title: Rhinopharyngeal Retrograde Clearance Induces Less Respiratory Effort and Fewer Adverse Effects in Comparison With Nasopharyngeal Aspiration in Infants With Acute Viral Bronchiolitis.
abstract: 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.).
authors.affiliation: Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
authors.forename: Gabriela R
authors.initials: GR
authors.lastname: Gomes
authors.affiliation: School of Nursing, Nutrition, and Physiotherapy, PUCRS, Porto Alegre, RS, Brazil.
authors.forename: Fernanda Pg
authors.initials: FP
authors.lastname: Calvete
authors.affiliation: School of Nursing, Nutrition, and Physiotherapy, PUCRS, Porto Alegre, RS, Brazil.
authors.forename: Gabriela F
authors.initials: GF
authors.lastname: Rosito
authors.affiliation: Centro Infant, Institute of Biomedical Research, PUCRS, Porto Alegre, RS, Brazil. mdonadio@pucrs.br.
authors.forename: Márcio Vf
authors.initials: MV
authors.lastname: Donadio
mesh_terms: D000208:Acute Disease; D001990:Bronchiolitis, Viral / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects / Q000379:methods; D004844:Epistaxis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D059747:Nasal Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D009305:Nasopharynx / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000601:surgery* / Q000821:virology; D012135:Respiratory Sounds / Q000209:etiology; D013396:Suction / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D014839:Vomiting / Q000453:epidemiology / Q000209:etiology
keywords: acute viral bronchiolitis; children; clearance; respiratory physiotherapy