Respiratory compromise is the leading cause of mortality in children with severe global development delay (SGDD) yet there are no guidelines for their respiratory care.
Respiratory physio Naomi Winfield emphasised that there had never been a comprehensive analysis before the 2014 Cochrane Review
This was the message from Cochrane Review author Naomi Winfield at the Association of Paediatric Chartered Physiotherapists conference in Newcastle on 13 November 2015.
‘Children with SGDD are my biggest challenge on the ward as they have complex needs and are subject to lengthy and recurrent admissions.’ said specialist paediatric physiotherapist Ms Winfield.
She described how the patient group is managed by generalist community paediatricians and the patients rarely access specialist respiratory clinics.
‘Children with SGDD can have chest wall deformity, muscle weakness, feeding difficulties, aspiration, seizure disorders, severe cognitive impairment and immobility,’ she said.
Before the 2014 Cochrane Review, there had never been a comprehensive analysis to inform best practice, she told the event.
Treatment options
Ms Winfield presented a number of treatment adjuncts, looking at their implications and limitations. Considerations for using standard chest physiotherapy included positioning difficulties, timing around feeds and the time consuming nature, she said.
The use of positive expiratory pressure masks may be beneficial for patients with reduced functional residual capacity, atelectasis and secretion retention, she added.
High frequency chest wall oscillation could be beneficial for patients with lower respiratory tract secretions and as an alternative to chest physical therapy, but she said that cost could be an issue.
Children with weakness affecting cough efficacy and those with chronic respiratory problems may benefit from mechanical insufflation-exsufflation. Evidence also supported the use of non-invasive ventilation to aid secretion mobilisation.
‘The Cochrane Review concluded there was no definitive evidence for one single intervention, but the study results have been useful in my practice,’ she said.
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