tomography. Intensive Care Med 2009;35(12):2130-2134.
59. Seymour CW, Cross BJ, Cooke CR, Gallop RL, Fuchs BD. Physiologic impact of closed-system endotracheal suctioning in spontaneously breathing patients receiving mechanical ventilation. Respir Care 2009;54(3):367-374.
60. Copnell B. Effect of endotracheal suction on lung dynamics in mechanically-ventilated paediatric patients. Nurs Crit Care 2008; 13(1):54-55.
61. Caruso P, Denari S, Ruiz SA, Demarzo SE, Deheinzelin D. Saline instillation before tracheal suctioning decreases the incidence of ventilator-associated pneumonia. Crit Care Med 2009;37(1):32-38.
62. Christensen RD, Henry E, Baer VL, Hoang N, Snow GL, Rigby G, et al. A low-sodium solution for airway care: results of a multicenter trial. Respir Care 55(12):1680-1685.
63. Helder OK, Latour JM. Endotracheal suctioning: there's more to it than just technical care. Pediatr Crit Care Med 2008;9(5):539-540.
64. Pneumatikos IA, Dragoumanis CK, Bouros DE. Ventilator-associated pneumonia or endotracheal tube-associated pneumonia? An approach to the pathogenesis and preventive strategies emphasizing the importance of endotracheal tube. Anesthesiology 2009;110(3):673-680.
65. Donahue M. "Spare the cough, spoil the airway:" back to the basics in airway clearance. Pediatr Nurs 2002;28(2):107-111.
66. Gaston B, Kelly R, Urban P, Liu L, Henderson EM, Doctor A, et al. Buffering airway acid decreases exhaled nitric oxide in asthma. J Allergy Clin Immunol 2006;118(4):817-822.
67. Rau J. Mucous-controlling, surface-active, and cold and cough agents. In: Respiratory Care Pharmacology. Chicago: Year Book, 1989;144-179.
68. Connolly MA. Mucolytics and the critically ill patient: help or hindrance? AACN Clin Issues 1995;6(2):307-315.
69. American Association for Respiratory Care. Clinical practice guideline: Postural drainage therapy. Respir Care 1991;36(12):1418-1426.
70. da Silva VM, Lopes MV, de Araujo TL, Ciol MA, de Carvalho EC. Clinical indicators of ineffective airway clearance in children with congenital heart disease. J Clin Nurs 2009;18(5):729-736.
71. Hess D. The AARC (American Association for Respiratory Care) clinical practice guidelines. Respir Care 1991;36(12):1398-1401.
72. Schechter MS. Airway clearance applications in infants and children. Respir Care 2007;52(10):1382-1390; discussion 1390-1391.
73. Tripathi RS, Blum JM, Rosenberg AL, Tremper KK. Pulse oximetry saturation to fraction inspired oxygen ratio as a measure of hypoxia under general anesthesia and the influence of positive endexpiratory pressure. J Crit Care 2010;25(3):542; e549-513.
74. Vandenplas Y, Diericx A, Blecker U, Lanciers S, Deneyer M. Esophageal pH monitoring data during chest physiotherapy. J Pediatr Gastroenterol Nutr 1991;13(1):23-26.
75. Button BM, Heine RG, Catto-Smith AG, Phelan PD, Olinsky A. Chest physiotherapy, gastro-oesophageal reflux, and arousal in infants with cystic fibrosis. Arch Dis Child 2004;89(5):435-439.
76. Oberwaldner B, Zach MS. [Mucous clearing respiratory-physiotherapy in pediatric pneumology]. Schweiz Med Wochenschr 2000; 130(19):711-719. Article in German.
77. Siew ML, Te Pas AB, Wallace MJ, Kitchen MJ, Lewis RA, Fouras A, et al. Positive end-expiratory pressure enhances development of a functional residual capacity in preterm rabbits ventilated from birth. J Appl Physiol 2009;106(5):1487-1493.
78. Zidulka A, Chrome JF, Wight DW, Burnett S, Bonnier L, Fraser R. Clapping or percussion causes atelectasis in dogs and influences gas exchange. J Appl Physiol 1989;66(6):2833-2838.
79. Hough JL, Flenady V, Johnston L, Woodgate PG. Chest physiotherapy for reducing respiratory morbidity in infants requiring ventilatory support. Cochrane Database Syst Rev 2008(3):CD006445.
80. Ernst MM, Wooldridge JL, Conway E, Dressman K, Weiland J, Tucker K, et al. Using quality improvement science to implement a multidisciplinary behavioral intervention targeting pediatric inpatient airway clearance. J Pediatr Psychol 35(1):14-24.
81. Hess DR. Secretion clearance techniques: absence of proof or proof of absence? (editorial) Respir Care 2002;47(7):757-758.
82. Fink JB. Positive pressure techniques for airway clearance. Respir Care 2002;47(7):786-796.
83. Lamb D, Reid L. The tracheobronchial submucosal glands in cystic fibrosis: a qualitative and quantitative histochemical study. Br J Dis Chest 1972;66(4):240-247.
84. Zuelzer W, Newton W. The pathogenesis of fibrocystic disease of the pancreas: a study of 36 cases with special reference to pulmonary lesions. Pediatrics 1949;4(1):53-69.
85. Katz S, Holsclaw, DS Jr. Ultrastructural features of respiratory cilia in cystic fibrosis. Am J Clin Pathol 1980;73(5):682-685.
86. Flume PA, Robinson KA, O'Sullivan BP, Finder JD, Vender RL, Willey-Courand DB, et al. Cystic fibrosis pulmonary guidelines: airway clearance therapies. Respir Care 2009;54(4):522-537.
87. Varekojis SM, Douce FH, Flucke RL, Filbrun DA, Tice JS, McCoy KS, et al. A comparison of the therapeutic effectiveness of and preference for postural drainage and percussion, intrapulmonary percussive ventilation, and high-frequency chest wall compression in hospitalized cystic fibrosis patients. Respir Care 2003;48(1):24-28.
88. Asher MI, Douglas C, Airy M, Andrews D, Trenholme A. Effects of chest physical therapy on lung function in children recovering from acute severe asthma. Pediatr Pulmonol 1990;9(3):146-151.
89. Girard JP, Terki N. The Flutter VRP1: a new personal pocket therapeutic device used as an adjunct to drug therapy in the management of bronchial asthma. J Investig Allergol Clin Immunol 1994;4(1):23-27.
90. Myers TR. Positive expiratory pressure and oscillatory positive expiratory pressure therapies. Respir Care 2007;52(10):1308-1326; discussion 1327.
91. Gupta VK, Cheifetz IM. Heliox administration in the pediatric intensive care unit: an evidence-based review. Pediatr Crit Care Med 2005;6(2):204-211.
92. Anderson M, Svartengren M, Bylin G, Philipson K, Camner P. Deposition in asthmatics of particles inhaled in air or in heliumoxygen. Am Rev Respir Dis 1993;147(3):524-528.
93. Kass JE, Terregino CA. The effect of heliox in acute severe asthma: a randomized controlled trial. Chest 1999;116(2):296-300.
94. Bach JR, Saporito LR. Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure. A different approach to weaning. Chest 1996;110(6):1566-1571.
95. Panitch HB. Respiratory issues in the management of children with neuromuscular disease. Respir Care 2006;51(8):885-893; discussion 894-885.
96. Dohna-Schwake C, Ragette R, Teschler H, Voit T, Mellies U. IPPB-assisted coughing in neuromuscular disorders. Pediatr Pulmonol 2006;41(6):551-557.
97. Panitch HB. Airway clearance in children with neuromuscular weakness. Curr Opin Pediatr. 2006;18(3):277-281.
98. Miske LJ, Hickey EM, Kolb SM, Weiner DJ, Panitch HB. Use of the mechanical in-exsufflator in pediatric patients with neuromuscular disease and impaired cough. Chest 2004;125(4):1406-1412.
99. Birnkrant DJ, Pope JF, Lewarski J, Stegmaier J, Besunder JB. Persistent pulmonary consolidation treated with intrapulmonary percussive ventilation: a preliminary report. Pediatr Pulmonol 1996; 21(4):246-249.
100. Deakins K, Chatburn RL. A comparison of intrapulmonary percussive ventilation and conventional chest physiotherapy for the treatment of atelectasis in the pediatric patient. Respir Care 2002;47(10): 1162-1167.
101. Toussaint M, De Win, Steens M, Soudon P. Effect of intrapulmonary percussive ventilation on mucus clearance in duchenne muscular dystrophy patients: a preliminary report. Respir Care 2003; 48(10):940-947.
102. Vianello A, Corrado A, Arcaro G, Gallan F, Ori C, Minuzzo M, et al. Mechanical insufflation-exsufflation improves outcomes for neuromuscular disease patients with respiratory tract infections. Am J Phys Med Rehabil 2005;84(2):83-88; discussion 89-91.
103. Striegl AM, Redding GJ, Diblasi R, Crotwell D, Salyer J, Carter ER. Use of a lung model to assess mechanical in-exsufflator therapy in infants with tracheostomy. Pediatr Pulmonol 2010 [Epub ahead of print].
104. Plioplys AV. Correspondence on "safety, tolerability, and efficacy of high-frequency chest wall oscillation in pediatric patients with cerebral palsy and neuromuscular diseases: an exploratory randomized controlled trial". J Child Neurol 2010;25(12):1598; author reply 1598.
105. Perrotta C, Ortiz Z, Roque M. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database Syst Rev 2007(1):CD004873.
106. Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics 2006;118(4): 1774-1793.
107. Bailleux S, Lopes D, Geoffroy A, Josse N, Labrune P, Gajdos V. [What evidence for chest physiotherapy in infants hospitalized for acute viral bronchiolitis?]. Arch Pediatr 2011;18(4):472-475. Article in French.
108. Gajdos V, Katsahian S, Beydon N, Abadie V, de Pontual L, Larrar S, et al. Effectiveness of chest physiotherapy in infants hospitalized with acute bronchiolitis: a multicenter, randomized, controlled trial. PLo S Med 2010;7(9):e1000345.
109. Reines HD, Sade RM, Bradford BF, Marshall J. Chest physiotherapy fails to prevent postoperative atelectasis in children after cardiac surgery. Ann Surg 1982;195(4):451-455.
110. Flenady VJ, Gray PH. Chest physiotherapy for preventing morbidity in babies being extubated from mechanical ventilation. Cochrane Database Syst Rev 2002(2):CD000283.
111. Levin AN. [Classification of acute pneumonia in children]. Pediatriia 1978(4):69-70. Article in Russian.
112. Stapleton T. Chest physiotherapy in primary pneumonia. BMJ (Clin Res Ed) 1985;291(6488):143.
113. Britton S, Bejstedt M, Vedin L. Chest physiotherapy in primary pneumonia. BMJ (Clin Res Ed) 1985;290(6483):1703-1704.