Effect of Postural Drainage With or Without Thoracic Squeezing on O2 and Respiratory Rate in Infant With RDS.

Immediate Effects of Postural Drainage With or Without Thoracic Squeezing on Oxygen Saturation and Respiratory Rate in Children With Respiratory Distress Syndrome.

This study investigated whether adding thoracic squeezing to postural drainage improves immediate respiratory outcomes in preterm infants with Respiratory Distress Syndrome (RDS).

Over nine months, 14 preterm infants (all born via cesarean section) were randomly assigned to two groups. The control group received standard care with postural drainage, while the experimental group received postural drainage combined with the lung squeezing technique (LST), which applies gentle chest pressure to enhance airflow and mucus clearance. Infants with genetic disorders, congenital anomalies, or on neurotropic drugs were excluded.

Oxygen saturation and respiratory distress were measured using the Oxygen Saturation Index and Silverman-Anderson Scale, with data analyzed in SPSS.

The study aimed to determine whether combining thoracic squeezing with postural drainage has a greater immediate effect on improving oxygen levels and reducing respiratory distress compared to postural drainage alone.

Study Overview

• Status: Recruiting
• Conditions: Respiratory Distress Syndrome
• Intervention / Treatment: Other: POSTURAL DRAINAGE TECHNIQUE

Detailed Description

Respiratory distress syndrome (RDS) is a common respiratory condition affecting preterm infants, characterized by insufficient lung function leading to impaired oxygenation and increased respiratory effort. Physiotherapy interventions like postural drainage are often used to improve lung clearance and respiratory status. However, the effectiveness of combining postural drainage with thoracic squeezing on immediate respiratory outcomes remains unclear. The lung squeezing technique (LST), an advanced form of chest physiotherapy, involves applying gentle, sustained pressure to the chest wall, followed by a full release. This process helps elevate intrathoracic pressure, which can activate the cough reflex, aid in the movement of mucus, promote deeper inhalation, and enhance ventilation within the alveoli. The objective of the study is aimed to evaluate the immediate effects of postural drainage with or without thoracic squeezing on oxygen saturation and respiratory rate in children with RDS.

This study was conducted over nine months at AMTH and HLTH settings, enrolling a total of 14 preterm infants with a history of cesarean section birth. Participants were selected using the Epi tool for sample size calculation and randomized into two groups: the control group received standard care involving postural training, while the experimental group underwent postural drainage combined with thoracic squeezing techniques. Exclusion criteria included infants under treatment with neurotropic drugs, those diagnosed with genetic disorders, and those presenting with congenital cardiac or respiratory anomalies. Data collection employed the Oxygen Saturation Index to measure oxygen levels and the Silverman-Anderson Scale to assess respiratory distress. Collected data were analyzed using SPSS software to determine the effects of the interventions on oxygen saturation and respiratory rate.

• Study Type: Interventional
• Enrollment (Estimated): 14
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: IMRAN AMJAD, PHD; Phone Number: +9233224390125; Email: imran.amjad@riphah.edu.pk
• Study Contact Backup: Name: Muhammad Asif Javed, PhD*; Phone Number: +923224209422; Email: a.javed@riphah.edu.pk

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54000
      • Recruiting
      • Children Hospital
      • Contact: IMRAN AMJAD, PHD; Phone Number: +9233224390125; Email: imran.amjad@riphah.edu.pk
      • Contact: MUHAMMAD ASIF JAVED, MS-PT; Phone Number: +923224209422; Email: a.javed@riphah.edu.pk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• ● Children diagnosed with RDS.

  • Pre term infants. Birth history with c- section.
  • No congenital malformation.

Exclusion Criteria:

• ● Under treatment with neurotropic drugs.

  • Respiratory and cardiac congenital anamolies.
  • Genetic disorder.
  • Interventricular hemorrhage or seizures.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Oxygenation levels; Evaluated using measures such as pulse oxygen saturation (SpO2) or arterial oxygen saturation (SaO2), arterial partial pressure of oxygen (PaO2), or the Oxygen Saturation Index (OSI). This calculation provides a non-invasive measure of oxygenation efficiency. Research has shown that OSI is just as reliable as the Oxygenation Index (OI) in evaluating the severity of pediatric acute respiratory distress syndrome (PARDS). Since OSI uses peripheral oxygen saturation (SpO₂) instead of arterial blood gases, it serves as a practical and effective alternative, particularly in settings where frequent arterial sampling is not feasible. The Oxygen Saturation Index (OSI) is determined using the formula: (FiO₂ × mean airway pressure × 100) ÷ SpO₂ (14).	Other: POSTURAL DRAINAGE TECHNIQUE; A structured chest physiotherapy protocol will be applied in neonates to enhance airway clearance by targeting specific lung segments. This includes appropriate positioning-supine for upper lobes and side-lying for lower lobes-combined with gentle chest percussion to mobilize secretions while avoiding sensitive areas. Sessions last 4-5 minutes and are repeated every 3 hours, with careful monitoring of vital signs and precautions such as avoiding treatment soon after feeding. Additionally, the thoracic squeezing technique is used to simulate a cough by applying gentle, rhythmic compressions during expiration in a side-lying position. Performed for about 10 minutes on each side after drainage or percussion, it helps move secretions toward central airways, particularly in infants with weak cough reflexes, with continuous monitoring to ensure safety and immediate cessation if distress occurs.; Other Names: Thoracic Squeezing Technique
Experimental: ANDERSON Scale.; The Silverman-Anderson scores are widely used clinical tools designed to evaluate the severity of respiratory distress in newborns. Both systems rely on objective clinical parameters to quantify respiratory difficulty. The Silverman-Anderson score specifically measures five key signs: chest retractions in the upper and lower thorax, subxiphoid retraction, nasal flaring, and audible grunting during exhalation. Each of these indicators is rated on a scale from 0 to 2, allowing healthcare providers to systematically assess and monitor the progression or improvement of respiratory distress in neonates.	Other: POSTURAL DRAINAGE TECHNIQUE; A structured chest physiotherapy protocol will be applied in neonates to enhance airway clearance by targeting specific lung segments. This includes appropriate positioning-supine for upper lobes and side-lying for lower lobes-combined with gentle chest percussion to mobilize secretions while avoiding sensitive areas. Sessions last 4-5 minutes and are repeated every 3 hours, with careful monitoring of vital signs and precautions such as avoiding treatment soon after feeding. Additionally, the thoracic squeezing technique is used to simulate a cough by applying gentle, rhythmic compressions during expiration in a side-lying position. Performed for about 10 minutes on each side after drainage or percussion, it helps move secretions toward central airways, particularly in infants with weak cough reflexes, with continuous monitoring to ensure safety and immediate cessation if distress occurs.; Other Names: Thoracic Squeezing Technique

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Oxygenation levels	Evaluated using measures such as pulse oxygen saturation (SpO2) or arterial oxygen saturation (SaO2), arterial partial pressure of oxygen (PaO2), or the Oxygen Saturation Index (OSI). This calculation provides a non-invasive measure of oxygenation efficiency. Research has shown that OSI is just as reliable as the Oxygenation Index (OI) in evaluating the severity of pediatric acute respiratory distress syndrome (PARDS). Since OSI uses peripheral oxygen saturation (SpO₂) instead of arterial blood gases, it serves as a practical and effective alternative, particularly in settings where frequent arterial sampling is not feasible. The Oxygen Saturation Index (OSI) is determined using the formula: (FiO₂ × mean airway pressure × 100) ÷ SpO₂ (14).	BASE LINE, 4 WEEKS

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
ANDERSON Scale	The Silverman-Anderson scores are widely used clinical tools designed to evaluate the severity of respiratory distress in newborns. Both systems rely on objective clinical parameters to quantify respiratory difficulty. The Silverman-Anderson score specifically measures five key signs: chest retractions in the upper and lower thorax, subxiphoid retraction, nasal flaring, and audible grunting during exhalation. Each of these indicators is rated on a scale from 0 to 2, allowing healthcare providers to systematically assess and monitor the progression or improvement of respiratory distress in neonates.	BASE LINE, 4 WEEKS

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: NIMRA MUBASHAR, MS-PT, Riphah International University

Publications and helpful links

Helpful Links

• Effect of Thoracic Squeezing Technique and Expiratory Flow Increase Technique on Neonates With Neonatal Respiratory Distress Syndrome: A Case Report

Study record dates

Study Major Dates

• Study Start (Actual): October 28, 2025
• Primary Completion (Estimated): July 5, 2026
• Study Completion (Estimated): August 6, 2026

Study Registration Dates

• First Submitted: May 5, 2026
• First Submitted That Met QC Criteria: May 5, 2026
• First Posted (Actual): May 11, 2026

Study Record Updates

• Last Update Posted (Actual): May 11, 2026
• Last Update Submitted That Met QC Criteria: May 5, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: RDS, Postural drainage, Thoracic squeezing, O2
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Lung Diseases; Respiration Disorders; Respiratory Distress Syndrome
• Other Study ID Numbers: REC/RCR&AHS/NIMRA

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No