González-Bellido Vanesa, Rama Suárez Noelia, Yánez Yepez Gustavo Adolfo, Jimeno Esteo Maria Del Carmen, García Caraballo Rubén, Mayoralas Alises Sagrario, Cuenca Zaldívar Juan Nicolás, Fagundes Donadio Márcio Vinícius, Sánchez Romero Eleuterio A, Fernández Carnero Samuel
Fisiobronquial Physiotherapy Clinic, Madrid, Spain.
Pediatric Service, Hospital QuirónSalud Valle del Henares, Madrid, Spain.
Clinics (Sao Paulo). 2025 Aug 1;80:100735. doi: 10.1016/j.clinsp.2025.100735.
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.
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 (SpO) recorded immediately after each intervention.
Both airway clearance techniques, PSE and AAD, demonstrated significant improvements in clinical severity scores (ABSS and BROSJOD) and SpO levels compared to the control group, with PSE showing the most pronounced effects. ABSS (ATSboot p = 0.001; η = 0.105) and BROSJOD (ATSboot p = 0.003; η=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 SpO 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.
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 SpO than the control and AAD groups.
急性病毒性细支气管炎是2岁以下婴幼儿最常见的下呼吸道感染。气道廓清技术（ACTs）旨在减轻气道阻塞，从而降低气道阻力、改善气体交换并减轻呼吸负荷，所有这些都可使临床稳定性得到改善。
192名婴儿使用基于流量的技术被随机分配至以下ACTs之一：辅助自主引流（AAD；n = 62）、延长缓慢呼气（PSE；n = 63）或对照组（n = 67）。治疗在门诊进行，每次持续20分钟，并在48小时后重复。观察指标为每次干预后立即记录的急性细支气管炎严重程度量表（ABSS）、圣琼德迪乌细支气管炎评分（BROSJOD）和外周血氧饱和度（SpO）。
与对照组相比，气道廓清技术PSE和AAD在临床严重程度评分（ABSS和BROSJOD）及SpO水平方面均显示出显著改善，其中PSE效果最为显著。ABSS（ATSboot p = 0.001；η = 0.105）和BROSJOD（ATSboot p = 0.003；η = 0.037）存在显著差异且与时间存在交互作用，从基线至治疗后48小时呈下降趋势。在降低ABSS方面，PSE优于对照组（p < 0.001；Hedges' g = 1.4 vs. g = 0.37）。与对照组相比，ACTs改善了ABSS和BROSJOD评分，PSE在基线后20分钟和1小时时SpO升高幅度最大且哮鸣音减少。在48小时时，AAD组和PSE组的ABSS变化大于对照组，且在基线后20分钟时凹陷减少。AAD组心率较低，对照组呼吸频率较高，PSE组心率最低。未观察到明显的临床不良反应。
在非住院的中度急性病毒性细支气管炎婴儿中，两种基于流量的ACTs技术在治疗后即刻及48小时后均显著降低了ABSS和BROSJOD评分，优于对照组。然而，与对照组和AAD组相比，PSE干预在降低ABSS和提高SpO方面效果更佳。
