Effect of lung squeezing technique for correcting atelectasis in mechanically ventilated preterm infants with respiratory distress syndrome
Corresponding Author(s) : Neha J Thacker
Neha_thacker@rediffmail.com
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 2 No. 4 (2014): 2014 Volume 2- Issue -4
Abstract
Background
Respiratory distress syndrome (RDS) is the primary cause of neonatal mortality¹ usually occurring in infants of less than 35 weeks of gestation.² In the surfactant deficient lung of preterm infants with respiratory distress, an unstable state occurs between alveoli, leading to diffuse atelectasis.³Various manual techniques like conventional chest physiotherapy (CCP) and lung squeezing technique (LST) are used in neonatal settings to mobilize secretions, enhance mucociliaryclearance and reexpanding the atelectatic regions of the lung.9,10However the available evidences of comparing the effectiveness of both techniques are very few.
Objective
To test the efficacy of Lung Squeezing Technique with that of Conventional Chest Physiotherapy for correcting atelectasis in mechanically ventilated pre term infants with RDS.
Study design
Experimental study
Method
With parental consent, 30 infants with gestational ages of less than 37 weeks who required mechanical ventilation and with presence of a segmental or lobar collapse confirmed on a chest X-ray, were randomly enrolled into this study. Fifteen infants in LST and CCP each.Chest radiograph was taken three days after intervention as outcome measure.
Result
After three days of intervention program Lung squeezing technique showed statistically higher improvement compared with the conventional chest physiotherapy.
Conclusion
LST is more effective in correcting atelectasis as compared to CCP technique in mechanically ventilated preterm infants with RDS. LST is less stressful and practically convenient technique than CCP technique.
Keywords
Respiratory Distress Syndrome
Lung Squeezing Technique
Conventional Chest Physiotherapy
1.
Neha J Thacker. Effect of lung squeezing technique for correcting atelectasis in mechanically ventilated preterm infants with respiratory distress syndrome . Int. J. of Allied Med. Sci. and Clin. Res. [Internet]. 2020 Aug. 2 [cited 2025 Nov. 16];2(4):433-8. Available from: https://ijamscr.com/ijamscr/article/view/115
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References
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[1] Farrell PM, Wood RE: Epidemiology of hyaline membrane disease in the United States: Analysis of national mortality statistics. pediatrics 58:167,1976.
[2] Farrell PM, Avery ME: Hyaline membrane disease. Am Rev Respir Dis 111:657,1975.
[3] Neonatal and Pediatric respiratory care: second edition: Donald Eitzman.
[4] Ivor Wong, Ti Fi fok: Randomized comparison of two physiotherapy regimens for correcting atelectasis in ventilated pre term neonates: 2003.
[5] Tepper R S , Morgan W J , Cota K, et al, GHMA Pediatricians .Physiologic growth and development of the lung during the first year of life. Am RevRespirDis1986; 13 :513 - 9 .
[6] Kotecha S. Lung growth: implications for the newborn infant .Arch Dis Child Fetal Neonatal Ed 2000 ; 82:F69-74.
[7] Menkes HA, Traystman R .Collateral ventilation. Am RevRespirDis1977;116:287-309.
[8] Flenady VJ, Gray PH. Chest physical therapy for preventing morbidity in babies being extubated from mechanical ventilation. Cochrane Review. Oxford: Update Software; 2000 (The Cochrane Library, 4).
[9] Antuneslco, silvaeg, bocardo p, daherdr, faggiottord&rugololmss, issn Effects of conventional chest physical therapy versus Lung Squeezing Technique on oxygen saturation, heart rate and respiratory rate in premature infants following extubation. 1809-9246, rev. bras. fisioter. Vol.10, No.1 (2006), 87-92 ©RevistaBrasileira de Fisioterapia.
[10] saleh al-alaiyan,md, frcp(c),david dyer and bashir khan Chest physiotherapy and post-extubation atelectasis in infants.. 1996. Pediatric Pulmonology. 21:227-230.
[11] Crane L Physical therapy for neonates with respiratory dysfunction.PhysTher1981;61:1764-73.
[12] Tudehope DI, Bagley C Techniques of physiotherapy in intubated babies with the respiratory distress syndrome..AustPaediatr J 1980;16:226-8.
[13] Fox WW, Schwartz JG, Shaffer TH. J Pulmonary physiotherapy in neonates: physiologic changes and respiratory management. Pediatr1978;92:977-81
[14] .Finer NN, Boyd DPT. Chest physiotherapy in the neonate: A controlled study. Pediatrics 1978;61:282-5.
[15] Curran LC, Kachoyeanos MK. The effects on neonates of two methods of chest physical therapy. Mothercraft Nursing 1979;4:309-13.
[16] Etches PC, Scott B. Chest physiotherapy in the newborn: Effects on secretions removed. Pediatrics 1978;62:713-5.
[17] Fox WH, Schwartz JG, Shaffer TH. Pulmonary physiotherapy in neonates: Physiologic changes and respiratory management. Journal of Pediatrics 1978;92:977-81.
[18] Purohit DM, Caldwell C, Levkoff AH. Multiple rib fractures due to physiotherapy in a neonate with hyaline membrane disease. American Journal of Disease of Children 1975;129:1103-4.
[19] Raval D, Yeh TF, Mora A, Cuevas D, Pyati S, Pildes RS. Chest physiotherapy in preterm infants with RDS in the first 24 hours of life. Journal of Perinatology 1987;7:301-4.
[20] Cross JH, Harrison CJ, Preston PR, Rushton DI, Newell SJ, Morgan MEI, et al. Postnatal encephaloclasticporencephaly - a new lesion? Archives of Disease in Childhood 1992;67:307-11
[21] Harding JE, Miles FKI, Becroft DMO, Allen BC, Knight DB. Chest physiotherapy may be associated with brain damage in extremely premature babies. Journal of Pediatrics 1998;132:440-4.
[22] Chest physiotherapy for reducing respiratory morbidity ininfants requiring ventilatory support (Review)Hough JL, Flenady V, Johnston L, Woodgate PG
Evid.-Based Child Health 5: 54–79 (2010)
[23] Herper RG and Sia C et al neonatal outcomes of infants born at 500-800 grams from 1990 through 1998 in a tertiary care center. J. perinatal 2002;22:555-62
[24] King M Zidulka A et al. Tracheal mucus clearance in high frequency oscillation; chest wall versus mouth oscillation.Am Rev Respir Dis 1984;130: 703-6
[25] Wong I Fok TF Resolution of pulmonary over inflation in an extreme low birth weight neonate utilizing “ lung squeezing” technique – a case report. Hong Kong Physiotherapy Journal 2001; 19:17-20
[26] Jonson B,Svantesson C. Elastic pressure-volume curve: what information do they convey? Thorax 1999;54:82-7.
[27] Macklem PT, Mead J. Resistance of central and peripheral air-ways as measured by are trogradecatheter.JApplPhysiol 1967;22:395.
[28] Brandford Bf et al Chest physiotherapy failed to prevent postoperative atelectasis in children after cardiac surgery. Am surg 1982;195:451-5
[29] Jan Stephen Tecklin Pediatric Physical therapy: third edition
[30] Evorwong 2006 Effects of Lung squeezing technique on lung mechanics in mechanically ventilated preterm infants with respiratory distress syndrome.
References
[1] Farrell PM, Wood RE: Epidemiology of hyaline membrane disease in the United States: Analysis of national mortality statistics. pediatrics 58:167,1976.
[2] Farrell PM, Avery ME: Hyaline membrane disease. Am Rev Respir Dis 111:657,1975.
[3] Neonatal and Pediatric respiratory care: second edition: Donald Eitzman.
[4] Ivor Wong, Ti Fi fok: Randomized comparison of two physiotherapy regimens for correcting atelectasis in ventilated pre term neonates: 2003.
[5] Tepper R S , Morgan W J , Cota K, et al, GHMA Pediatricians .Physiologic growth and development of the lung during the first year of life. Am RevRespirDis1986; 13 :513 - 9 .
[6] Kotecha S. Lung growth: implications for the newborn infant .Arch Dis Child Fetal Neonatal Ed 2000 ; 82:F69-74.
[7] Menkes HA, Traystman R .Collateral ventilation. Am RevRespirDis1977;116:287-309.
[8] Flenady VJ, Gray PH. Chest physical therapy for preventing morbidity in babies being extubated from mechanical ventilation. Cochrane Review. Oxford: Update Software; 2000 (The Cochrane Library, 4).
[9] Antuneslco, silvaeg, bocardo p, daherdr, faggiottord&rugololmss, issn Effects of conventional chest physical therapy versus Lung Squeezing Technique on oxygen saturation, heart rate and respiratory rate in premature infants following extubation. 1809-9246, rev. bras. fisioter. Vol.10, No.1 (2006), 87-92 ©RevistaBrasileira de Fisioterapia.
[10] saleh al-alaiyan,md, frcp(c),david dyer and bashir khan Chest physiotherapy and post-extubation atelectasis in infants.. 1996. Pediatric Pulmonology. 21:227-230.
[11] Crane L Physical therapy for neonates with respiratory dysfunction.PhysTher1981;61:1764-73.
[12] Tudehope DI, Bagley C Techniques of physiotherapy in intubated babies with the respiratory distress syndrome..AustPaediatr J 1980;16:226-8.
[13] Fox WW, Schwartz JG, Shaffer TH. J Pulmonary physiotherapy in neonates: physiologic changes and respiratory management. Pediatr1978;92:977-81
[14] .Finer NN, Boyd DPT. Chest physiotherapy in the neonate: A controlled study. Pediatrics 1978;61:282-5.
[15] Curran LC, Kachoyeanos MK. The effects on neonates of two methods of chest physical therapy. Mothercraft Nursing 1979;4:309-13.
[16] Etches PC, Scott B. Chest physiotherapy in the newborn: Effects on secretions removed. Pediatrics 1978;62:713-5.
[17] Fox WH, Schwartz JG, Shaffer TH. Pulmonary physiotherapy in neonates: Physiologic changes and respiratory management. Journal of Pediatrics 1978;92:977-81.
[18] Purohit DM, Caldwell C, Levkoff AH. Multiple rib fractures due to physiotherapy in a neonate with hyaline membrane disease. American Journal of Disease of Children 1975;129:1103-4.
[19] Raval D, Yeh TF, Mora A, Cuevas D, Pyati S, Pildes RS. Chest physiotherapy in preterm infants with RDS in the first 24 hours of life. Journal of Perinatology 1987;7:301-4.
[20] Cross JH, Harrison CJ, Preston PR, Rushton DI, Newell SJ, Morgan MEI, et al. Postnatal encephaloclasticporencephaly - a new lesion? Archives of Disease in Childhood 1992;67:307-11
[21] Harding JE, Miles FKI, Becroft DMO, Allen BC, Knight DB. Chest physiotherapy may be associated with brain damage in extremely premature babies. Journal of Pediatrics 1998;132:440-4.
[22] Chest physiotherapy for reducing respiratory morbidity ininfants requiring ventilatory support (Review)Hough JL, Flenady V, Johnston L, Woodgate PG
Evid.-Based Child Health 5: 54–79 (2010)
[23] Herper RG and Sia C et al neonatal outcomes of infants born at 500-800 grams from 1990 through 1998 in a tertiary care center. J. perinatal 2002;22:555-62
[24] King M Zidulka A et al. Tracheal mucus clearance in high frequency oscillation; chest wall versus mouth oscillation.Am Rev Respir Dis 1984;130: 703-6
[25] Wong I Fok TF Resolution of pulmonary over inflation in an extreme low birth weight neonate utilizing “ lung squeezing” technique – a case report. Hong Kong Physiotherapy Journal 2001; 19:17-20
[26] Jonson B,Svantesson C. Elastic pressure-volume curve: what information do they convey? Thorax 1999;54:82-7.
[27] Macklem PT, Mead J. Resistance of central and peripheral air-ways as measured by are trogradecatheter.JApplPhysiol 1967;22:395.
[28] Brandford Bf et al Chest physiotherapy failed to prevent postoperative atelectasis in children after cardiac surgery. Am surg 1982;195:451-5
[29] Jan Stephen Tecklin Pediatric Physical therapy: third edition
[30] Evorwong 2006 Effects of Lung squeezing technique on lung mechanics in mechanically ventilated preterm infants with respiratory distress syndrome.
[2] Farrell PM, Avery ME: Hyaline membrane disease. Am Rev Respir Dis 111:657,1975.
[3] Neonatal and Pediatric respiratory care: second edition: Donald Eitzman.
[4] Ivor Wong, Ti Fi fok: Randomized comparison of two physiotherapy regimens for correcting atelectasis in ventilated pre term neonates: 2003.
[5] Tepper R S , Morgan W J , Cota K, et al, GHMA Pediatricians .Physiologic growth and development of the lung during the first year of life. Am RevRespirDis1986; 13 :513 - 9 .
[6] Kotecha S. Lung growth: implications for the newborn infant .Arch Dis Child Fetal Neonatal Ed 2000 ; 82:F69-74.
[7] Menkes HA, Traystman R .Collateral ventilation. Am RevRespirDis1977;116:287-309.
[8] Flenady VJ, Gray PH. Chest physical therapy for preventing morbidity in babies being extubated from mechanical ventilation. Cochrane Review. Oxford: Update Software; 2000 (The Cochrane Library, 4).
[9] Antuneslco, silvaeg, bocardo p, daherdr, faggiottord&rugololmss, issn Effects of conventional chest physical therapy versus Lung Squeezing Technique on oxygen saturation, heart rate and respiratory rate in premature infants following extubation. 1809-9246, rev. bras. fisioter. Vol.10, No.1 (2006), 87-92 ©RevistaBrasileira de Fisioterapia.
[10] saleh al-alaiyan,md, frcp(c),david dyer and bashir khan Chest physiotherapy and post-extubation atelectasis in infants.. 1996. Pediatric Pulmonology. 21:227-230.
[11] Crane L Physical therapy for neonates with respiratory dysfunction.PhysTher1981;61:1764-73.
[12] Tudehope DI, Bagley C Techniques of physiotherapy in intubated babies with the respiratory distress syndrome..AustPaediatr J 1980;16:226-8.
[13] Fox WW, Schwartz JG, Shaffer TH. J Pulmonary physiotherapy in neonates: physiologic changes and respiratory management. Pediatr1978;92:977-81
[14] .Finer NN, Boyd DPT. Chest physiotherapy in the neonate: A controlled study. Pediatrics 1978;61:282-5.
[15] Curran LC, Kachoyeanos MK. The effects on neonates of two methods of chest physical therapy. Mothercraft Nursing 1979;4:309-13.
[16] Etches PC, Scott B. Chest physiotherapy in the newborn: Effects on secretions removed. Pediatrics 1978;62:713-5.
[17] Fox WH, Schwartz JG, Shaffer TH. Pulmonary physiotherapy in neonates: Physiologic changes and respiratory management. Journal of Pediatrics 1978;92:977-81.
[18] Purohit DM, Caldwell C, Levkoff AH. Multiple rib fractures due to physiotherapy in a neonate with hyaline membrane disease. American Journal of Disease of Children 1975;129:1103-4.
[19] Raval D, Yeh TF, Mora A, Cuevas D, Pyati S, Pildes RS. Chest physiotherapy in preterm infants with RDS in the first 24 hours of life. Journal of Perinatology 1987;7:301-4.
[20] Cross JH, Harrison CJ, Preston PR, Rushton DI, Newell SJ, Morgan MEI, et al. Postnatal encephaloclasticporencephaly - a new lesion? Archives of Disease in Childhood 1992;67:307-11
[21] Harding JE, Miles FKI, Becroft DMO, Allen BC, Knight DB. Chest physiotherapy may be associated with brain damage in extremely premature babies. Journal of Pediatrics 1998;132:440-4.
[22] Chest physiotherapy for reducing respiratory morbidity ininfants requiring ventilatory support (Review)Hough JL, Flenady V, Johnston L, Woodgate PG
Evid.-Based Child Health 5: 54–79 (2010)
[23] Herper RG and Sia C et al neonatal outcomes of infants born at 500-800 grams from 1990 through 1998 in a tertiary care center. J. perinatal 2002;22:555-62
[24] King M Zidulka A et al. Tracheal mucus clearance in high frequency oscillation; chest wall versus mouth oscillation.Am Rev Respir Dis 1984;130: 703-6
[25] Wong I Fok TF Resolution of pulmonary over inflation in an extreme low birth weight neonate utilizing “ lung squeezing” technique – a case report. Hong Kong Physiotherapy Journal 2001; 19:17-20
[26] Jonson B,Svantesson C. Elastic pressure-volume curve: what information do they convey? Thorax 1999;54:82-7.
[27] Macklem PT, Mead J. Resistance of central and peripheral air-ways as measured by are trogradecatheter.JApplPhysiol 1967;22:395.
[28] Brandford Bf et al Chest physiotherapy failed to prevent postoperative atelectasis in children after cardiac surgery. Am surg 1982;195:451-5
[29] Jan Stephen Tecklin Pediatric Physical therapy: third edition
[30] Evorwong 2006 Effects of Lung squeezing technique on lung mechanics in mechanically ventilated preterm infants with respiratory distress syndrome.