急性儿科呼吸系统疾病的气道清除治疗:最新进展综述

B. Morrow
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引用次数: 17

摘要

尽管有效性和安全性证据不明确,但气道清除治疗(ACT)经常用于婴幼儿和儿童急性肺部疾病。本综述的目的是批判性地综合已发表的证据、专家意见和病理生理学原理,以描述治疗急性肺部疾病的婴儿和儿童常用ACT模式的适应症、效果、预防措施和应用。方法对已发表的文献进行综合叙述性综述。优先考虑描述儿科人群的文章,但在适当情况下也考虑成人和动物研究。结果缺乏高水平的证据支持在急性疾病婴儿和儿童中使用ACT。相反,研究强调,不同的模式对各种情况缺乏效果,在某些情况下,已经报道了严重的相关并发症。当存在肺分泌物潴留,并且随之而来的气道阻塞严重影响呼吸力学和气体交换和/或有可能产生长期不良后遗症(先前疾病或损伤的后果)时,可考虑气道清除治疗。然而,它不应被视为常规干预。结论急性呼吸道疾病患儿入院不宜常规进行气道清除率治疗。对于那些有可能适用ACT的体征和症状的患者,应根据个人表现进行临床评估和治疗计划。本综述可以作为物理治疗师在急性呼吸道疾病患儿的呼吸管理方面的指导,以及确定临床研究的领域。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Airway clearance therapy in acute paediatric respiratory illness: A state-of-the-art review
Background Despite unclear evidence of effectiveness or safety, airway clearance therapy (ACT) is frequently performed in infants and children with acute pulmonary disease. Objectives The aim of this review was to critically synthesise published evidence, expert opinion and pathophysiological principles to describe the indications, effects, precautions and application of commonly used ACT modalities for managing infants and children with acute pulmonary disease. Method A comprehensive narrative review of published literature was conducted. Articles describing paediatric populations were prioritised, but adult and animal studies were also considered where appropriate. Results There is a dearth of high-level evidence supporting the use of ACT in acutely ill infants and children. Conversely, studies have highlighted the lack of effect of different modalities for a variety of conditions, and in some cases serious associated complications have been reported. Airway clearance therapy may be considered when there is retention of pulmonary secretions, and the consequential airway obstruction impacts either acutely on respiratory mechanics and gaseous exchange and/or has the potential for long-term adverse sequelae [a condition that is the consequence of a previous disease or injury]. However, it should not be considered a routine intervention. Conclusion Airway clearance therapy should not be performed routinely in children admitted to hospital with acute respiratory conditions. Patients should be clinically assessed and treatment planned according to individual presentation, in those with signs and symptoms that are potentially amenable to ACT. Clinical implications This review can serve as a guide for physiotherapists in the respiratory management of children with acute respiratory illness, as well as identifying areas for clinical research.
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