Physical therapy for airway clearance improves cardiac autonomic modulation in children with acute bronchiolitis

Abstract

BackgroundThe effects of physical therapy on heart rate variability (HRV), especially in children, are still inconclusive. ObjectiveWe investigated the effects of conventional physical therapy (CPT) for airway clearance and nasotracheal suction on the HRV of pediatric patients with acute bronchiolitis. Method24 children were divided into two groups: control group (CG, n=12) without respiratory diseases and acute bronchiolitis group (BG, n=12). The heart rate was recorded in the BG at four different moments: basal recording (30 minutes), 5 minutes after the CPT (10 minutes), 5 minutes after nasotracheal suction (10 minutes), and 40 minutes after nasotracheal suction (30 minutes). The CG was subjected to the same protocol, except for nasotracheal suction. To assess the HRV, we used spectrum analysis, which decomposes the heart rate oscillations into frequency bands: low frequency (LF=0.04-0.15Hz), which corresponds mainly to sympathetic modulation; and high frequency (HF=0.15-1.2Hz), corresponding to vagal modulation. ResultsUnder baseline conditions, the BG showed higher values in LF oscillations, lower values in HF oscillations, and increased LF/HF ratio when compared to the CG. After CPT, the values for HRV in the BG were similar to those observed in the CG during basal recording. Five minutes after nasotracheal suction, the BG showed a decrease in LF and HF oscillations; however, after 40 minutes, the values were similar to those observed after application of CPT. ConclusionsThe CPT and nasotracheal suction, both used for airway clearance, promote improvement in autonomic modulation of HRV in children with acute bronchiolitis.

Rhinopharyngeal Retrograde Clearance Induces Less Respiratory Effort and Fewer Adverse Effects in Comparison With Nasopharyngeal Aspiration in Infants With Acute Viral Bronchiolitis

“…The results show that there is a reduction in heart rate after retrograde rhinopharyngeal clearance was performed (collections 1 and 2), whereas no change was observed in the aspiration group. These findings are consistent with previous studies 9,14 and indicate that heart rate reduction may be related to the reduction of respiratory distress. The mobilization of secretions with the use of less manipulative techniques, as already shown for the prolonged slow expiration, 14 may have a role in this effect.…”

“…6,17,23 In fact, outcomes such as length of hospital stay and oxygen use do not seem to change with respiratory physiotherapy, regardless of the technique studied. 5 However, signs of respiratory distress, such as wheezing and chest retractions, 8,14 and cardiorespiratory parameters, such as heart rate and breathing frequency, 9,14 besides the use of clinical scores, appear as favorable outcomes. Moreover, it seems well established that there are no adverse effects associated with the use of these techniques.…”

“…In general, chest physiotherapy in pediatrics has as its main objectives the removal of secretions, improvement of gas exchange, and reduction of the respiratory effort. 5 The use of chest physiotherapy in acute viral bronchiolitis has been evaluated and discussed in several studies, [6][7][8][9] analyzing different techniques and outcomes, but there is still no consensus. In the last Cochrane review, 5 results indicated that outcomes such as hospitalization and duration of oxygen therapy do not benefit from the use of physiotherapy techniques, especially percussion, vibration with postural drainage, and prolonged slow exhalation.…”

Análise da variabilidade da frequência cardíaca como preditora de falha/sucesso da extubação traqueal em pediatria

“…As novas tecnologias que, provavelmente, irão auxiliar na condução e na monitoração do paciente em desmame ventilatório em pediatria são: o aEEG ou eletroencefalograma de amplitude integrada, por fornecer em tempo real uma análise seriada da estimulação/funcionamento elétrico cerebral 40,41,42 ; a espectroscopia infravermelha, pois fornece a saturação tecidual regional do cérebro, rins e mesentérica 43,44 ; as cintas pletismográficas, por detectarem os sinais da contração diafragmática 45 ; o monitor Pollar ® , pois permite a aferição da variabilidade da frequência cardíaca (VFC) 46 ; a tomografia por impedância elétrica (TIE), pois possibilita analisar de forma visual e gráfica a ventilação pulmonar regional, assim como a VFC 47,48,49 .…”

Estudo do efeito da estimulação colinérgica crônica com brometo de piridostigmina sobre as adaptações hemodinâmicas, autonômicas e morfofuncionais cardíacas induzidas pelo treinamento físico aeróbio em ratos espontaneamente hipertensos (SHR)

“…circulatória, evitando a diminuição SBR e danos na VFC, que são características típicas de coração falha(JACINTO et al, 2013). Os resultados da função cardíaca por meio do emprego da ecocardiografia bidimensional mostrou uma tendência à diminuição da FC nos grupos tratados e treinados.…”