title: Pediatric airway maintenance and clearance in the acute care setting: how to stay out of trouble.
abstract: Traditional airway maintenance and clearance therapy and principles of application are similar for neonates, children, and adults. Yet there are distinct differences in physiology and pathology between children and adults that limit the routine application of adult-derived airway-clearance  techniques in children. This paper focuses on airway-clearance techniques and airway maintenance in the pediatric patient with acute respiratory disease, specifically, those used in the hospital environment, prevailing lung characteristics that may arise during exacerbations, and the differences  in physiologic processes unique to infants and children. One of the staples of respiratory care has been chest physiotherapy and postural drainage. Many new airway clearance and maintenance techniques have evolved, but few have demonstrated true efficacy in the pediatric patient population.  Much of this is probably due to the limited ability to assess outcome and/or choose a proper disease-specific or age-specific modality. Airway-clearance techniques consume a substantial amount of time and equipment. Available disease-specific evidence of airway-clearance techniques and airway  maintenance will be discussed whenever possible. Unfortunately, more questions than answers remain.
authors.affiliation: Department of Respiratory Care, Children's Medical Center Dallas, Dallas, Texas 75235, USA. brian.walsh@children.com
authors.forename: Brian K
authors.initials: BK
authors.lastname: Walsh
authors.forename: Kristen
authors.initials: K
authors.lastname: Hood
authors.forename: Greg
authors.initials: G
authors.lastname: Merritt
mesh_terms: D055371:Acute Lung Injury / Q000473:pathology; D001249:Asthma / Q000628:therapy; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D015916:Drainage, Postural; D006801:Humans; D006813:Humidity; D007231:Infant, Newborn; D007234:Infant, Premature; D010474:Percussion; D012138:Respiratory Therapy; D013396:Suction / Q000379:methods
chemical_list: D001993:Bronchodilator Agents