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Background: Acute viral bronchiolitis is an inflammatory disease of the lower respiratory tract. This study aimed to compare the immediate effects of retrograde rhinopharyngeal clearance with nasopharyngeal aspiration in children admitted with acute viral bronchiolitis., Methods: This was a randomized controlled clinical trial with children admitted for acute viral bronchiolitis up to 12 months old. Subjects were divided into a nasopharyngeal aspiration group and a clearance group, submitted to retrograde rhinopharyngeal clearance with physiological solution (0.9%) instillation. In both groups, there were 3 evaluations on the same day (data collections 1, 2, and 3), including cardiorespiratory parameters, clinical score of respiratory dysfunction, and adverse effects., Results: One hundred children were included, with no statistical differences between groups regarding the characteristics of the sample. There was a significant reduction (P < .05) in heart rate in data collections 1 and 2 after 10 and 30 min. The number of episodes of nasal bleeding (28 vs 1) and vomiting (11 vs 7) was higher in the aspiration group compared with the clearance group. Children classified as moderate showed a significant reduction of retractions (100% vs 84.6%) and nasal bleeding (44.8% vs 0%). An increase of 6.7 and 19.5% in wheezing and retractions, respectively, was shown for the aspiration group, whereas the clearance group showed only 4.6% for both parameters., Conclusions: The use of retrograde rhinopharyngeal clearance in the management of infants with acute viral bronchiolitis can be an alternative for the clearance of the upper airways, since it showed immediate positive effects on the occurrence of complications and signs of respiratory effort compared with nasopharyngeal aspiration. Children classified with a moderate clinical score appear to benefit the most. (ClinicalTrials.gov registration NCT02460614.)., (Copyright © 2016 by Daedalus Enterprises.)

Background: Pulmonary changes that occur in cystic fibrosis may influence inspiratory muscle strength and endurance. We evaluated inspiratory muscle strength and endurance in children and adolescents with cystic fibrosis in comparison with healthy subjects., Methods: This is a cross-sectional observational study with subjects with cystic fibrosis and paired healthy individuals, age 6-18 y. Spirometry, impulse oscillometry, plethysmography, manovacuometry, and a protocol of inspiratory muscle endurance were performed., Results: Subjects with cystic fibrosis (n = 34) had higher maximum percent-of-predicted inspiratory pressure (PImax) than healthy (n = 68) subjects (118.5 ± 25.8% vs 105.8 ± 18.0%) and no significant difference in endurance (60.9 ± 13.3% vs 65.3 ± 12.3%). When restricting the analysis to subjects without Pseudomonas aeruginosa colonization and with FEV1 > 80%, PImax values were significantly higher, and inspiratory muscle endurance was lower, in comparison with the control group. PImax correlated significantly with FVC (r = 0.44, P = .02) and FEV1 (r = 0.41, P = .02), whereas endurance correlated better with total airway resistance (r = 0.35, P = .045) and with central airway resistance (r = 0.48, P = .004)., Conclusions: Children and adolescents with cystic fibrosis with no colonization by P. aeruginosa and normal lung function present increased inspiratory muscle strength and decreased endurance compared with healthy individuals, indicating that changes in the respiratory muscle function seem to be distinctly associated with pulmonary involvement. Strength was related to pulmonary function parameters, whereas endurance was associated with airway resistance., (Copyright © 2016 by Daedalus Enterprises.)

Background: Regular aerobic exercise in patients with cystic fibrosis (CF) improves aerobic conditioning and delays disease progression, resulting in better quality of life. The purpose of this study was to evaluate the effect of an aerobic exercise program based on verbal and written guidelines on maximum exercise capacity using a cardiopulmonary exercise test, quality of life, and the self-reported aerobic exercise practice of children and adolescents with CF., Methods: This randomized controlled trial followed guidelines for physical exercise in a CF center. Subjects were assigned to 2 groups: intervention (group 1), with 17 subjects; and control (group 2), also with 17 subjects. Data were collected from October 2010 to October 2011, and the study population comprised 7-20-y-old children and adolescents with CF. The intervention consisted of handing out a manual with guidelines for aerobic physical exercises and reinforcing recommendations in telephone calls every 2 weeks., Results: Thirty-four subjects were included in the study, 20 of whom were boys (58.5%). The groups were similar at baseline. In group 1, 6 subjects (35.2%) reported practicing physical exercises regularly. The mean age was 13.4 ± 2.8 y, the mean percent-of-predicted FEV1 was 95.5 ± 17.9%, and the mean peak oxygen uptake (V̇O2 ) relative to body mass was 34.9 ± 9.0 mL/kg/min. In group 2, 4 subjects (23.5%) reported practicing physical exercises regularly. The mean age was 12.7 ± 3.3 y, the mean percent-of-predicted FEV1 was 100.1 ± 21.2%, and the mean peak V̇O2 was 33.2 ± 8.2 mL/kg/min. In group 1, there was a significant increase in physical exercise practice as reported by subjects after 3 months of intervention compared with group 2 (P = .01). No statistically significant differences were found for the other variables., Conclusions: Verbal and written guidelines for aerobic exercise, together with supervision over the telephone, had a positive impact on the self-reported regular physical exercise practice of children and adolescents. However, no improvement was found in lung function and maximum exercise capacity or domains of the quality of life questionnaire., (Copyright © 2015 by Daedalus Enterprises.)

Background: Septic shock presents as a continuum of infectious events, generating tissue hypoxia and hypovolemia, and increased oxidative stress. Chest physiotherapy helps reduce secretion, improving dynamic and static compliance, as well as improving secretion clearance and preventing pulmonary complications. The purpose of this study was to evaluate the immediate effect of chest physiotherapy on hemodynamic, metabolic, inflammatory, and oxidative stress parameters in subjects in septic shock., Methods: We conducted a quasi-experimental study in 30 subjects in septic shock, who underwent chest physiotherapy, without associated heart diseases and with vasopressors < 0.5 μg/kg/min. Venous and arterial blood gases, clinical and hemodynamic data, inflammatory data, lactate, and oxidative stress were evaluated before and 15 min after physiotherapy., Results: Thirty subjects with a mean age of 61.8 ± 15.9 y and Sequential Organ Failure Assessment of 8 (range 6-10) were included. Chest physiotherapy caused a normalization of pH (P = .046) and P(aCO2) (P = .008); reduction of lactate (P = .001); and an increase in P(aO2) (P = .03), arterial oxygen saturation (P = .02), and P(aO2)/F(IO2) (P = .034), 15 min after it was applied., Conclusions: The results indicate that chest physiotherapy has immediate effects, improving oxygenation and reducing lactate and oxidative damage in subjects in septic shock. However, it does not cause alterations in the inflammatory and hemodynamic parameters., (Copyright © 2014 by Daedalus Enterprises.)

Objective: To evaluate the accuracy of the modified Borg scale to estimate lung impairment, measured via FEV(1) in children and adolescents with cystic fibrosis., Methods: This cross-sectional prospective study was conducted with cystic fibrosis patients, 6-18 y old. With the modified Borg scale we evaluated their subjective perceptions of dyspnea before and after submaximal exercises, and its correlation with lung function (spirometry), 6-min walk test (6MWT), and nutritional status according to body mass index., Results: Forty-one patients (mean +/- SD age range 11.1 +/- 4.1 y), were included in the study. The median (and interquartile range) modified Borg scale score after 6MWT was 2 (1-3). The mean percent-of-predicted FEV(1) (FEV(1)%) was 97 +/- 32%. The Z score of the 6MWT distance (6MWTZ) for 61% of the patients was < or = -2. The modified Borg scale correlated weakly with the other variables when all patients in the sample were analyzed. There was a significantly greater correlation of the Borg-scale score with FEV(1)% (r = -0.59, P = .003) and with 6MWTZ (r = 0.46, P = .03) when patients older than 9 years were evaluated separately. The receiver operating characteristic curve analysis revealed that a modified-Borg-scale cut-off point of 2.5 generated an area of 0.80, a sensitivity of 80%, a specificity of 77%, and an accuracy of 0.78 to predict FEV(1)% lower than 80% in the group of patients older than 9 years., Conclusions: The modified Borg scale is accurate to assess the subjective perception of dyspnea of children older than 9 years and adolescents with cystic fibrosis.

Background: Positive-expiratory-pressure (PEP) therapy uses positive airway pressure generated by a either a fixed-orifice resistor or a threshold resistor. We hypothesized that tubing diameter and length, and the diameter of the PEP bottle's air-escape orifice would impact the PEP pressure delivered to the airway and determine whether the PEP bottle acts as a threshold resistor or a fixed-orifice resistor., Methods: We designed a model composed of a bottle partially filled with water, a compressed air source, a pneumotachometer, and a manometer, to evaluate the effects of various tubing diameters (range 2-25 mm inner diameter) and lengths (range 20-80 cm long). In the first set of experiments, the PEP bottle had an open top, so there was no pressure other than the atmospheric pressure against the air escaping from the immersed tubing. The distal tip of the tube was 10 cm below the surface of the water (ie, a water-column pressure of 10 cm H(2)O), and we tested flows of 1, 5, 10, 15, 20, and 25 L/min. In the second set of experiments we tested a PEP bottle, the top of which was closed except for an air-escape orifice (4, 6, 8, 9, or 10 mm)., Results: With tubing of 2-6 mm inner diameter, the length of the tubing and the flow significantly affected the PEP pressure (ie, the system was not a threshold resistor). With tubing > or = 8 mm inner diameter there were no significant PEP-pressure differences with any of the tubing lengths or flows tested, which indicates a threshold-resistor system. The 4-mm and 6-mm air-escape orifices significantly increased the PEP pressure, whereas the 8 mm air-escape orifice did not increase the PEP pressure., Conclusions: To obtain a threshold-resistor PEP bottle system (ie, the PEP pressure is generated only by the water-column pressure), the tubing must be > or = 8 mm inner diameter, and the air-escape orifice must be > or = 8 mm.