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Corten L.1, Jelsma J.1, Human A.2, Rahim S.3, Morrow B.M.4
1University of Cape Town, Health and Rehabilitation Sciences, Cape Town, South Africa, 2Sefako Makgatho Health Sciences University, School of Health Care Sciences, Pretoria, South Africa, 3Red Cross War Memorial Children's Hospital, Physiotherapy, Cape Town, South Africa, 4University of Cape Town, Paediatrics and Child Health, Cape Town, South Africa
Background: Pneumonia is the most important respiratory problem in low-to-middle income countries. Airway clearance therapy continues to be used in children with pneumonia and secretion retention, however, there is lack of evidence to support or reject this treatment.
Purpose: This study aimed to determine whether assisted autogenic drainage (AAD) was more effective than standard nursing care in children hospitalised uncomplicated pneumonia.
Methods: A single blinded randomised controlled trial was conducted on children hospitalised in 2 tertiary hospitals in South Africa, with uncomplicated pneumonia between the ages of 1 month and 8 years. Exclusion criteria were: bronchiolitis; Pneumocystis jirovecii pneumonia; active tuberculosis; any cardiac or respiratory comorbidities; recent history ( six months) of pneumothorax or thoracic/abdominal surgery; increased intracranial pressure; pleural effusion with or without intercostal drain; chest deformities; any condition for which mobilisation out of bed was contraindicated; osteoporosis; premature (≤30 weeks) birth; hospitalised for less than two days; and marked respiratory distress and/or hypoxia. Children hospitalised and off mechanical ventilator for more than four days prior to recruitment were also ineligible for the study (for baseline data purposes).The intervention group received standard nursing care with additional bi-daily AAD, for 10 to 30 minutes. The control group only received standard nursing care, unless otherwise deemed necessary by the physician or physiotherapist. The primary outcome measure was duration of hospitalisation. The secondary outcome measures included: days of fever and supplemental oxygen support; respiratory rate (RR) and heart rate adjusted for age; RR pre-, post- and one hour post-treatment; oxygen saturation; adverse events; and mortality.
Results: A total of 896 children were screened for eligibility, however, only 29 met the inclusion criteria (median age 3.50 months, IQR 1.509.43). No difference was found for duration of hospitalisation (median 7.50 and 7.00 days for the control and intervention group respective), however, Kaplan-Meier analysis revealed a strong tendency towards a shorter time to discharge in the intervention group (p= 0.06). No significant differences were found for the other outcome measures at time of discharge. No adverse events or casualties were reported. Within the intervention group, a significant reduction in RR adjusted for age was found. A statistical but clinically irrelevant increase in RR immediately after treatment was seen, which returned to pre-treatment values after one hour.
Conclusion(s): The study was halted due to the slow rate of recruitment, therefore, the study was underpowered (42%). Hence no conclusions can be made on the effectiveness of AAD in children hospitalised with uncomplicated pneumonia. However, no adverse events or casualties were reported.
Implications: AAD can currently not be recommended as a standard intervention for children hospitalised with uncomplicated pneumonia. However, AAD might be a safe technique to be used in children.
Funding acknowledgements: - Margaret Roper Scholarship (Division of Physiotherapy, UCT)
- Department of Paediatrics and Child Health research award (UCT)
- Department of Paediatrics and Child Health research award (UCT)
Topic: Paediatrics
Ethics approval: The University of Cape Town Human Research Ethics Committee approved this study (HREC 532/2013).
All authors, affiliations and abstracts have been published as submitted.
