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Effectiveness of airway clearance techniques versus control in non-hospitalized infants with moderate acute viral
Vanesa González-Bellido1, Noelia Rama Suárez1, Gustavo Adolfo Yánez Yepez2
1Fisiobronquial Physiotherapy Clinic, Madrid, Spain.
Insights
Prolonged Slow Expiration (PSE) and Assisted Autogenic Drainage (AAD) significantly improved clinical scores and oxygen saturation in infants with acute viral bronchiolitis. PSE demonstrated the most significant benefits, offering a promising non-hospitalized treatment option.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Critical Care
Background:
- Acute viral bronchiolitis is a common respiratory infection in infants under two years old.
- Airway Clearance Techniques (ACTs) aim to improve clinical stability by reducing airway obstruction, resistance, and respiratory load.
Purpose of the Study:
- To evaluate the effectiveness of two flow-based ACTs, Assisted Autogenic Drainage (AAD) and Prolonged Slow Expiration (PSE), in treating infants with moderate acute viral bronchiolitis.
Main Methods:
- 192 infants were randomized into AAD, PSE, or control groups.
- Interventions were performed in an outpatient setting over 20 minutes, with a follow-up session 48 hours later.
- Outcome measures included the Acute Bronchiolitis Severity Scale (ABSS), Bronchiolitis Score of Sant Joan de Déu (BROSJOD), and peripheral oxygen saturation (SpO2).
Main Results:
- Both AAD and PSE significantly improved ABSS and BROSJOD scores and SpO2 levels compared to the control group.
- PSE showed the most pronounced effects, with greater reductions in ABSS and increases in SpO2.
- No significant adverse clinical effects were observed during the study.
Conclusions:
- Flow-based ACTs, specifically PSE and AAD, are effective in reducing severity scores and improving oxygenation in non-hospitalized infants with moderate acute viral bronchiolitis.
- PSE intervention appears to be more effective than AAD and the control group in improving clinical outcomes.
Background:
Acute viral bronchiolitis is the most common lower respiratory tract infection in infants < 2-years of age. Airway Clearance Techniques (ACTs) aim to reduce airway obstruction, thereby decreasing airway resistance, improving gas exchange, and reducing respiratory load, all of which can lead to improved clinical stability.
Methods:
One hundred ninety-two infants were randomly allocated to one of the following ACTs using flow-based techniques: Assisted Autogenic Drainage (AAD; n = 62), Prolonged Slow Expiration (PSE; n = 63), or a control group (n = 67). The sessions were performed in an outpatient setting, with a duration of 20 min and repeated 48 h later. The outcome measures were the Acute Bronchiolitis Severity Scale (ABSS), Bronchiolitis Score of Sant Joan de Déu (BROSJOD), and peripheral oxygen saturation (SpO2) recorded immediately after each intervention.
Results:
Both airway clearance techniques, PSE and AAD, demonstrated significant improvements in clinical severity scores (ABSS and BROSJOD) and SpO2 levels compared to the control group, with PSE showing the most pronounced effects. ABSS (ATSboot p = 0.001; η2p = 0.105) and BROSJOD (ATSboot p = 0.003; η2p=0.037) significantly differed and interacted with time, decreasing from baseline to 48 h post-treatment. PSE outperformed the controls in reducing ABSS (p < 0.001; Hedges' g = 1.4 vs. g = 0.37). ACTs improved ABSS and BROSJOD scores compared to controls, with PSE showing the greatest SpO2 increase and wheezing reduction at 20 minutes and one hour post-baseline. At 48 h, the AAD and PSE groups had greater ABSS changes than the controls and fewer retractions at 20 min post-baseline. The AAD group had a lower heart rate, while the controls had higher respiratory rates, and the PSE group had the lowest heart rate. No significant clinical adverse effects were observed.
Conclusions:
Both ACTs using flow-based techniques significantly reduced ABSS and BROSJOD scores immediately after treatment and 48 h later in non-hospitalized infants with moderate acute viral bronchiolitis than in the control group. However, PSE intervention showed greater effectiveness in reducing ABSS and increasing SpO2 than the control and AAD groups.
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