Respiratory Physiotherapy After Paediatric Cardiac Surgery: The Interaction between Physiotherapist, Nurse and Parent

  • Davide Girelli


Technically, paediatric rehabilitation is not different from adult rehabilitation. The main difference consists in the possibility of establishing a verbal communication. This is difficult, if not impossible, in the paediatric patient since the abilities of verbal expression and comprehension are not completely developed, especially during the neonatal period.

The main purpose in the context of paediatric cardiac surgery is to guarantee the patient a better future quality of life. Recognizing the clinical conditions of rehabilitative interest and the management of anxiety and fears of the relatives of the young patients represents additional difficulties. The fundamental difference with the adult patient is that this one can communicate his or her own perceptions, fears, difficulties and hopes but even his or her own symptoms. So the keywords in the rehabilitative treatment of the newborn are imagination and simplicity. The treatment includes the aid in enforcing motoric planning and execution. In paediatric rehabilitation, careful observation is one of the central competences of the physiotherapist [1].


  1. 1.
    Giornale italiano di cardiologia. Vol. 15. aprile 2014.Google Scholar
  2. 2.
    Schaaf RC, Sherwen LN, Youngblood N. An interdisciplinary, environmentally-based model of care for children with HIV infection and their caregivers. Phys Occup Ther Pediatr. 1997;17(3):63–85.CrossRefGoogle Scholar
  3. 3.
    Zuffo S. La fisioterapia respiratoria disostruente con PEP mask nel lattante e nel bambino non collaborante (cerebropatie di varia natura). Quaderni AITR. 1995;9(1–8):15–22.Google Scholar
  4. 4.
    Jenkins SC. Chapter 8: Pre-operative and post-operative physiotherapy—are they necessary? In: Respiratory care. Churchill Livingstone; 1991. p. 147–68.Google Scholar
  5. 5.
    Terry PB, Traytsman RJ, Newball HH, et al. Collateral ventilation in man. N Engl J Med. 1978;298:10–5.CrossRefGoogle Scholar
  6. 6.
    Zuffo S. Fisioterapia respiratoria in terapia intensiva neonatale (TIN). Boll ARIR. 1996; anno 5, n. 1:11–20 e 27–8.Google Scholar
  7. 7.
    Review Article “Pediatric cardiac surgery: what to expect from physiotherapeutic intervention?” Braz J Cardiovasc Surg (Rev Bras Cir Cardiovasc). 2011;26(2). São José do Rio Preto Apr./June 2011.Google Scholar
  8. 8.
    Leininger M, Mcfarland MR. Transcultural nursing: concepts, theories, research and practice. 3rd ed. New York: McGraw-Hill; 2002.Google Scholar
  9. 9.
    World Health Organization.
  10. 10.
    The Ottawa charter for health promotion. 1986. 10-3-2012.Google Scholar
  11. 11.
    Isaacs S, Valaitis R, Newbold KB, Black M, Sargeant J. Competence trust among providers as fundamental to a culturally competent primary healthcare system for immigrant families. Prim Health Care Res Dev. 2012;13:1–10.Google Scholar
  12. 12.
    Ferrari B. Il lavaggio nasale: aspetti pratici. Riv Ital Fisioter Riabil Respir. 2007;3:18–22.Google Scholar
  13. 13.
    Marchisio P, Fusi M, Dusi E, Bianchini S, Nazari E, Principi N. Il lavaggio nasale con soluzioni saline come terapia delle infezioni delle alte vie respiratorie in etá pediatrica: dai presupposti ai metodi. Riv Ital Fisioter Riabil Respir. 2007;3:11–22.Google Scholar
  14. 14.
    Walsh BK, Hood K, Merritt G. Pediatric airway maintenance and clearance in the acute care setting: how to stay out of trouble. Respir Care. 2011;56(9):1424–40. ; discussion 1440–4. Scholar
  15. 15.
    Hess DR. Secretion clearance techniques: absence of proof or proof of absence? (editorial). Respir Care. 2002;47(7):757–8.PubMedGoogle Scholar
  16. 16.
    Fink JB. Positive pressure techniques for airway clearance. Respir Care. 2002;47(7):786–96.PubMedGoogle Scholar
  17. 17.
    Gaskell D, Webber BA. The Brompton Hospital guide to chest physiotherapy. Oxford: Blackwell Scientific; 1973.Google Scholar
  18. 18.
    Hough A. Physiotherapy in respiratory care: a problem solving approach. London: Chapman & Hall; 1991.Google Scholar
  19. 19.
    Oberwaldner B. Physiotherapy for airway clearance in paediatrics. Eur Respir J. 2000;15(1):196–204.CrossRefPubMedGoogle Scholar
  20. 20.
    Mellins R. Pulmonary physiotherapy in the pediatric age group. Am Rev Respir Dis. 1974;110(2):137–42.PubMedGoogle Scholar
  21. 21.
    Review Article. “Importance of pre- and postoperative physiotherapy in pediatric cardiac surgery”. Rev Bras Cir Cardiovasc. 2009;24(3). São José do Rio Preto July/Sept. 2009.Google Scholar
  22. 22.
    Faling L. Chest physical therapy. Philadelphia: Lippincott; 1991. p. 625–54.Google Scholar
  23. 23.
    ACPRC 2011: Leaflet No. GL-05. “The active cycle of breathing techniques” recommendations from guidelines for physiotherapy management of adult, medical, spontaneously breathing patient.Google Scholar
  24. 24.
    Bellone A. Riabilitazione respiratoria – Nuovi Orientamenti, Ed. Midia, Monza (MI), Bottiglia d’acqua con il tubo; 1996.Google Scholar
  25. 25.
    Brivio A, Lazzeri M, Oliva G, Zampogna E. La disostruzione bronchiale - dalla teoria alla pratica, Ed. Masson, Milano; 2001.Google Scholar
  26. 26.
    Great Ormond Street Hospital (G.O.S.H.) for Children NHS Foundation Trust, “Bubble Pep, Information for Families” compiled by the respiratory physiotherapists, January 2014.Google Scholar
  27. 27.
    AARC clinical practice guideline: use of PAP adjuncts to bronchial hygiene therapy. Respir Care. 1993:38:516–20.Google Scholar
  28. 28.
    EzPAP package insert on Suggested Instructions for Use, DHD Healthcare Corporation.Google Scholar
  29. 29.
    Brivio A, Privitera E, Lazzeri M, Sommariva M, Repossini E, Zuffo S. Protocollo clinico pratico per l’utilizzo del presidio EzPAPTM, Rivista Italiana di Fisioterapia e Riabilitazione Respiratoria Maggio-Agosto 2013 • Numero 2.Google Scholar
  30. 30.
    Manual hyperinflation (MHI) guideline for practice. 2015.Google Scholar
  31. 31.
    de Godoy VC, Zanetti NM, Johnston C. Manual hyperinflation in airway clearance in pediatric patients: a systematic review. Rev Bras Ter Intensiva. 2013;25(3):258–62. Scholar
  32. 32.
    Craven RF, Himle CJ. Principi fondamentali dell’assistenza infermieristica. Vol. I e II. Milano: Casa editrice Ambrosiana; 2007.Google Scholar
  33. 33.
    American Association for Respiratory Care. Nasotracheal suctioning. Respir Care. 2004;49:1080–4.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Davide Girelli
    • 1
  1. 1.Pediatric and Adult Congenital Heart CentreIRCCS Policlinico San DonatoMilanItaly

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