Effect of Assisted Autogenic Drainage In Children Suffering From Pneumonia
Condition: Pneumonia Childhood
MeSH terms: Pneumonia
Study type: Interventional

Summary: 
      Quasi experimental study with duration will be of 6 month, data will be collected from Fauji
      Foundation Hospital, Rawalpindi. Sample size was calculated from open epi tool (2017) was
      n=60. Non probability convenient type of sampling technique is used. Children suffering from
      pneumonia between the ages 5-15 years with class III & IV on pneumonia severity index. Both
      genders are included under study. Patients on 2nd & 3rd generation anti-biotic therapy for
      pneumonia are included in the study. Children with musculoskeletal disorders, neuromuscular
      disorders, cardiovascular co-morbidities and children with diagnosed lobular pneumonia will
      be excluded. Self-structured questionnaire will be used which includes the demographics,
      Pneumonia Severity Index, type of Assistive Breathing devices/ Litre of Oxygen support,
      Vitals, Atrial blood gases(ABG's), Chest X rays and Pediatric Early Warning Sign-Respiratory
      system.
    

Detailed description: 
      Pneumonia is the number one infectious killer of children under age 5 globally, according to
      a World Health Organization (WHO) report year 2015, about 9,35,002 children die of pneumonia
      every year. In the same report it is stated that Pakistan ranks at third among 15 countries
      contributing to the global burden of child pneumonia. Pneumonia is basically an infection in
      one or both lungs. It can be caused by bacteria, viruses, or fungi. Bacterial pneumonia is
      the most common type in infants however in children Respiratory Syncytial Virus (RSV) is most
      common cause of Viral Pneumonia. Regarding the pathophysiology of Pneumonia, there is an
      inflammation in the air sacs of lungs, which are called alveoli, resultantly the alveoli are
      filled with fluid or pus, making it difficult for the patient to breathe. In order to clear
      the airways assistive techniques are used besides standard airway management. Autogenic
      drainage (AD) is an airway clearance technique which utilizes controlled breathing at
      different lung volumes in order to loosen, mobilize and move secretions in three stages
      towards the larger central airways.One of the modified form of Autogenic Drainage is Assisted
      Autogenic Drainage (AAD) which is based upon the principles of Autogenic Drainage and is used
      in infants and younger patient groups. This technique is performed by placing the hands on
      the child's chest, the therapist manually increases the expiratory flow in order to achieve
      the different lung volume breathing.

      The chapter 07: vol 1 of book "Physiotherapy Intervention" states that the aim of AAD is to
      achieve an optimal expiratory flow progressively through all generations of bronchi without
      causing dynamic airway collapse. In 2007 on " Forced expiratory technique, directed cough and
      autogenic drainage" and sates that these techniques in combined manner are effective in
      producing significant results.The direct method of chest percussion was first described by
      Auenbrugger as reported by the European Respiratory Journal, later it was used globally. The
      Chochrane Library published a research review on Chest physiotherapy for pneumonia in
      children in 2012, stating that Autogenic drainage is effective in treating cystic fibrosis
      (CF). In March 2017 on " The use of assisted autogenic drainage in children with acute and
      chronic respiratory disease" in population of South Africa which states that AAD is of
      significance importance while treating chronic respiratory diseases however the efficacy in
      direct effect on acute respiratory diseases is not studied before.In 1998 conducted a study
      on the topic of "Alternatives to percussion and postural drainage: A review of mucus
      clearance therapies: AD, positive expiratory pressure (PEP), Flutter valve, Intrapulmonary
      percussive ventilation and high frequency with Thira vest." Since late 1990's work has
      continuously been done on chronic respiratory diseases like Cystic Fibrosis in relation with
      Autogenic Drainage however regarding Assisted Autogenic Drainage in children suffering from
      Pneumonia, there is not much work done according to my knowledge. A study conducted in March
      2017 in population of South Africa which states that AAD is of significance importance while
      treating chronic respiratory diseases however the efficacy in direct effect on acute
      respiratory diseases is not studied before. This study will be going to add Evidence Based
      Treatment in the practice of Cardiopulmonary Rehabilitation and could be effective treatment
      of Pneumonia in Children population through Assisted Autogenic Drainage technique of chest
      clearance. It will be helpful in treating children suffering from Pneumonia by adding
      literature using an evidence based Chest Physical therapy treatment.

      According to the consort guidelines of the assessment of manuscript the only limitation found
      in the parent study was that the study title included both infants and young children however
      only infants were actually recruited in the study. The objective of my current study is to
      determine the effects of Assisted Autogenic Drainage in children with pneumonia.
    

Intervention name(s): Assistive autogenic Drainage
Intervention type(s): Other
Intervention description(s): Assistive autogenic Drainage : All the 3 components of Autogenic drainage was given passively to the patients. By placing the hands on the child's chest, the therapist manually increases the expiratory flow to achieve the different lung volume breathing.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Pneumonia; Drainage; Autogenic Drainage