Peri-operative chest physiotherapy for paediatric cardiac patients: a systematic review and meta-analysis

Strategy nursing in children with compromised ventilation: Umbrella review

PROBLEM

Changes in the ventilation demand nursing interventions duly adapted to the management of said impairment and to the adaptability of the child/parents. This revision aimed to investigate the evidence behind the interventions performed on children with impaired ventilation.'

ELIGIBILITY CRITERIA

Systematic reviews of literature in English, Spanish, French, and Portuguese from studies on nursing interventions related to children with impaired ventilation in all contexts of the clinical practice. The Joanna Briggs Institute recommendations were followed.

SAMPLE

We conducted a comprehensive search as of January 2022 and updated as of June 2023. The following electronic databases were searched: SCOPUS, Web of Science, Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, MEDLINE (via PubMed), CINAHL (via EBSCO), MedicLatina (via EBSCO), The Cochrane Database of Systematic Reviews (via EBSCO), and Database of Abstracts of Reviews of Effects (DARE). Nineteen articles published between 2012 and 2022 were included in this review.

RESULTS

Nineteen studies investigated the efficacy of respiratory exercises (Breathing Control - relaxed breathing, pursed lip breathing, Diaphragmatic breathing exercises, respiratory expansion exercise - deep breathing exercise, thoracic expansion exercises (with device), exercises for respiratory muscle strengthening and position to optimize ventilation. In the majority of the studies, it was not possible to evaluate the interventions separately. Thirteen studies evidenced the efficacy of respiratory exercises, BIPAP, and oxygen therapy. Seven articles demonstrated the effectiveness of respiratory muscle-strengthening exercises, and only three mentioned the efficacy of positioning regarding impaired ventilation. Interventions based on respiratory exercises and respiratory muscle training were the most common ones.

CONCLUSIONS

The results suggest that nursing interventions to optimize ventilation are efficient. Nevertheless, the same present a low to moderate evidence degree, justified by the population characteristics (small and heterogeneous).

IMPLICATIONS

There is proof of evidence for the studied interventions. However, the lack of methodological robustness points to future research to duly describe interventions, data, and comparable results, using reliable samples in which the focus of the study is clear.

Stewardship of physiotherapy services in Iran: common pitfalls and policy solutions

Physiotherapy (PT) is a key component of the rehabilitative health strategy and an effective approach to the management and treatment of a wide range of health conditions. However, it remains underdeveloped and poorly implemented in many national health systems. Previous studies show that weak stewardship of rehabilitation services is, among others, a significant barrier to equitable access to services and supports in many parts of the world, including in Iran. This study investigated the common pitfalls and potential policy solutions to improve the stewardship of PT services in Iran from the perspective of key stakeholders. Semi-structured interviews were conducted by telephone, via the internet, and in face-to-face sessions in Iran with a purposive sample of health planners and policy decision-makers, university professors, rehabilitation managers, and physiotherapists. In total, 30 individuals agreed to participate. Participants identified several pitfalls across the six dimensions of stewardship: 1) strategy formulation; 2) inter-sectoral collaboration; 3) governance and accountability; 4) health system design; 5) policy and regulation; and 6) intelligence generation. In addition, several policy options and solutions to address critical deficiencies in the system were suggested to improve the stewardship of PT services. The study identified challenges and pitfalls affecting the stewardship of the PT sector in Iran as perceived by key stakeholders. Participants' insights can inform deliberative dialogue processes, agenda-setting, and strategy formulation to support the development, expansion, and implementation of PT services.

The usefulness of respiratory ultrasound assessment for modifying the physiotherapeutic algorithm in children after congenital heart defect surgeries

Background

The aim of the study was to assess the effectiveness and the possible use of diagnostic transthoracic ultrasound of the respiratory tract to qualify patients for therapy and to monitor the effectiveness of physiotherapy in children after cardiac surgeries.

Materials and methods

A total of 103 patients aged between 1 and 12 months who underwent a series of congenital heart surgeries using cardiopulmonary bypass were qualified for the prospective analysis. Point-of-care respiratory ultrasound imaging was performed according to a tailored protocol during the patient’s stay in the intensive care unit. In order to evaluate the method, the obtained findings were subject to comparative analysis against the available radiographic findings with a division into sectors.

Results

The comparative analysis of ultrasonographic and radiographic findings with a division into sectors showed the highest concordance rate (89.6%) for S1L (the apex of the left lung) and the lowest concordance rate (57.0%) for S2L (pericardial region). The highest discordance rate, i.e. when a lesion was detected in radiography (X-ray = 1), but was not confirmed by ultrasound (US = 0), was reported for sectors S1P (right lung apex) – 26.1%, and S2L – 40.0%, whereas the lowest discordance rate was reported for S1L – 7.0%. The highest discordance rate, i.e. when a lesion was shown in ultrasound (US = 1), but was not confirmed by radiography (X-ray = 0) was reported for S3P (the base of the right lung) and S3L (base of the right lung) – 28.3% and 26.1%, respectively.

Conclusions

The author’s protocol for ultrasonographic assessment of the respiratory tract is an optimal tool for determining therapeutic goals, as well as for the assessment of the efficacy of pulmonary physiotherapy. The diagnostic value of ultrasonographic assessment of the respiratory tract and standard radiography in the study group depends on the location of the investigated lung segment.