Skip to main content
 

Main menu

  • Home
  • Content
    • Current Issue
    • Editor's Commentary
    • Coming Next Month
    • Archives
    • Most-Read Papers of 2021
  • Authors
    • Author Guidelines
    • Submit a Manuscript
  • Reviewers
    • Reviewer Information
    • Create Reviewer Account
    • Reviewer Guidelines: Original Research
    • Reviewer Guidelines: Reviews
    • Appreciation of Reviewers
  • CRCE
    • Through the Journal
    • JournalCasts
    • AARC University
    • PowerPoint Template
  • Open Forum
    • 2022 Call for Abstracts
    • 2021 Abstracts
    • Previous Open Forums
  • Podcast
    • English
    • Español
    • Portugûes
    • 国语
  • Videos
    • Video Abstracts
    • Author Interviews
    • Highlighted Articles
    • The Journal

User menu

  • Subscribe
  • My alerts
  • Log in

Search

  • Advanced search
American Association for Respiratory Care
  • Subscribe
  • My alerts
  • Log in
American Association for Respiratory Care

Advanced Search

  • Home
  • Content
    • Current Issue
    • Editor's Commentary
    • Coming Next Month
    • Archives
    • Most-Read Papers of 2021
  • Authors
    • Author Guidelines
    • Submit a Manuscript
  • Reviewers
    • Reviewer Information
    • Create Reviewer Account
    • Reviewer Guidelines: Original Research
    • Reviewer Guidelines: Reviews
    • Appreciation of Reviewers
  • CRCE
    • Through the Journal
    • JournalCasts
    • AARC University
    • PowerPoint Template
  • Open Forum
    • 2022 Call for Abstracts
    • 2021 Abstracts
    • Previous Open Forums
  • Podcast
    • English
    • Español
    • Portugûes
    • 国语
  • Videos
    • Video Abstracts
    • Author Interviews
    • Highlighted Articles
    • The Journal
  • Twitter
  • Facebook
  • YouTube
Research ArticleOriginal Research

Evaluation of an Alternative Chest Physiotherapy Method in Infants With Respiratory Syncytial Virus Bronchiolitis

Guy Postiaux, Jacques Louis, Henri C Labasse, Julien Gerroldt, Anne-Claire Kotik, Amandine Lemuhot and Caroline Patte
Respiratory Care July 2011, 56 (7) 989-994; DOI: https://doi.org/10.4187/respcare.00721
Guy Postiaux
Department of Pediatrics; and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: [email protected]
Jacques Louis
Department of Pediatrics; and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Henri C Labasse
Department of Neurosciences, Grand Hôpital de Charleroi, Montignies-sur-Sambre, Belgium.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Julien Gerroldt
Department of Pediatrics; and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Anne-Claire Kotik
Department of Pediatrics; and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Amandine Lemuhot
Department of Pediatrics; and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Caroline Patte
Department of Pediatrics; and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • References
  • Info & Metrics
  • PDF
Loading

Abstract

BACKGROUND: We proposed a new chest physiotherapy (CPT) secretion clearance method to treat respiratory syncytial virus bronchiolitis in infants. Our new CPT method consists of 15 prolonged slow expirations, then 5 provoked cough maneuvers.

METHODS: We randomized 20 infants (mean age 4.2 months) into 2 groups: 8 patients received 27 sessions of nebulization of hypertonic saline; 12 patients received 31 sessions of nebulization of hypertonic saline followed by our new CPT method. We used the Wang clinical severity scoring system (which assesses wheezing, respiratory rate, retractions, and general condition) and measured SpO2 and heart rate before each CPT session (T0), immediately after the 30-min session (T30), and 120 min after the session (T150).

RESULTS: Within the groups: in the first group, Wang score was significantly lower at T150 than at T0: 4.6 vs 5.0 (P = .008). In the new-method-CPT group, Wang score was significantly lower at T30 (3.6 vs 4.3, P = .001) and at T150 (3.7 vs 4.3, P = .002). Wheezing score was significantly lower at T150 than at T0 (1.1 vs 1.2, P = .02) in the first group, and in the new-method-CPT group at T30 than at T0 (0.8 vs 1.3, P = .001) and at T150 than at T0 (0.9 vs 1.3, P = .001). Between the groups: at T30 the improvement was significantly better in the new-method-CPT group for overall Wang score (P = .02), retractions (P = .05), respiratory rate (P = .001), and heart rate (P < .001). At T150 the Wang score was not significantly different between the groups. At T30 (versus T0) the difference in percent gain between the groups was significant for Wang score (P = .004), wheezing (P = .001), and heart rate (P = .02). Over 5-hospital days, the daily baseline (T0) Wang score decreased significantly in the new-method-CPT group (P = .002), whereas it did not in the first group. There were no adverse events. Average hospital stay was not significantly different between the groups.

CONCLUSIONS: Our new CPT method showed short-term benefits to some respiratory symptoms of bronchial obstruction in infants with acute respiratory syncytial virus bronchiolitis.

  • bronchial obstruction
  • chest physiotherapy
  • infant
  • prolonged slow expiration technique
  • viral bronchiolitis
  • respiratory syncytial virus
  • airway clearance

Introduction

Infant viral bronchiolitis is an obstructive lower respiratory tract infection that is responsible for substantial morbidity in children under age 2. Bronchiolitis is characterized by acute inflammation, edema, increased mucus production, and bronchospasm, which affect the flow and the permeability of the small airways, causing hyperinflation, atelectasis, and wheezing. Bronchiolitis affects more than 10% of children.1 Most treatments for bronchiolitis have limited efficacy. According to the current literature, conventional chest physiotherapy (CPT) has no effect on outcome, especially on illness duration or hospital stay,2–4 but new techniques have given encouraging clinical results. In Belgium a 2-stage new CPT method, which was proposed by our group, is widely applied, and was recommended by a consensus conference held in Paris in 2000.5 The first stage involves a prolonged slow expiration (in French, expiration lente prolongée) technique. The second stage involves provoked cough.6,7 This new CPT method had not been submitted to a controlled trial.

The Wang clinical severity scoring system assigns a value between 0 and 3 to each of 4 variables: respiratory rate, wheezing, retractions, and general condition (Table 1). The maximum Wang score is 12, and a higher Wang score indicates worse condition. Mandelberg and colleagues found a significant change in Wang score in infants with acute viral bronchiolitis by substituting the usual 0.9% isotonic saline solution with a 3% hypertonic saline solution, and a bronchodilator (terbutaline).8–10 A more recent study showed similar results as to efficacy, safety, and hospital stay in patients with viral bronchiolitis.11

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table 1.

Wang Clinical Severity Scoring System

During the winters of 2004–2005, 2005–2006, and 2006–2007 we assessed the efficacy of the new CPT method (prolonged slow expiration and provoked cough) following albuterol administered with 3% NaCl hypertonic saline solution on the Wang score of hospitalized infants with respiratory syncytial virus (RSV) bronchiolitis.

Methods

This randomized controlled trial was approved by our institution's ethics committee, all the patients' parents or legal representative gave informed consent, and all research procedures were per the Helsinki declaration.

Subjects

Sixty-five infants with bronchiolitis were admitted to the pediatric unit of the Grand Hôpital de Charleroi, Belgium, during the winter months (November to March) of 2004–2005, 2005–2006, and 2006–2007. Twenty patients met the inclusion criteria:

  • First clinical episode of acute bronchiolitis

  • Age < 12 months

  • Wang score ≥ 3

  • RSV in nasopharyngeal secretions, via immunochromatography (Veda Lab, Alençon, France)

The exclusion criteria were:

  • Parents' refusal

  • No nasopharyngeal RSV

  • Comorbidity such as cardiac or neurological disease

  • Previous episodes of wheezing

  • Wang score < 3

  • Prescription of CPT on parents' request

  • Chronic lung disease, such as bronchodysplasia

  • Immunodeficiency

  • Congenital anomaly

  • Need for mechanical ventilatory support in the intensive care unit

Randomization and Groups

The enrolled patients were randomly assigned to nebulization of hypertonic saline (the control group), followed in the second group by the new CPT method, based on a stratified sampling for homogeneity (Fig. 1).12 During randomization, to ensure a balance of illness severity and age across the groups, we grouped the patients into 4 subgroups: Wang score between 3 and 5; Wang score ≥ 6; age < 2 months; and age 2–12 months.

Fig. 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig. 1.

Flow chart.

Interventions

Both groups received albuterol in 3 mL of hypertonic saline (3% NaCl), nebulized over 8–10 min with a Sidestream nebulizer (Respironics, Murrysville, Pennsylvania) at a flow of 8 L/min. The new-method-CPT group then received the new CPT method for 10–15 min.

The new CPT method includes prolonged slow expiration and provoked cough. The prolonged slow expiration slowly increases the intrathoracic pressure through an thoraco-abdominal compression by the clinician, to avoid the bronchial collapse and the flow interruption of forced expirations.13 Provoked cough is obtained with a brief pressure applied on the trachea above the sternal notch. The cough-induced secretions are swallowed, which obviates nasopharyngeal suctioning and thus avoids the risk of damaging the mucosal lining and/or strong coughing bouts. Most RSV bronchiolitis patients have a high respiratory rate, so for optimal secretion clearance the thoracic pressure is applied during 2 or 3 consecutive expiratory phases. The infant is supine, with a head elevation of 35°, to prevent gastroesophageal reflux.14 The treatment was applied at least 2 hours after the last meal to avoid reflux vomiting during expectoration. The treatment was carried out once a day until the Wang score was normalized or until hospital discharge, based on the usual criteria: normal food intake and no need for supplemental oxygen.

Data Collection

Two pediatricians evaluated the Wang score variables, SpO2 (N-595, Nellcor/Covidien, Boulder, Colorado), and heart rate. A recent multi-center study that evaluated a clinical scoring system that included the same variables as the Wang score (wheezing, respiratory rate, and retractions) found a high level of inter-observer agreement between physicians, nurses, and respiratory therapists.15 Both of our pediatrician evaluators were blinded to the applied treatment and goals. The evaluations took place at the beginning of each session (T0), immediately after the 30-min treatment session (T30), and 2 hours after the treatment session (T150). During the study, 3 trained physiotherapists were in charge of administering the treatments, and they were instructed to ignore the results of each evaluation until the end of the study. The patients' parents were unaware of the group in which their child was included. In both groups the periods of time spent in the room were identical, so outside observers were blinded to the applied treatment.

Data Analysis

We entered the data into a spreadsheet (Excel, Microsoft, Redmond, Washington), then imported them into statistics software (Minitab 13.20, Minitab, State College, Pennsylvania). We used the Student t test for paired values to assess the Wang-score changes within the groups, one-way analysis of variance to assess the Wang-score differences between the groups, one-way analysis of variance for independent samples to assess the Wang-score and Wang-score component changes expressed as the differences between the groups, one-way analysis of variance for repeated measures to compare the daily evolution of the Wang score in each group, and the Mann-Whitney U test to compare hospital stay between the groups. We report mean ± SD values. Differences were considered significant when P < .05. We did not adjust for multiple comparisons, which is a limitation of the study.

Results

Twenty infants were included and randomized (Table 2). The 8 infants in the control group underwent 27 nebulization sessions. The 12 infants in the new-method-CPT group underwent 31 nebulization and new-method-CPT sessions.

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table 2.

Subjects

At T0 the baseline Wang scores were not significantly different between the groups. Within the groups (Table 3), in the control group, the session benefit versus T0 was significant at T150 for Wang score (P = .008) and wheezing (P = .02), and in the new-method-CPT group the session benefit was significant at T30 (P = .001) and at T150 (P = .001) for Wang score, and at T30 (P = .001) and at T150 (P = .001) for wheezing. At T150 the clinical scores were no longer significantly different between the groups.

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table 3.

Wang Clinical Severity Score Differences Within the Groups*

Between the groups (Table 4), at T0 there were no differences, but at T30 the difference was significantly better in the new-method-CPT group for Wang score, respiratory rate, retractions, and heart rate. At T150 there were no significant differences between the groups.

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table 4.

Wang Clinical Severity Score Differences Between the Groups*

At T30, versus T0, the percentage gains (Table 5) in both groups were significant for Wang score, wheezing, and heart rate. In the control group, 3 of the 8 infants improved, whereas in the new-method-CPT group 10 of the 12 infants improved.

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table 5.

Session Results on Wang Clinical Severity Score*

On day 1 (Fig. 2) the baseline Wang scores were not significantly different between the 2 groups (P = .72). In the control group, day by day, throughout the study, the daily baseline Wang score did not change significantly (P = .06), whereas it significantly decreased in the new-method-CPT group (P = .002) (Table 6). After 5 days, 6 of the 8 control group patients had been discharged, whereas all 12 of the new-method-CPT group had been discharged. The average hospital stay was not significantly different between the groups: 6.3 ± 2.0 days in the control group, vs 5.3 ± 1.8 days in the new-method-CPT group (P = .25). There were no adverse events.

Fig. 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig. 2.

Daily baseline (T0) Wang clinical severity scores. On day 1 the baseline Wang scores were not significantly different between the groups (P = .72).

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table 6.

Evolution of Daily Baseline (T0) Wang Clinical Severity Score

Discussion

This randomized controlled trial showed short-term benefit from our new CPT method on several respiratory variables in infants with RSV bronchiolitis. Thus far, 3 randomized controlled trials have reported conventional CPT in hospitalized patients with bronchiolitis, and those studies found no clinical benefit from vibration and percussion techniques.2–4 They have in common the association of clapping performed with the cupped hand for 3 min in 5 positions of drainage, assisted cough, and/or oropharyngeal suctioning. These maneuvers may be detrimental to infants, and the American Academy of Pediatrics and a Cochrane systematic review do not recommend conventional CPT.16,17 Our new CPT method is more attuned to pulmonary physiology, and in our study there were no adverse events. The main component of our new CPT method is the prolonged slow expiration, which is a slow passive and progressive expiration from functional residual capacity to expiratory reserve volume. The obtained lung deflation helps the secretions to flow from the smaller to the larger airways, where cough can move the secretions to the trachea. It is also likely that the immediate improvement in Wang score and wheezing at T30 is due to the mechanical advantage from lung deflation, rather than from secretion drainage.

Nebulizing hypertonic saline before the CPT maneuver induces an osmotic flow of water in the inspissated mucus, which facilitates drainage and reduces edema in the submucosal tissue.18 The benefits we observed from nebulized hypertonic saline in this study are similar to those of Mandelberg's group; at T150 the Wang score of the control group showed a significant improvement.9,10 With the addition of the prolonged slow expirations and provoked cough the results were better in the new-method-CPT group at T30, but similar for the groups at T150.

By contributing actively to a direct and immediate drainage of secretions, the new CPT method reduces some bronchial obstruction symptoms that are usually associated with an increased load of breathing, due to a positive intrathoracic pressure and an increased respiratory rate.19 The CPT and nebulized hypertonic saline act in synergy. The improvement was cumulative in the new-method-CPT group, with a day-to-day baseline improvement in Wang score significantly better than that in the control group. This trend was observed over 3 winters. The day-to-day effect could result from the viral load reduction in airway secretions, as suggested by Mandelberg. The benefit might also result from hyperventilation and persistent cough after the session. The time required for mucociliary transport of secretions from the smaller to the larger airways could be another explanation for the difference. We suggest that the new CPT method is the cornerstone of a longer-lasting benefit.

Wheezing and cough are common symptoms of bronchial obstruction in childhood. The improvement of the Wang score is directly related to reduction in wheezing (see Table 3). This leads us to believe that mucus drainage in infants is the mainstay of the improvement, as the CPT maneuvers cannot affect edema and bronchospasm, although both are usually associated with wheezing.20

Conclusions

Our new CPT method reduced some respiratory symptoms of bronchial obstruction in infants with acute RSV bronchiolitis. A multi-center study is needed to confirm these preliminary results.

Acknowledgments

We thank Maurice Meunier, Haute Ecole Charleroi Europe-Belgium, and Stéphanie Postiaux, Dow Corning Europe SA, for assistance with the biostatistics.

Footnotes

  • Correspondence: Guy Postiaux PT, Department of Pediatrics, Grand Hôpital de Charleroi, Site Reine Fabiola, Avenue du Centenaire 73, 6061 Montignies-sur-Sambre, Belgium. E-mail: guy.postiaux{at}gmail.com.
  • Mr Postiaux presented a version of this paper at the Annual Congress of the European Respiratory Society, held October 3-7, 2008, in Berlin, Germany.

  • The authors have disclosed no conflicts of interest.

  • Copyright © 2011 by Daedalus Enterprises Inc.

References

  1. 1.↵
    1. Bellon C
    . Bronchiolitis aiguë. Histoire naturelle. Arch Pédiatr 2001;8(Suppl. 1):31–38. Article in French.
    OpenUrl
  2. 2.↵
    1. Bohe L,
    2. Ferrero ME,
    3. Cuestas E,
    4. Polliotto L,
    5. Genoff M
    . Indications of conventional chest physiotherapy in acute bronchiolitis. Medicina (B Aires) 2004;64(3):198–200. Article in Spanish.
    OpenUrlPubMed
  3. 3.
    1. Nicholas KJ,
    2. Dhouieb MO,
    3. Marshal TG,
    4. Edmunds AT,
    5. Grant MB
    . An evaluation of chest physiotherapy in the management of acute bronchiolitis. Changing clinical practice. Physiotherapy 1999;85(12):669–674.
    OpenUrl
  4. 4.↵
    1. Webb MS,
    2. Martin JA,
    3. Cartlidje PH,
    4. Ng YK,
    5. Wright NA
    . Chest physiotherapy in acute bronchiolitis. Arch Dis Child 1985;60(11):1078–1079.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. Stagnara J,
    2. Balagny E,
    3. Cossalter B,
    4. Dommergues JP,
    5. Dournel C,
    6. Drahi E,
    7. et al
    . Management of bronchiolitis in the infant. Recommendations. Long text. Arch Pediatr 2001;8(Suppl1):11S–23S. Article in French.
    OpenUrlPubMed
  6. 6.↵
    1. Postiaux G
    . Quelles sont les techniques de désencombrement bronchique et des voies aériennes supérieures adaptées chez le nourrisson? Arch Pediatr 2001;(Suppl 1):117S–125S. Article in French.
  7. 7.↵
    Union Régionale des Médecins Libéraux Ile de France. Conférence de consensus sur la prise en charge de la bronchiolitis du nourrisson. Paris, September 2000. Arch Pediatr 2001;8(Suppl. 1):1–196.
    OpenUrl
  8. 8.↵
    1. Wang EE,
    2. Milner RA,
    3. Navas L,
    4. Maj H
    . Observer agreement for respiratory signs and oxymetry in infants hospitalized with lower respiratory infections. Am Rev Respir Dis 1992;145(1):106–109.
    OpenUrlPubMed
  9. 9.↵
    1. Sarrel EM,
    2. Tal G,
    3. Witzling M,
    4. Someck E,
    5. Houri S,
    6. Cohen HA,
    7. Mandelberg A
    . Nebulised 3% hypertonic saline solution treatment in ambulatory children with viral bronchiolitis decreases symptoms. Chest 2002;122(6):2015–2020.
    OpenUrlCrossRefPubMed
  10. 10.↵
    1. Mandelberg A,
    2. Tal G,
    3. Witzling M,
    4. Someck E,
    5. Houri S,
    6. Balin A,
    7. Priel IE
    . Nebulised 3% hypertonic saline solution treatment in hospitalized infants with viral bronchiolitis. Chest 2003;123(2):481–487.
    OpenUrlCrossRefPubMed
  11. 11.↵
    1. Kuzik BA,
    2. Al Qadhi SA,
    3. Kent S,
    4. Flavin MP,
    5. Hopman W,
    6. Hotte S,
    7. Gander S
    . Nebulised hypertonic saline in the treatment of viral bronchiolitis in infants. J Pediatr 2007;15(3):266–270.
    OpenUrl
  12. 12.↵
    1. Dagnelie P
    . Statistique théorique et appliquée. Tome 1, statistique descriptive et bases de l'inférence statistique. De Boeck Université; 1998. French.
  13. 13.↵
    1. Postiaux G,
    2. Lens E
    . De ladite Accélération du Flux Expiratoire…où forced is fast (Expiration Technique-FET). Ann Kinésithér 1992;19,8:411–427. Article in French.
    OpenUrl
  14. 14.↵
    1. Demont B,
    2. Escourrou P,
    3. Vincon C,
    4. Cabas CH,
    5. Grisan A,
    6. Odievre M
    . Effects of respiratory physical therapy and nasopharyngeal suction on gastroesophageal reflux in infants less than a year of age, with or without abnormal reflux. Arch Fr Pediatr 1991;48(9):621–625.
    OpenUrlPubMed
  15. 15.↵
    1. Gajdos V,
    2. Beydon N,
    3. Bommenel L,
    4. Pellegrino B,
    5. de Pontual L,
    6. Bailleux S,
    7. et al
    . Inter-observer agreement between physicians, nurses, and respiratory therapists for respiratory clinical evaluation in bronchiolitis. Pediatr Pulmonol 2009;44(8):754–762.
    OpenUrlPubMed
  16. 16.↵
    1. Perrotta C,
    2. Ortiz Z,
    3. Roque M
    . Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database Syst Rev 2007;(1):CD004873.
  17. 17.↵
    American Academy of Pediatrics subcommittee. Diagnosis and management of bronchiolitis. Pediatrics, 2006;118(4):1774–1793.
    OpenUrlAbstract/FREE Full Text
  18. 18.↵
    1. Mandelberg A,
    2. Amirav I
    . Hypertonic saline or high volume normal saline for viral bronchiolitis: mechanisms and rationale. Pediatr Pulmonol 2010;45(1):36–40.
    OpenUrlCrossRefPubMed
  19. 19.↵
    1. Stokes GM,
    2. Milner AD,
    3. Groggins RC
    . Work of breathing, intra-thoracic pressure and clinical findings in a group of babies with bronchiolitis. Acta Paediatr Scand 1981;70(5):689–694.
    OpenUrlPubMed
  20. 20.↵
    1. Gavriely N,
    2. Shee TR,
    3. Cugell DW,
    4. Grotberg J
    . Flutter in flow-limited collapsible tubes as a mechanism for generation of wheezes. J Appl Physiol 1989;66(5):2251–2261.
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top

In this issue

Respiratory Care: 56 (7)
Respiratory Care
Vol. 56, Issue 7
1 Jul 2011
  • Table of Contents
  • Table of Contents (PDF)
  • Cover (PDF)
  • Index by author

 

Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on American Association for Respiratory Care.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Evaluation of an Alternative Chest Physiotherapy Method in Infants With Respiratory Syncytial Virus Bronchiolitis
(Your Name) has sent you a message from American Association for Respiratory Care
(Your Name) thought you would like to see the American Association for Respiratory Care web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Evaluation of an Alternative Chest Physiotherapy Method in Infants With Respiratory Syncytial Virus Bronchiolitis
Guy Postiaux, Jacques Louis, Henri C Labasse, Julien Gerroldt, Anne-Claire Kotik, Amandine Lemuhot, Caroline Patte
Respiratory Care Jul 2011, 56 (7) 989-994; DOI: 10.4187/respcare.00721

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Evaluation of an Alternative Chest Physiotherapy Method in Infants With Respiratory Syncytial Virus Bronchiolitis
Guy Postiaux, Jacques Louis, Henri C Labasse, Julien Gerroldt, Anne-Claire Kotik, Amandine Lemuhot, Caroline Patte
Respiratory Care Jul 2011, 56 (7) 989-994; DOI: 10.4187/respcare.00721
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Introduction
    • Methods
    • Results
    • Discussion
    • Conclusions
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • References
  • PDF

Related Articles

Cited By...

Keywords

  • bronchial obstruction
  • chest physiotherapy
  • infant
  • prolonged slow expiration technique
  • viral bronchiolitis
  • respiratory syncytial virus
  • airway clearance

Info For

  • Subscribers
  • Institutions
  • Advertisers

About Us

  • About the Journal
  • Editorial Board
  • Reprints/Permissions

AARC

  • Membership
  • Meetings
  • Clinical Practice Guidelines

More

  • Contact Us
  • RSS
American Association for Respiratory Care

Print ISSN: 0020-1324        Online ISSN: 1943-3654

© Daedalus Enterprises, Inc.

Powered by HighWire