BACKGROUND:We proposed a new chest physiotherapy (CPT) secretion clearance method to treat respiratory syncytial virus bronchiolitis in infants. Our new CPT method consists of 15 prolonged slow expirations, then 5 provoked cough maneuvers. METHODS: We randomized 20 infants (mean age 4.2 months) into 2 groups: 8 patients received 27 sessions of nebulization of hypertonic saline; 12 patients received 31 sessions of nebulization of hypertonic saline followed by our new CPT method. We used the Wang clinical severity scoring system (which assesses wheezing, respiratory rate, retractions, and general condition) and measured S pO 2 and heart rate before each CPT session (T0), immediately after the 30-min session (T30), and 120 min after the session (T150). RESULTS: Within the groups: in the first group, Wang score was significantly lower at T150 than at T0: 4.6 vs 5.0 (P ‫؍‬ .008). In the new-method-CPT group, Wang score was significantly lower at T30 (3.6 vs 4.3, P ‫؍‬ .001) and at T150 (3.7 vs 4.3, P ‫؍‬ .002). Wheezing score was significantly lower at T150 than at T0 (1.1 vs 1.2, P ‫؍‬ .02) in the first group, and in the new-method-CPT group at T30 than at T0 (0.8 vs 1.3, P ‫؍‬ .001) and at T150 than at T0 (0.9 vs 1.3, P ‫؍‬ .001). Between the groups: at T30 the improvement was significantly better in the new-method-CPT group for overall Wang score (P ‫؍‬ .02), retractions (P ‫؍‬ .05), respiratory rate (P ‫؍‬ .001), and heart rate (P < .001). At T150 the Wang score was not significantly different between the groups. At T30 (versus T0) the difference in percent gain between the groups was significant for Wang score (P ‫؍‬ .004), wheezing (P ‫؍‬ .001), and heart rate (P ‫؍‬ .02). Over 5-hospital days, the daily baseline (T0) Wang score decreased significantly in the new-method-CPT group (P ‫؍‬ .002), whereas it did not in the first group. There were no adverse events. Average hospital stay was not significantly different between the groups. CONCLUSIONS: Our new CPT method showed short-term benefits to some respiratory symptoms of bronchial obstruction in infants with acute respiratory syncytial virus bronchiolitis.

Objective: To evaluate the effectiveness of chest physical therapy (CP) in reducing the clinical score in infants with acute viral bronchiolitis (AVB). Methods: Randomized controlled trial of 30 previously healthy infants (mean age 4.08 SD 3.0 months) with AVB and positive for respiratory syncytial virus (RSV), evaluated at three moments: at admission, then at 48 and 72 hours after admission. The procedures were conducted by blinded assessors to each of three groups: G1 -new Chest Physical therapy-nCPT (Prolonged slow expiration -PSE and Clearance rhinopharyngeal retrograde -CRR), G2 -conventional Chest Physical therapy-cCPT (modified postural drainage, expiratory compression, vibration and percussion) and G3 -aspiration of the upper airways. The outcomes of interest were the Wang's clinical score (CS) and its components: Retractions (RE), Respiratory Rate (RR), Wheezing (WH) and General Conditions (GC). Results:The CS on admission was reduced in G1 (7.0-4.0) and G2 (7.5-5.5) but was unchanged in G3 (7.5-7.0). We observed a change 48 hours after hospitalization in G1 (5.5-3.0) and G2 (4.0-2.0) and in 72 hours, there was a change in G1 (2.0-1.0). Conclusion: The CP was effective in reducing the CS in infants with AVB compared with upper airway suction only. After 48 hours of admission, both techniques were effective and nCPT techniques were also effective in the 72 hours after hospitalization compared with cCPT techniques.Trial Registration NCT00884429-www.clinicaltrials.gov.Keywords: respiratory suncytial virus; bronchiolitis; physical therapy. ResumoObjetivo: Avaliar a efetividade da fisioterapia respiratória na redução do escore clínico em lactentes com bronquiolite viral aguda (BVA). Métodos: Ensaio controlado randomizado de 30 lactentes (média de idade 4,08±3,12 meses) com BVA, previamente hígidos, com vírus sincicial respiratório (VSR) positivo, avaliados em três momentos: admissão, 48 e 72 horas, antes e após os procedimentos por avaliadores cegos, em três grupos: G1 -técnicas atuais de fisioterapia (expiração lenta e prolongada e desobstrução rinofaríngea retrógrada), G2 -técnicas convencionais de fisioterapia (drenagem postural modificada, compressão expiratória, vibração e percussão) e G3 -aspiração de vias aéreas superiores por meio do escore clínico de Wang e seus componentes: retrações (RE), frequência respiratória (RR), sibilos (WH) e condições gerais (GC). Resultados: O escore clínico de Wang (CS) no momento admissão, no G1, reduziu de 7,0-4,0; no G2, de 7,5-5,5 e no G3 de 7,5-7,0, não apresentando alteração. No momento 48 horas, também houve alteração tanto no G1 (5,5-3,0) quanto no G2 (4,0-2,0) e, em 72 horas, apenas no G1 (2,0-1,0). Conclusão: A fisioterapia respiratória foi efetiva na redução do escore clínico em lactentes com BVA quando comparada com a aspiração isolada das vias aéreas na admissão. No momento 48 horas, ambas as técnicas foram efetivas, sendo que as técnicas atuais foram efetivas também nas 72 horas após a internação, comparada às técnicas convencionais.Registro de Ensa...

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BACKGROUND: Prolonged slow expiration (PSE) is a physiotherapy technique often applied in infants to reduce pulmonary obstruction and clear secretions, but there have been few studies of PSE's effects on the respiratory system. OBJECTIVE: To describe PSE's effects on respiratory mechanics in infants. METHODS: We conducted a cross-sectional study with 18 infants who had histories of recurrent wheezing. The infants were sedated for lung-function testing, which was followed by PSE. The PSE consisted of 3 sequences of prolonged manual thoraco-abdominal compressions during the expiratory phase. We measured peak expiratory flow (PEF), tidal volume (V T ), and the frequency of sighs during and immediately after PSE. We described the exhaled volume during PSE as a fraction of expiratory reserve volume (%ERV). We quantified ERV with the raised-volume rapid-thoracic-compression technique. RESULTS: The cohort's mean age was 32.2 weeks, and they had an average of 4.8 previous wheezing episodes. During PSE there was significant V T reduction (80 ؎ 17 mL vs 49 ؎ 11 mL, P < .001), no significant change in PEF (149 ؎ 32 mL/s vs 150 ؎ 32 mL/s, P ‫؍‬ .54), and more frequent sighs (40% vs 5%, P ‫؍‬ .03), compared to immediately after PSE. The exhaled volume increased in each PSE sequence (32 ؎ 18% of ERV, 41 ؎ 24% of ERV, and 53 ؎ 20% of ERV, P ‫؍‬ .03). CONCLUSIONS: It was possible to confirm and quantify that PSE deflates the lung to ERV. PSE caused no changes in PEF, induced sigh breaths, and decreased V T , which is probably the main mechanical feature for mucus clearance.