title: Early respiratory therapy reduces postoperative atelectasis in children undergoing lung resection.
abstract: BACKGROUND
  Early physiotherapy reduces pulmonary complications after lung resection in adult patients. However, the effectiveness and the techniques used in postoperative physiotherapy in children undergoing lung resection have not been well described. Therefore, the standardization of a physiotherapeutic attendance after lung resection in children is necessary.
  
  
  METHODS
  This was a retrospective and prospective, interventional, descriptive, and quantitative study. We evaluated 123 pediatric subjects undergoing lung resection. Fifty-two children were prospectively submitted to a standardized physiotherapy protocol that included a mask with a positive expiratory pressure of 10 cm H2O, expiratory rib cage compression, coughing, lifting the upper limbs, and ambulation, starting within the first 4 hours after surgery and continuing 3 times each day. A historical control group of 71 subjects received physiotherapeutic techniques without specific standardization and with variability in the start date and number of days attended. We recorded the presence of postoperative complications, prolonged air leak, postoperative bronchoscopy, the time of chest tube removal, and hospital stay following surgery.
  
  
  RESULTS
  The group that received a standardized protocol of physiotherapy had fewer instances of atelectasis than the control group (15.4% vs 7.6%, P = .01). Subjects in the control group were more likely than those in the intervention group to require fiberoptic bronchoscopy for bronchial toilet (n = 14 [19.7%] vs n = 5 [9.6%], P ≤ .001). There was no difference in the time of drainage or hospital stay between the groups.
  
  
  CONCLUSIONS
  Implementation of a standardized physiotherapeutic protocol after lung resection in children decreases atelectasis but does not reduce the time of chest tube removal or the duration of hospital stay.
authors.affiliation: Department of Thoracic Surgery, Hospital da Criança Santo Antônio/Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Patrícia Nerys
authors.initials: PN
authors.lastname: Kaminski
authors.forename: Luiz Alberto
authors.initials: LA
authors.lastname: Forgiarini
authors.forename: Cristiano Feijó
authors.initials: CF
authors.lastname: Andrade
mesh_terms: D001132:Arm / Q000502:physiology; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D003371:Cough; D004322:Drainage; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D009068:Movement / Q000502:physiology; D026741:Physical Therapy Modalities; D011013:Pneumonectomy / Q000009:adverse effects*; D011175:Positive-Pressure Respiration; D011182:Postoperative Care; D001261:Pulmonary Atelectasis / Q000209:etiology / Q000517:prevention & control*; D012138:Respiratory Therapy; D013997:Time Factors; D016138:Walking / Q000502:physiology