Chest physiotherapy following paediatric cardiac surgery: The influence of mode of treatment on oxygen saturation and haemodynamic stability

Abstract

Chest physiotherapy is widely used after open heart surgery to prevent secondary pathology in the lungs. Yet chest physiotherapy has been reported to cause hypoxaemia. In order to investigate the relationship between specific chest physiotherapy techniques and oxygen saturation in children post-cardiac surgery, a prospective clinical study was undertaken. Sixty-seven ventilated children below 4 years of age completed the study. Their oxygen saturation, heart rate and blood pressure were recorded before, during and after chest physiotherapy, which included endotracheal suctioning. Exploratory data analysis on the eight resulting treatment groups showed that maximum falls in oxygen saturation varied from less than 1% (vibrations and bag squeezing) to almost 6% (percussion, vibrations and position change). Analysis of covariance revealed that the treatment ‘package’ given to the child was the main determinant of the maximum fall in oxygen saturation (P<0.001) and that younger children demonstrated greater falls in oxygen saturation with chest physiotherapy (P<0.01). Variables such as oxygen requirement, length of treatment time and baseline oxygen saturation did not influence the change in oxygen saturation with therapy.