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Evaluation of an Alternative Chest Physiotherapy Method in Infants With Respiratory Syncytial Virus Bronchiolitis

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Abstract:

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 SpO2 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.

Keywords: airway clearance; bronchial obstruction; chest physiotherapy; infant; prolonged slow expiration technique; respiratory syncytial virus; viral bronchiolitis

Document Type: Research Article

DOI: http://dx.doi.org/10.4187/respcare.00721

Affiliations: 1: Department of Pediatrics, Grand Hôpital de Charleroi, Montignies-sur-Sambre, Belgium 2: Department of Neurosciences, Grand Hôpital de Charleroi, Montignies-sur-Sambre, Belgium.

Publication date: July 1, 2011

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