Effectiveness of Chest Physiotherapy in Infants Hospitalized with Acute Bronchiolitis: A Multicenter, Randomized, Controlled Trial

Gajdos, Vincent; Katsahian, Sandrine; Beydon, Nicole; Abadie, Véronique; Pontual, Loïc de; Larrar, Sophie; Epaud, Ralph; Chevallier, Bertrand; Bailleux, Sylvain; Mollet-Boudjemline, A.; Bouyer, Jean; Chevret, Sylvie; Labrune, Philippe

doi:10.1371/journal.pmed.1000345

Cited by 83 publications

(85 citation statements)

References 29 publications

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“…[145][146][147][148] Since that review, a study 149 of the passive expiratory technique found a small, but significant reduction in duration of oxygen therapy, but no other benefits.…”

Section: Figurementioning

confidence: 99%

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

Ralston¹,

Lieberthal²,

Meissner³

et al. 2014

Pediatrics

1,421

1,654

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This guideline is a revision of the clinical practice guideline, “Diagnosis and Management of Bronchiolitis,” published by the American Academy of Pediatrics in 2006. The guideline applies to children from 1 through 23 months of age. Other exclusions are noted. Each key action statement indicates level of evidence, benefit-harm relationship, and level of recommendation. Key action statements are as follows:

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“…[145][146][147][148] Since that review, a study 149 of the passive expiratory technique found a small, but significant reduction in duration of oxygen therapy, but no other benefits.…”

Section: Figurementioning

confidence: 99%

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

Ralston¹,

Lieberthal²,

Meissner³

et al. 2014

Pediatrics

1,421

1,654

View full text Add to dashboard Cite

show abstract

“…Gajdos et al 25 , conducted a multicenter clinical trial in 496 infants using the forced expiratory technique, this study showed no benefits of the CP but the primary end point was the time of randomization to the recovery of these patients. It is very important to emphasize that the forced expiratory technique should be avoided in children under 24 months of age due to high compliance tracheal and chest, because the rapid chest compression promotes an interruption of expiratory flow 26 thus demonstrating the importance of creating a modulated flow so that there is an appropriate extension of the expiratory phase and a subsequent clearance of the distal airways.…”

Section: Discussionmentioning

confidence: 99%

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial

Gomes¹,

Postiaux²,

Medeiros³

et al. 2012

Rev. bras. fisioter.

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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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“…Controlled studies have demonstrated no benefit from increased-exhalation technique on hospital stay or cardiorespiratory parameters in severe acute viral bronchiolitis. [41][42][43] In addition, side effects have been observed (vomiting, transient respiratory dysfunction, bouts of hypotonia), requiring interruption of the procedure. Rib fracture and mechanical drawbacks such as tracheal collapse leading to air and secretion trapping have also been observed.…”

Section: Chest Physical Therapymentioning

confidence: 99%

“…CPT may delay or prevent the need for mechanical ventilation and may result in fewer complications, but the study was unable to demonstrate such outcomes, as the study did not have sufficient power. Also, the Gajdos et al study 41 and the Rochat et al study 53 have identified patient subgroups whose auscultation was improved by this treatment. This improvement would be due to the absence of atopic background.…”

Section: Chest Physical Therapymentioning

confidence: 99%

Chest Physical Therapy in Acute Viral Bronchiolitis: An Updated Review

2013

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Effectiveness of Chest Physiotherapy in Infants Hospitalized with Acute Bronchiolitis: A Multicenter, Randomized, Controlled Trial

Abstract: Vincent Gajdos and colleagues report results of a randomized trial conducted among hospitalized infants with bronchiolitis. They show that a physiotherapy technique (increased exhalation and assisted cough) commonly used in France does not reduce time to recovery in this population.

Cited by 83 publications

References 29 publications

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

Chest physical therapy is effective in reducing the clinical score in bronchiolitis: randomized controlled trial

Chest Physical Therapy in Acute Viral Bronchiolitis: An Updated Review

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