Measuring the effects of airway clearance in mechanically ventilated infants and children: A systematic review.

Background: Robust measurement tools are essential in guiding physiotherapy-delivered airway clearance techniques to ventilated infants and children.

Objective: To identify measurement tools used to evaluate effects of airway clearance techniques in ventilated infants and children and to determine the clinimetric properties of these tools.

Data Sources: Pubmed, CINAHL, Embase, The Cochrane Library, Physiotherapy Evidence Database and Web of Science, up to November 2020.

Study Selection: Randomized and non-randomized clinical trials measuring any aspect of lung function during and/or after airway clearance techniques in mechanically ventilated infants and children from birth to sixteen years.

Data Extraction And Data Synthesis: Two independent reviewers identified tools measuring effects of airway clearance techniques including secretion clearance, respiratory mechanics, gas exchange and changes on lung imaging. Extracted data included details of the tool, airway clearance intervention being evaluated and aspects of lung function being measured. Assessment of quality and clinimetric properties, including validity, reliability and responsiveness, were evaluated for each tool using the COnsensus-based Standards for the selection of health status Measurement INstruments methodology.

Results: Nine measurement tools measured the effects of airway clearance techniques on secretion clearance, respiratory mechanics, gas exchange and lung imaging. Five tools reported clinimetric properties although the yield and overall quality of studies was low. Tools measured many different aspects of lung function. The COSMO Plus respiratory mechanics monitor reported the most clinimetric data.

Limitations: Unpublished or in-progress studies were not included to ensure all data collected were peer-reviewed, therefore additional or novel tools may not have been identified. Included age ranges and definition of airway clearance techiques were kept broad to optimise study identification which may limit generalisability of results.

Conclusion: Measurement tools used by physiotherapists to enhance airway clearance in ventilated infants and children lack high quality evidence of validity, reliability and responsiveness. Measurements gained through these tools should therefore be interpreted with careful consideration until further climimetric evidence is available. CONTRIBUTION OF PAPER.