Respiratory Physical Therapy on the Cardiac Autonomic Modulation Paediatric Patients
Condition: Viral Bronchiolitis
MeSH terms: Bronchiolitis; Bronchiolitis, Viral
Study type: Interventional

Summary: 
      The present study investigated the influence of respiratory affections on the heart rate
      variability (HRV) of paediatric patients. We have hypothesised that respiratory physiotherapy
      would promote a beneficial effect on the cardiac autonomic modulation. Twenty-four children,
      who were divided into respiratory disease group (RG) and control (CG) groups, were studied.
      Analysis of HRV was performed with the RG in the dorsal decubitus position during four
      different moments: basal record (30 minutes); 5 minutes after respiratory physiotherapy by
      means of airway clearance techniques (10-minute record); 5 minutes after nasotracheal suction
      (10-minute record); and 40 minutes after nasotracheal suction (30-minute record). CG group
      was submitted to the same protocol, except nasotracheal suction, which was not performed due
      to ethical reasons.
    

Detailed description: 
      The study of heart rate variability (HRV) is a method allowing non-invasive and selective
      evaluation of the changes in cardiac autonomic modulation. Its use in several clinical
      situations has provided important information, serving as an evaluation instrument for a
      better understanding of the involvement of the autonomic nervous system in various
      physiopathological situations.

      With regard to the applicability of HRV analysis in paediatric populations, it is known that
      the maturity progression of sympathetic and vagal divisions is accompanied by a growing
      increase in autonomic modulation over the pre- and post-natal periods. In turn, a few studies
      have addressed the association between pathological paediatric conditions and changes in the
      cardiac autonomic modulation, consequently, HRV.

      Among these pathologies, the respiratory affections are the main factors of morbidity and
      mortality in children, since newborns have peculiar aspects involving the respiratory system
      that can easily lead to a lung failure. Within this context, one can note the importance of
      the respiratory physiotherapy as an intervention using specific procedures in each case in
      order to decrease the airway resistance and improve the ventilation/perfusion ratio, thus
      improving the respiratory function and minimising the clinical severity. Consequently, in
      patients suffering from obstructive pathologies or neuromuscular dysfunctions, which makes
      cough an inefficient mechanism, physiotherapy can help them to recover from their condition.

      Therefore, the respiratory physiotherapy has influence on the several hospitalisation phases,
      contributing to make the hospital stays shorter and less difficult to the paediatric
      inpatient and promoting a more humanised and more efficient environment based on the
      patient's needs. In this sense, it is possible that the paediatric inpatients present
      important alterations in their cardiovascular autonomic control, since constant oscillations
      in the cardiac and hemodynamic parameters are observed. However, studies correlating HRV with
      respiratory pathological conditions in paediatric inpatients are rare, either before or after
      the respiratory physiotherapy procedures, such as application of airway clearance techniques.
    

Intervention name(s): Respiratory physical therapy
Intervention type(s): Procedure
Intervention description(s): Respiratory physical therapy using airway clearance techniques was conducted by a physiotherapist according to a detailed clinical evaluation of each patient, consisting of thoracic percussion, manual vibration, postural drainage, and cough stimulation.
Other intervention name(s): chest therapy
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: respiratory physiotherapy; cardiac autonomic modulation; paediatric patients