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Contexto: a bronquiolite aguda é a principal patologia a afectar a criança nos
primeiros 2 anos de vida, a fisioterapia respiratória é uma intervenção
terapêutica utilizada com a intenção de melhorar o curso desta doença
mantendo-se a incerteza sobre a sua eficácia. Objectivo: determinar a eficácia
e segurança da fisioterapia respiratória em crianças com menos de 2 anos com
bronquiolite aguda. Fontes de Informação: Medline (1966 a Agosto 2010),
EMBASE(1990 a Agosto 2010), Pedro e Lilacs (1982 a Agosto 2010). Outra
fonte de informação incluiu a bibliografia dos estudos obtidos. Selecção de
estudos: estudos experimentais comparando a fisioterapia respiratória com
cuidados habituais, em crianças com menos de 2 anos e bronquiolite aguda,
em ventilação espontânea, em qualquer contexto. Estudos pré-experimentais
ou observacionais com os mesmos participantes e intervenções foram
admitidos complementarmente aos experimentais. Extracção de dados e
análise: um investigador extraiu os dados dos artigos obtidos e avaliou o risco
de viés. A eficácia e segurança da fisioterapia respiratória foram determinadas
pelos seguintes outcomes: duração do internamento hospitalar ou do evento,
variação de scores de severidade clínica, saturação periférica e suplementação
de oxigénio, recidivas, recurso a antibióticos e efeitos deletérios ou
deterioração clínica reportada. Síntese de dados: 6 estudos experimentais
foram admitidos. As suas amostras provinham de criança internadas em
hospital. As técnicas de fisioterapia respiratória foram comparadas com
cuidados habituais. Nenhum estudo evidenciou melhoria dos outcomes de
interesse na comparação entre grupos, excepto avaliações de curta duração da
saturação periférica de oxigénio e scores de severidade clínica. 1 estudo
reportou uma percentagem significativamente maior no grupo submetido a
fisioterapia respiratória de crianças que vomitaram, tiveram uma
desestabilização respiratória transitória, e na percepção de stress da criança
pelos cuidadores. São relatadas ainda fracturas costais a causa de fisioterapia
respiratória. Limitações: o risco de viés era alto em 2 estudos, baixo num
estudo e indeterminado nos restantes. Conclusões: aparentemente a
fisioterapia respiratória não é eficaz e pode produzir efeitos deletérios
importantes, mas a evidência é pobre, carecendo de novos estudos.
Context: acute bronchiolitis is the leading pathology affecting children in their first 2 years of life, respiratory physiotherapy is used to treat acute bronchiolitis but the effectiveness of this intervention remains unclear. Objective: to determine the effectiveness and safety of respiratory physiotherapy in infants aged less than 2 years old with acute bronchiolitis Information Sources: Medline (1966 to August 2010), EMBASE (1990 to August 2010), Pedro and Lilacs (1982 to August 2010). Other source included bibliography of the included studies. Study selection: randomized controlled trials in which respiratory physiotherapy was compared against usual care. Additionally observational or randomized trials were included to improve this data for this review. Data extraction and analysis: one researcher extracted the data from the retrieved studies and evaluated their risk of bias. To assess the effectiveness and safety of respiratory physiotherapy the following outcomes were used: length of disease or hospital stay, clinical scoring variation, oxygen saturation, oxygen supplementation, relapses, antibiotics usage or clinical deterioration caused by respiratory physiotherapy. Results: 6 randomized controlled trials were retrieved. Respiratory physiotherapy was compared with standard care in children admitted to the hospital. Apart from short term measurements of oxygen saturation and clinical scoring variation, no differences were found between respiratory physiotherapy and usual care. 1 study showed a higher proportion of vomiting, transient respiratory distress and caregivers’ perception of child’ stress in the intervention group compared to the control group. Rib fractures caused by respiratory physiotherapy were also reported in observational studies. Limitations: 2 studies had high risk of bias, 1 study had low risk of bias and the risk of bias in the remaining studies was unclear. Conclusion: respiratory physiotherapy appears to be ineffective and may have some harmful effects, but the papers retrieved were poor, as a result, the effectiveness and safety of respiratory physiotherapy should be further investigated.
Context: acute bronchiolitis is the leading pathology affecting children in their first 2 years of life, respiratory physiotherapy is used to treat acute bronchiolitis but the effectiveness of this intervention remains unclear. Objective: to determine the effectiveness and safety of respiratory physiotherapy in infants aged less than 2 years old with acute bronchiolitis Information Sources: Medline (1966 to August 2010), EMBASE (1990 to August 2010), Pedro and Lilacs (1982 to August 2010). Other source included bibliography of the included studies. Study selection: randomized controlled trials in which respiratory physiotherapy was compared against usual care. Additionally observational or randomized trials were included to improve this data for this review. Data extraction and analysis: one researcher extracted the data from the retrieved studies and evaluated their risk of bias. To assess the effectiveness and safety of respiratory physiotherapy the following outcomes were used: length of disease or hospital stay, clinical scoring variation, oxygen saturation, oxygen supplementation, relapses, antibiotics usage or clinical deterioration caused by respiratory physiotherapy. Results: 6 randomized controlled trials were retrieved. Respiratory physiotherapy was compared with standard care in children admitted to the hospital. Apart from short term measurements of oxygen saturation and clinical scoring variation, no differences were found between respiratory physiotherapy and usual care. 1 study showed a higher proportion of vomiting, transient respiratory distress and caregivers’ perception of child’ stress in the intervention group compared to the control group. Rib fractures caused by respiratory physiotherapy were also reported in observational studies. Limitations: 2 studies had high risk of bias, 1 study had low risk of bias and the risk of bias in the remaining studies was unclear. Conclusion: respiratory physiotherapy appears to be ineffective and may have some harmful effects, but the papers retrieved were poor, as a result, the effectiveness and safety of respiratory physiotherapy should be further investigated.
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Instituto Politécnico do Porto. Escola Superior de Tecnologia da Saúde do Porto