Chest Physiotherapy in Infants Between 0 and 12 Months Old With Acute Bronchiolitis SRV(+)
Condition: Bronchiolitis, Viral
MeSH terms: Bronchiolitis; Bronchiolitis, Viral
Study type: Interventional

Summary: 
      The purpose of this research is to determine the effect of prolonged slow expiration
      techniques, provoked coughing and standard therapy compared to chest wall manual vibration
      and standard therapy in infants between 0 and 12 months old with confirmed diagnosis of acute
      bronchiolitis SRV (+). The effect will be measured on respiratory insufficiency and use of
      supplementary oxygen.
    

Detailed description: 
      Bronchiolitis is the main cause of hospital admission for infants under 1 year old in Chile.
      Currently, approximately 4800 children are admitted to the hospital during the cold season,
      affecting the health services' effectiveness. The most frequent causal agent is the
      Respiratory Syncytial Virus (RSV). To date, there is no specific treatment for this disease
      and only support measures are recommended.

      Chest physiotherapy is a support measure that improves the mucociliary clearance and reduces
      obstruction of the airways.

      A clinical trial on the effect of prolonged slow expiration (PSE), chest wall vibrations, and
      provoked coughing as treatment for bronchiolitis in infants admitted to the hospital found
      that the subgroup with RSV required oxygen for 10 hours less than the control group. Gomes
      and Postiaux (2012) reported a 50% decrease on respiratory distress measured by the Wang
      score when PSE and suction were compared to traditional chest physiotherapy techniques in
      patients with bronchiolitis RSV(+).

      Currently recommendations in Chile suggest chest physiotherapy for outpatients with
      bronchiolitis, but the guideline does not refer to the case of inpatients. It is proposed to
      carry out a randomized controlled trial in infants under one year old. The active group will
      receive standard therapy, PSE, and provoked coughing, while the control group will receive
      standard therapy and manual chest wall vibrations. The effectiveness of chest physiotherapy
      will be measured though a clinical score of respiratory distress, hours using supplementary
      oxygen, vital signs before and after the intervention in both groups during hospital stay.
      The main outcome is clinical severity score 48 hours after admission.
    

Intervention name(s): Prolonged slow expiration+provoked coughing; Manual chest wall vibration; Standard Therapy
Intervention type(s): Other; Other; Other
Intervention description(s): Five cycles of prolonged slow expiration and provoked coughing, which will be repeated five times.
During the prolonged slow expiration, the infant will be in supine while the therapist applies pressure at the same time on the rib cage and abdomen during spontaneous expiration. The pressure is applied slowly during two o three respiratory cycles, only during the final phase of expiration.; Five cycles of manual chest wall vibrations during 20 seconds each, being repeated five times.
The manual chest wall vibrations are oscillatory maneuvers applied on the thorax to improve mucociliary clearance of bronchial mucus and ease its removal.; Standard therapy (ST): nasopharyngeal suction, oxygen therapy, fluids administration, 0.5% adrenaline nebulization, and chest physiotherapy.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: acute viral bronchiolitis; respiratory syncytial virus; chest physiotherapy