Acute Bronchiolitis-Should We Be Doing More?

作者：Carr Siobhan B^*; Main Eleanor

来源：Pediatric Pulmonology, 2017, 52(3): 279-280.

DOI：10.1002/ppul.23642

The mantra of many clinicians when it comes to the inpatient management of infants with acute bronchiolitis is "supportive management and hands off". Recommendations in countries around the globe 1,2 suggest that the best approach is supportive care alone: support respiratory distress with oxygen (stepping up to CPAP or ventilation if needed), support nutrition/fluid balance and wait for the natural history of this acute viral infection to take its course, which for the commonest pathogen, respiratory syncytial virus is a gradual worsening for 5 days from onset of coryzal symptoms then a slow recovery taking about 3 weeks. They all say do not perform chest physiotherapy in children with no comorbidities. Even in France, one country that has recommended physiotherapy for bronchiolitis, evidence could not be found for improved symptoms or length of stay in a large blinded randomized controlled study using increased exhalation technique physiotherapy with assisted cough in just under 500 infants. 3 This year's Cochrane review included data from 12 studies in 9 countries across three continents, concluding that routine physiotherapy for hospitalized infants and children under two with bronchiolitis could not be recommended because there was a risk of harm and a lack of proven benefit. 4 In particular the review emphasized that `forced expiratory techniques' in severe bronchiolitis could be related to adverse effects such as vomiting, bradycardia with desaturation and respiratory destabilization. A paper in this month's journal 5 seems to fly in the face of this well-established stance. A large blinded randomized trial of physiotherapy in any paediatric respiratory condition is hard to find, but one in the acute infant condition of bronchiolitis suggesting we step in and perform airway clearance techniques is at odds with common wisdom. However, this study presents evidence for the benefits of two different physiotherapy modalities for infants with bronchiolitis at the milder end of the spectrum.

• 出版日期2017-3