title: What is the role of the physiotherapist in paediatric intensive care units? A systematic review of the evidence for respiratory and rehabilitation interventions for mechanically ventilated patients.
abstract: BACKGROUND
  Physiotherapy in intensive care units (ICU) has traditionally focussed on the respiratory management of mechanically ventilated patients. Gradually, focus has shifted to include rehabilitation in adult ICUs, though evidence of a similar shift in the paediatric ICU (PICU) is limited.
  
  
  OBJECTIVE
  Review the evidence to determine the role of physiotherapists in the management of mechanically ventilated patients in PICU.
  
  
  METHODS
  A search was conducted of: PEDro, CINAHL, Medline, PubMed and the Cochrane Library.
  
  
  METHODS
  Studies involving PICU patients who received physiotherapy while invasively ventilated were included in this review. Those involving neonatal or adult ICU patients, or patients on non-invasive or long-term ventilation, were not included in the study.
  
  
  METHODS
  All articles were critically appraised by two reviewers and results were analysed descriptively.
  
  
  RESULTS
  Six studies on chest physiotherapy (CPT) met the selection criteria. Results support the use of the expiratory flow increase technique and CPT, especially manual hyperinflation and vibrations, for secretion clearance. Evidence does not support the routine use of either CPT or suction alone. No studies investigating rehabilitation in PICU met selection criteria.
  
  
  CONCLUSIONS
  A lack of high level evidence was available to inform this review.
  
  
  CONCLUSIONS
  Evidence indicates that CPT is still the focus of physiotherapy intervention in PICU for mechanically ventilated patients, and supports its use for secretion clearance in this setting. PROSPERO register for systematic reviews (registration no. CRD42014009582).
authors.affiliation: Discipline of Physiotherapy, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Australia. Electronic address: ellie.hawkins@my.jcu.edu.au.
authors.forename: Ellie
authors.initials: E
authors.lastname: Hawkins
authors.affiliation: Discipline of Physiotherapy, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Australia. Electronic address: anne.jones@jcu.edu.au.
authors.forename: Anne
authors.initials: A
authors.lastname: Jones
mesh_terms: D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D059825:Physical Therapists / Q000706:statistics & numerical data*; D024382:Professional Role; D012121:Respiration, Artificial; D012138:Respiratory Therapy / Q000592:standards*
keywords: Intensive care; Mechanical; Pediatrics; Physical therapists; Physical therapy specialty; Ventilators