Airway clearance applications in infants and children.

The rationale for airway clearance therapy and basic principles of its application are identical for children and adults, but there are important differences in physiology (regarding airway mucus characteristics and airway mechanics) and pathological processes in children, as well as other considerations unique to the pediatric population. The major obstacle in reviewing the evidence for efficacy of airway clearance therapy in pediatrics is the lack of data from well-performed, adequately powered clinical trials. This problem is partially alleviated by the use of published meta-analyses. A review of pediatric studies suggests that airway clearance therapy is of clear and proven benefit in the routine care of cystic fibrosis, and that no specific airway-clearance technique is clearly superior, but for any individual patient the technique that is most likely to maximize patient adherence to treatment is preferred. Airway clearance therapy appears likely to be of benefit in the routine care of children with neuromuscular disease and cerebral palsy, and is probably of benefit in treating atelectasis in children on mechanical ventilation. Airway clearance therapy may be of benefit in preventing post-extubation atelectasis in neonates. Airway clearance therapy appears to be of minimal to no benefit in the treatment of children with acute asthma, bronchiolitis, hyaline membrane disease, and those on mechanical ventilation for respiratory failure in the pediatric intensive care unit, and it is not effective in preventing atelectasis in children immediately following surgery. All in all, however, given that these conclusions are based on very little data, future well-performed clinical trials might change the weight of evidence to contradict these current conclusions.