Respiratory physiotherapy for critically ill children: concern regarding a recommendation

The guideline entitled “Japanese Clinical Practice Guidelines for Rehabilitation in Critically Ill Patients 2023” was published by the Japanese Society of Intensive Care Medicine in 2023. However, there is an issue with the clinical question and recommendation for respiratory physiotherapy in mechanically ventilated children. Although the evidence was based on two randomized controlled trials regarding prone positioning, the recommendation may have risk of misunderstanding as a recommendation for all respiratory physiotherapy. There are abundant evidence-based recommendations against chest physiotherapy for infants with bronchiolitis with no benefit and possible adverse events. Revising the recommendation for respiratory physiotherapy in critically ill, mechanically ventilated children should be considered.