Comparative analysis of the effects of two chest physical therapy interventions in patients with bronchiolitis during hospitalization period.

Renata Remondini,Giselle De Castro,Adriana Zamprônio Dos Santos,Luiz Vicente Ribeiro Ferreira Da Silva Filho,Cristiane Do Prado

doi:10.1590/s1679-45082014ao3230

Abstract

Objective To evaluate and compare the effects of two chest physiotherapy interventions in patients hospitalized due to acute bronchiolitis.Methods Prospective randomized study with a sample of 83 calls for 29 patients aged between 3 months and 1 year hospitalized for acute bronchiolitis. Patients were distributed randomly into two groups: Group 1, submitted to postural drainage, tapping and tracheal aspiration; and Group 2, submitted to postural drainage, expiratory acceleration flow and tracheal aspiration. Assessments were made before and 10 and 60 minutes after the end of therapy. Patients also underwent drug treatment. The endpoint was to compare two physical therapy interventions as to clinical improvement in infants with acute bronchiolitis by means of oxygen saturation and the Respiratory Distress Assessment Instrument score. The parents/guardians was requested to answer a questionnaire about the treatment applied before the last evaluation in order to measure their satisfaction related to the interventions made.Results The groups were similar regarding the use of antibiotics and bronchodilators. A greater number of patients used corticosteroids in Group 2. A relevant improvement was observed on Respiratory Distress Assessment Instrument score with physical therapy, with reduction of the score 10 minutes after interventions, and the same score 60 minutes later, with no differences between techniques applied. There was no significant variation of pulse oximetry after chest physiotherapy. Most items assessed by the questionnaire had satisfactory answers.Conclusion No differences were observed between groups regarding the items assessed (time required to discharge from study, pulse oximetry in room air and disease severity according to the Respiratory Distress Assessment Instrument score). Parents answered positively about the effects of therapy in the majority of items in the questionnaire, both for the expiratory acceleration flow technique and for tapping.

Highlights

Acute bronchiolitis is considered one of the most common respiratory diseases in the first year of life
The treatment of bronchiolitis is quite controversial and includes hydration, oxygenation, respiratory therapy, and medications, including bronchodilators, epinephrine, mucolytics, and inhaled corticosteroids.[1,5,6] The use of supplemental oxygen is indicated in patients with peripheral oxygen saturation (SpO2)
Postural drainage consists in positioning the patient so as to use the force of gravity to help enhance the drainage of mucus from lobes and specific segments of the lungs into the central airways.[9]. Tapping aims to mobilize and remove lung secretions, facilitating their drainage from peripheral to central regions, and promoting the elimination of these secretions, improving lung function.[10]. Tracheal suction is considered an effective technique for tracheobronchial clearance in children with bronchiolitis, taking into account that approximately 60% of the respiratory resistance is located in the upper airway

Summary

Introduction

Acute bronchiolitis is considered one of the most common respiratory diseases in the first year of life. Postural drainage consists in positioning the patient so as to use the force of gravity to help enhance the drainage of mucus from lobes and specific segments of the lungs into the central airways.[9] Tapping aims to mobilize and remove lung secretions, facilitating their drainage from peripheral to central regions, and promoting the elimination of these secretions, improving lung function.[10] Tracheal suction is considered an effective technique for tracheobronchial clearance in children with bronchiolitis, taking into account that approximately 60% of the respiratory resistance is located in the upper airway. Specific techniques have been developed for each age group, highlighting among them the EAF, which consists of a passive stimulation in the thoracic region of the patient with prolonged expiratory time. One of the hands of the physiotherapist is positioned in the chest (expiratory pressure hand), and the other hand in the lower ribs, minimizing the increase in abdominal pressure.[10]

Methods

Discussion

Conclusion