Use of airway clearance therapy in children hospitalised with acute lower respiratory tract infections in a South African paediatric hospital.

BACKGROUND

Little is known about the prescription, frequency and nature of airway clearance therapy (ACT) in children hospitalised with lower respiratory tract infections (LRTIs).

OBJECTIVES

To describe the characteristics and outcomes of children hospitalised with LRTIs at a tertiary paediatric hospital in South Africa and to investigate the role and impact of ACT in these children.

METHOD

A retrospective folder review of children hospitalised with LRTI between January and June 2015 was conducted, extracting data on demographic characteristics, health condition, ACT interventions and patient outcomes.

RESULTS

A total of 1208 individual cases (median [IQR] age 7.6 (2.8-19.0) months), in 1440 hospitalisations, were included. The majority of children were hospitalised primarily for the management of bronchiolitis. Comorbidities were present in 52.6% of patients during at least one of their hospitalisations. Airway clearance therapy was administered in 5.9% ( = 85) of admissions, most commonly conventional (manual) ACT. Transient oxyhaemoglobin desaturation was reported in six children, and one child developed lobar collapse an hour post-treatment. No other adverse events were reported. The median (IQR) duration of hospitalisation was 2.3 (1.5-5.0) days, and the overall mortality rate was 0.7%. Children hospitalised for presumed nosocomial infections and pneumonia had the longest length of stay, were more likely to receive ACT and had the highest mortality rate.

CONCLUSION

Airway clearance therapy was infrequently used in this population and was more commonly applied in those with nosocomial LRTI and pneumonia.

CLINICAL IMPLICATIONS

Although ACT was generally well tolerated, safety has not been ascertained, and oxygen saturation should be carefully monitored during therapy.