Mucociliary Clearance Techniques in Moderate Bronchiolitis
Condition: Bronchiolitis
MeSH terms: Bronchiolitis
Study type: Interventional

Summary: 
      Acute viral bronchiolitis (BE) is an inflammatory disease of the lower respiratory tract,
      with a viral etiology, where the respiratory syncytial virus is the most prevalent agent.
      Respiratory physiotherapy (FTR) aims to remove airway obstruction, which decreases airway
      resistance, improves gas exchange, and reduces respiratory load. It is widely used in the
      treatment of children with chronic respiratory disease, but has long been debated as a
      treatment for bronchiolitis.

      The objective of this study is to evaluate the effectiveness of two mucociliary clearance
      techniques in non-hospitalized children <12 months with a first episode of moderate BE.

      This is a clinical trial that aims to recruit patients from 2 to 12 months who attend the
      Physiobronchial physiotherapy centers in Madrid, A Coruña, and Barcelona with a first-time
      medical diagnosis of BQ of 48 hours of maximum evolution. Participants will be randomly
      assigned into 3 groups: Group A: Assisted Autogenous Drainage (DAA), Group B: Prolonged Slow
      Expiration (ELPr) and Control Group. The main variables are the Acute Bronchiolitis Severity
      Scale (ESBA), oxygen saturation (SaO2), the modified Wood-Downes scale (WD-S), the Hospital
      scale Sant Joan de Déu (HSJD) and the ReSVinet Scale (RSV-S), and will be measured by a
      blinded evaluator at the beginning of the session (T0), 20 minutes after administering
      short-acting β2 adrenergic agonist (SABA) (T20 ), immediately after nebulization (T40) and at
      the end of the physiotherapist's intervention (T60). It will be reassessed 48 hours after the
      session (T48h) and the protocol will be repeated completely if it has not dropped at least
      two points according to the scales.
    

Detailed description: 
      The main objective of the present work is to evaluate the effectiveness of two mucociliary
      clearance techniques in non-hospitalized children <12 months with a first episode of moderate
      BE.

      Once each patient legal guardians has signed the informed consent document and it has been
      verified that the inclusion criteria are met, participants will be assigned the same
      identification number (ID) that is related to its Clinical History (CH) by simple coding;
      custody of the file with the relationship of each ID with its CH will be the responsibility
      of the principal investigator. The method of blinding in the allocation will be performed by
      choosing opaque sealed envelopes by a person external to the study. The contents of the
      envelopes will be the random assignment cards to each of the three groups, this simple random
      numerical sequence will be generated by computer using the R program see 3.5.1. (R Foundation
      for Statistical Computing,Institute for Statistics and Mathematics, Welthandelsplatz 1, 1020
      Vienna, Austria) based on stratified sampling for homogeneity, in three groups:Group A:
      assisted autogenous drainage group (DAA), group B: group prolonged slow expiration (ELPr),
      group C: control group (CG).

      None of the children that make up both intervention group A and B, and the control group,
      will be prohibited from the usual pharmacological treatment prescribed by their doctor. It
      will collect in the investigator's notebook the medications that each patient has prescribed
      by their doctor. Physiotherapists cannot prescribe drugs, but can administer them at the
      beginning of the protocol after the prescription by the doctor.

      Within the protocol, the short-acting β2 adrenergic agonist (SABA) will be administered,
      prior to nebulization with 4 ml Muconeb® 3% hypertonic serum, for 8 minutes in a Philips®
      vibrating mesh nebulizer. Next, following protocols will be applied:

        -  Intervention based on DAA Group A: the technique consists of positioning the patient in
           a supine position with the head slightly elevated on the supporting plane and then
           placing both hands around the rib cage and applying bimanual expiratory compression on
           both hemithoraxes. The physiotherapist must ensure that the child takes 2 to 3
           controlled breaths, close to the residual level, with the objective that the expiratory
           flow displaces the secretions, located distally, towards the central airways.

        -  Intervention based on ELPr Group B: this technique applied to the baby by means of a
           slow thoracic-abdominal pressure that begins at the end of a spontaneous expiration and
           continues until the residual volume. The physiotherapist through the provoked cough or
           stimulation of the trachea achieves the expectoration of the sputum.

        -  Group C: nebulization with 4 ml Muconeb® 3% hypertonic serum, for 8 minutes in a
           Philips® vibrating mesh nebulizer.

      The timing of intervention protocol will be followed: a) The SABA prescribed by the doctor
      will be administered to all patients; b) 20 minutes later the patient will then receive an
      8-minute nebulization of Muconeb® 3% hypertonic solution; c) The treatment techniques
      protocol will consist of a standard 20 minute session based on nasal washes and the protocols
      descrive above for each intervention group.

      Both groups will receive 3 evaluations by an investigator who will be blinded on the
      treatment and the objectives. The evaluations will be carried out at the beginning of the
      session (T0), 20 minutes after the SABA administration (T20), after the nebulization of
      Muconeb® 3% hypertonic solution (T30), after intervention treatment protocol (T60) and,
      finially, after 48 hours from ending treatment session (T48).

      The main variables will classify the participants according to the initial clinical severity
      score proposed by the Acute Bronchiolitis Severity Scale (ESBA), the Wood-Downes Scale
      modified by Ferres (WDF-S), the Scale of the Sant Joan de Déu Hospital (HSJD) and the
      ReSVinet Scale (RSV-S). HR is a variable that is collected on the HSJD and WDS scales. SaO2
      is included in the HSJD and ESBA scale, both will be measured through a pulse oximeter
      (Radical Touchscreen from Massimo®, Masimo Corporation, Irvine, CA).
    

Intervention name(s): Assisted autogenous drainage group (DAA); Group prolonged slow expiration (ELPr); Control group (CG)
Intervention type(s): Other; Other; Other
Intervention description(s): DAA, is used when the patient is not able to perform this technique autonomously and is assisted by the physiotherapist. Its greatest utility is in infants and preschoolers. The technique consists of positioning the patient in a supine position with the head slightly elevated on the supporting plane and then placing both hands around the rib cage and applying bimanual expiratory compression on both hemithoraxes. The physiotherapist must ensure that the child takes 2 to 3 controlled breaths, close to the residual level, with the objective that the expiratory flow displaces the secretions, located distally, towards the central airways.; Passive expiratory aid technique applied to the baby by means of a slow thoracic-abdominal pressure that begins at the end of a spontaneous expiration and continues until the residual volume. The physiotherapist through the provoked cough or stimulation of the trachea achieves the expectoration of the sputum.; Nebulization with 4 ml Muconeb® 3% hypertonic serum, for 8 minutes in a Philips® vibrating mesh nebulizer. Once the nebulization is finished, you will wait 30 minutes in a closed room.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Single-blind randomized controlled trial
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Physical Therapy; Respiratory; Pediatric