Cardio-respiratory physiotherapy

Cardio-respiratory physiotherapy aims to help clear lung secretions, prevent or improve areas of lung collapse and reduce the effort of breathing.

This form of physiotherapy helps treat children with chronic respiratory conditions such as cystic fibrosis. It may also be useful in children with an acute respiratory illness or following surgery, especially when ventilation is required on an intensive care unit.

The cardio-respiratory physiotherapy team at Great Ormond Street Hospital (GOSH) covers the following clinical specialties, each of which is led by specialist physiotherapists:

• cardiac critical care (Flamingo Ward)

• cardiothoracic transplant

• Paediatric Intensive Care Unit (PICU) and Neonatal Intensive Care Unit (NICU)

• cystic fibrosis and respiratory (Badger Ward)

The cardio-respiratory team has close links with the Institute of Child Health and University College London, which runs an MSc in Advanced Cardio-respiratory Physiotherapy and undertakes research in the area. Much of this research is undertaken at Great Ormond Street Hospital, keeping us at the forefront of advancing evidence in cardio-respiratory physiotherapy.

• cystic fibrosis

• bronchiectasis

• respiratory muscle weakness in neuromuscular conditions such as spinal muscular atrophy

• tracheal surgery (eg slide tracheoplasty)

• congenital cardiac conditions requiring surgery, such as hypoplastic left heart syndrome, septal defects, tetralogy of Fallot, transposition of the great arteries, cardiac and respiratory ECMO (extracorporeal membrane oxygenation)

• heart or lung transplant

• surgery for chest wall deformities

• head injuries

• meconium aspiration and pulmonary hypertension of the newborn

• congenital diaphragmatic hernias

• premature infants requiring surgery eg bowel perforation, necrotising entercolitis, closure of patent ductus arteriosus

• sepsis

• chest infections

• neurosurgery such as embolisation for vein of Galen, removal of brain tumours, insertion of shunts

All lungs produce secretions. In some instances excessive secretions can build up in the lungs, such as following a general anaesthetic, when on a ventilator or in specific conditions such as cystic fibrosis. If left untreated, this can lead to areas of lung collapse making breathing difficult and your body’s organs struggling to receive enough oxygen.

Physiotherapy aims to clear the lungs of secretions, reduce the effort of breathing and improve exercise tolerance. Physiotherapy is important for patients requiring mechanical ventilation for preventing or resolving respiratory complications. This enables ventilation to be stopped as quickly as possible, helping reduce the length of time spent on intensive care and promoting a speedy discharge from hospital.

Ventilated children on intensive care may be repositioned to improve breathing or allow gravity to help drain a specific area of lung. The physiotherapist can help to move secretions closer to the windpipe by giving deep breaths via a specialised bag, and chest vibrations where the secretions can then be suctioned from the breathing tube.

Children on intensive care usually require heavy sedation, which makes essential tasks such as physiotherapy more comfortable. Children with mobility, neurological or neurodevelopmental problems may also be assessed on intensive care and treatment can start here or when they are transferred to the ward.

Chest physiotherapy for children and young people on the ward may involve blowing games for younger children, or using more specific devices to help clear secretions. Wherever possible the physiotherapist will make it child-friendly and fun. Treatment may also be exercise focused, such as encouraging mobilisation and games in the gym.