Fisioterapia respiratoria en sujetos adultos cursando internación por neumonía adquirida en la comunidad. Revisión bibliográfica

María Victoria Herrero; Agustín García; Emilio Sebastian Rositi; Darío Villalba

Authors

María Victoria Herrero Asociación Argentina de Medicina Respiratoria. Buenos Aires, Argentina https://orcid.org/0000-0003-4046-5104
Agustín García Asociación Argentina de Medicina Respiratoria. Buenos Aires, Argentina https://orcid.org/0009-0000-2990-6234
Emilio Sebastian Rositi Asociación Argentina de Medicina Respiratoria. Buenos Aires, Argentina https://orcid.org/0000-0002-2236-9963
Darío Villalba Asociación Argentina de Medicina Respiratoria. Buenos Aires, Argentina https://orcid.org/0000-0001-8117-0949

Keywords:

Respiratory physiotherapy, pneumonia, community-acquired pneumonia, chest physiotherapy, respiratory rehabilitation

Abstract

Introduction:

Community-acquired pneumonia (CAP) is a respiratory infection in which the indication for respiratory physiotherapy (RF) is frequently observed. However, currently the recommendations regarding its use in CAP are controversial, and there is no evidence to support its use and allow us to know its real scope.

Objectives:

To review the evidence regarding the impact of RF in adult patients who are hospitalized for CAP.

Results:

5 studies met the inclusion criteria of this review. RF maneuvers included breathing exercises, postural drainage, percussion, vibration, incentive spirometry, expiratory resistance, chest support during respiratory movements, directed cough, and intermittent positive pressure. In the included studies, RF did not reduce mortality or improve spirometric values in patients with CAP, nor did it improve days to cure or hospital stay. Regarding costs, the use of RF in patients with CAP presented a significant increase in costs.

Conclusion:

There is no evidence to support the routine use of RF in adult patients with CAP. We believe that future research is required to determine the impact of RF in adult patients with CAP, as well as to establish consensus regarding its indication, selection of maneuvers, standardization of techniques, times, and dosage.

Downloads

Download data is not yet available.

References

Luna CM, Calmaggi A, Caberloto O, Gentile J, Valentini R, Ciruzzi J, et al. Neumonia adquirida en la comunidad. Guía práctica elaborada por un comité intersociedades. Medicina (B Aires). 2003;63(4):319-43.

Lopardo G, Basombrío A, Clara L, Desse J, De Vedia L, Di Libero E, et al. Neumonía adquirida de la comunidad en adultos. Recomendaciones sobre su atención. Medicina (B Aires) . 2015;75(4):245-57.

Ministerio de Salud, Presidencia de la Nación. Mortalidad por Enfermedades Respiratorias en Argentina, 2015. INER, ANLIS, MSAL. 2015. PRO.E.R.DOC.TEC Nª13/17.2015

Siempos II, Vardakas KZ, Kopterides P, Falagas ME. Adjunctive therapies for community-acquired pneumonia: A systematic review. J Antimicrob Chemother. 2008;62(4):661-8.

Lester MK, Flume PA. Airway-clearance therapy guidelines and implementation. Respir Care. 2009;54(6):733-50.

Volsko TA. Airway clearance therapy: Finding the evidence. Respir Care . 2013;58(10):1669-78.

McCool FD, Rosen MJ. Nonpharmacologic Airway Clearance Therapies. Chest. 2006;129(1):250S-259S.

Gosselink R, Bott J, Johnson M, Dean E, Nava S, Norrenberg M, et al. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Med. 2008 Jul;34(7):1188-99.

Rodrigues A, Muñoz Castro G, Jácome C, Langer D, Parry SM, Burtin C. Current developments and future directions in respiratory physiotherapy. Eur Respir Rev. 2020 Dec 15;29(158):200264.

Guessous I, Cornuz J, Stoianov R, Burnand B, Fitting JW, Yersin B, et al. Efficacy of clinical guideline implementation to improve the appropriateness of chest physiotherapy prescription among inpatients with community-acquired pneumonia. Respir Med. 2008;102(9):1257-63.

Björkqvist M, Wiberg B, Bodin L, Bárány M, Holmberg H. Bottle-blowing in hospital-treated patients with community-acquired pneumonia. Scand J Infect Dis. 1997;29(1):77-82.

Britton S, Bejstedt M, Vedin L. Chest physiotherapy in primary pneumonia. Br Med J (Clin Res Ed). 1985 Jun 8;290(6483):1703-4.

Graham BD. Efficacy of chest physiotherapy and intermittent positive-pressure breathing in the resolution of pneumonia. N Engl J Med. 1978;299(12):624-7.

Tydeman D. An investigation into the effectiveness of physiotherapy in the treatment of patients with community-acquired pneumonia. Physiotherapy Practice. 1989;5(2);75-81.

Lim WS, Baudouin SV, George RC, Hill AT, Jamieson C, Le Jeune I, et al. Pneumonia Guidelines Committee of the BTS Standards of Care Committee. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64 Suppl 3:iii1-55.

Cochrane GM, Webber BA, Clarke SW. Effects of sputum on pulmonary function. Br Med J. 1977 Nov 5;2(6096):1181-3.

Agrafiotis M. Insufficient evidence to recommend routine adjunctive chest physiotherapy for adults with pneumonia. BMJ Evidence-Based Med. 2010;15:76-7.

Alexander E, Weingarten S, Mohsenifar Z. Clinical strategies to reduce utilization of chest physiotherapy without compromising patient care. Chest . 1996;110(2):430-2.

Chen X, Jiang J, Wang R, Fu H, Lu J, Yang M. Chest physiotherapy for pneumonia in adults. Cochrane Database Syst Rev. 2022 Sep 6;9(9):CD006338