Effectiveness of Chest Physiotherapy in Infants Hospitalized with Acute Bronchiolitis: A Multicenter, Randomized, Controlled Trial: e1000345

• Published in: PLoS medicine 2010-09, Vol.7 (9)
• Main Authors: Gajdos, Vincent, Katsahian, Sandrine, Beydon, Nicole, Abadie, Véronique, Pontual, Loïc de, Larrar, Sophie, Epaud, Ralph, Chevallier, Bertrand, Bailleux, Sylvain, Mollet-Boudjemline, Alix, Bouyer, Jean, Chevret, Sylvie, Labrune, Philippe
• Format: Article
• Language: English
• Subjects: Antibiotics; Confidence intervals; Drug therapy; Hospitalization; Intensive care; Intervention; Pediatrics; Recessions
• ISSN: 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1000345

Background Acute bronchiolitis treatment in children and infants is largely supportive, but chest physiotherapy is routinely performed in some countries. In France, national guidelines recommend a specific type of physiotherapy combining the increased exhalation technique (IET) and assisted cough (AC). Our objective was to evaluate the efficacy of chest physiotherapy (IET + AC) in previously healthy infants hospitalized for a first episode of acute bronchiolitis. Methods and Findings We conducted a multicenter, randomized, outcome assessor-blind and parent-blind trial in seven French pediatric departments. We recruited 496 infants hospitalized for first-episode acute bronchiolitis between October 2004 and January 2008. Patients were randomly allocated to receive from physiotherapists three times a day, either IET + AC (intervention group, n = 246) or nasal suction (NS, control group, n = 250). Only physiotherapists were aware of the allocation group of the infant. The primary outcome was time to recovery, defined as 8 hours without oxygen supplementation associated with minimal or no chest recession, and ingesting more than two-thirds of daily food requirements. Secondary outcomes were intensive care unit admissions, artificial ventilation, antibiotic treatment, description of side effects during procedures, and parental perception of comfort. Statistical analysis was performed on an intent-to-treat basis. Median time to recovery was 2.31 days, (95% confidence interval [CI] 1.97-2.73) for the control group and 2.02 days (95% CI 1.96-2.34) for the intervention group, indicating no significant effect of physiotherapy (hazard ratio [HR] = 1.09, 95% CI 0.91-1.31, p = 0.33). No treatment by age interaction was found (p = 0.97). Frequency of vomiting and transient respiratory destabilization was higher in the IET + AC group during the procedure (relative risk [RR] = 10.2, 95% CI 1.3-78.8, p = 0.005 and RR = 5.4, 95% CI 1.6-18.4, p = 0.002, respectively). No difference between groups in bradycardia with or without desaturation (RR = 1.0, 95% CI 0.2-5.0, p = 1.00 and RR = 3.6, 95% CI 0.7-16.9, p = 0.10, respectively) was found during the procedure. Parents reported that the procedure was more arduous in the group treated with IET (mean difference = 0.88, 95% CI 0.33-1.44, p = 0.002), whereas there was no difference regarding the assessment of the child's comfort between both groups (mean difference = -0.07, 95% CI -0.53 to 0.38, p = 0.40). No evidence of differenc