Bronquiolitis y SBO

Klga. Francisca Molina Mallea

Mg. Fisioterapia del Trax
Dpl. Kinesiologa Neonatal y Seguimiento del Prematuro

BRONQUIOLITS

Acute Viral Bronchiolitis (AVB)

La American Academy of Pediatrics (AAP)
define Bronquiolits como: Inflamacin aguda,
Edema y Necrosis de las celulas epiteliales de
las vas areas de pequeo calibre con
aumento en la produccin de moco, causando
Broncoespasmo.

Epidemiologa
Se estima que entre 11 12% de todos los
infantes son afectados en su primer ao de
vida, 1- 2% requieren hospitalizacin.
De los hospitalizados, el 10% son previamente
sanos y 36% con comorbilidades que
requirieron tratamiento en UCIP; de ellos el
1% fallece.

Epidemiologa
9% de los nios se infectan con VRS en los
primeros 2 aos de vida.
5 40% experimenta infecciones de vida
area baja durante la infeccin inicial.

Sntomas
La tos y sibilancias son sntomas comunes de
obstruccin bronquial en nios.
La genesis de las sibilancias es debido al Edema
de Mucosa y un grado menor de Broncoespamo.
Las sibilancias es debido a la Oscilacin de la
Pared Bronquial, efecto Flutter; lo cual ocurre
debido a la disminucin del diametro debido a la
inflamacin, edema y espamo de la Pared
Bronquial.

Evolucin Bronquiolitis
La evolucin natural de la BA tiene:
Fase Inicial en la cual predomina el edema y la
inflamacin de las vas respiratorias de
pequeno calibre.
Fase Subaguda que acontecera en la segunda
semana y en la cual se acumulan las
secreciones en esas vas.
Cundo KTR?

Patgenos Ms Comunes
Virus Respiratorio Sinsicial (VRS): 50 80% de los
casos
Rinovirus
Parainfluenza
Influenza
Adenovirus
Coronavirus
No todos son detectados por el IFI viral

Virus, su accin
Estos patogenos actuan en las clulas ciliadas
del epitelio bronquial, causando Inflamacin;
debido a que producen Mediadores
inflamatorios.

No siempre un Solo Virus

Molecular diagnostic techniques have also
revealed a high frequency (15-25%) of mixed
viral infections among children evaluated for
bronchiolitis

Bronquiolits
Bronquiolitis afecta tipicamente a nios
menores de 2 aos, con mayor incidencia
entre 2 a 6 meses de edad.
Ocurre en Brotes durante los meses de
Invierno

Clnica
Nios se presentan con signos de infeccin
viral de la VAA;
Rinorrea
Tos
Fiebre (leve), en casos ocasionales.

Evolucin
Luego de 1 2 das los sntomas avanzan;
aumenta la tos, aumenta la frecuencia
respiratoria, retracciones y sibilancias.
El Infante se observa irritable, dificultad en la
alimentacin y vomitos.
Lo ms Comn es que comience a verse
mejora a los 3- 5 das.

 Most of the children with bronchiolitis have

tachycardia and tachypnea. Pulse oximetry
helps us in deciding about the need for
supplemental oxygen. The chest may appear
hyper-expanded and may be hyperresonant to
percussion. Wheezes and fine crackles may be
heard throughout the lungs. Severely affected
patients have grunting, marked retractions.
They may be cyanosed, and may have
impaired perfusion

Apneas
Apnea may occur in those born prematurely
and in younger than two months of age.

Evolucin
Disease Course and Prediction of Severity
Bronchiolitis usually is a self-limited disease.
Although symptoms may persist for several
weeks, the majority of children who do not
require hospital admission may continue to
have low grade symptoms upto 4 weeks

Diagnstico
El Diagnstico y Severidad debe ser evaluado
en base a la Clnica y Anamnesis del paciente.
Ni los examenes de laboratorio ni las
radiografias son requeridas ni tampoco
modifican el tratamiento de Bronquilitis,
excepto que exista alguna complicacin.

Diagnstico
Radiografa de Trax:
Hiperinsuflacin.
Aumento entramado intersticial.
Aumento entramado perihiliar.
Atelectasias subsegmentarias, se pueden
observar asociadas a estreches y tapones de
moco en la va area.

Deteccion VRS en menores de 2 aos

PCR, demostr ser una tcnica ms sensible
(11.1% positivos)
IFI (7.9% positivos)
Cultivo viral (6.3% positivos)

Tratamiento
En la mayora de los casos, puede ser
manejada de manera ambulatoria.
El manejo consiste en Educacin a los padres
y/o cuidadores acerca de:
Adecuada alimentacin.
Signos de alerta (aumento dificultad
respiratoria, retracciones, problemas para
alimentarse).
Cundo llevar a un servicio de atencin.

 The treatment of bronchiolitis is quite

controversial and includes hydration,
oxygenation, respiratory therapy, and
medications, including bronchodilators,
epinephrine, mucolytics, and inhaled
corticosteroids.

 According to the Clinical Guidelines on

Complementary Health of the Brazilian Society
of Pediatrics, corticosteroids are not
recommended in the outpatient or inpatient
treatment of acute bronchiolitis
(recommendation grade A)

 The use of bronchodilators is more effective in

the early stage of the infection, when the
small airways are not obstructed with
secretions.(16) According to the Clinical
Guidelines on Complementary Health of the
Brazilian Society of Pediatrics, the routine use
of inhaled bronchodilators is not
recommended in the outpatient or inpatient
treatment to improve the prognosis of acute
bronchiolitis (recommendation grade A)

KTR
KTR tiene el objetivo de producir la limpieza
bronquial.
Optimizar RE-EXPANSIN PULMONAR
Mejorar la Mecanica ventilatoria
Prevencin complicaciones respiratorias.

 In a recent study, in which physical therapy

was performed in all patients, less need for
ICU admission and ventilatory support has
been observed, compared to previously
reported data.

Estudios
French studies demonstrated benefits in
removing secretion by the EAF technique,
besides the interventions mentioned above.
EAF potentiates normal lung physiology
through changes in airflows, promoting
bronchial clearance and homogenization of
pulmonary ventilation

 During the analysis of the questionnaire applied to

parents/guardians, an immediate reduction of
respiratory distress was observed after chest
physiotherapy, and this benefit was evident. Despite
the lack of scientific evidence about the effects of chest
physiotherapy in patients with acute bronchiolitis,
bronchial clearance techniques have been requested to
treat these patients in several centers, due to improved
respiratory symptoms and reduced pulmonary
complications observed in clinical practice. These
techniques are recommended in cases of bronchial
obstruction due to secretions.

Estudios
In the daily application of physical therapy
techniques, we identified a more rapid
reduction of respiratory and clinical
symptoms, such as decreased fever and
dyspnea, increased appetite, improved
pulmonary auscultation and cough. In this
study, satisfactory responses were observed
regarding the effects of physiotherapy on
most items evaluated by parents/guardians.

 A recent French consensus9 paper and other

European studies10,11 have encouraged the
practice of CP for these infants with AVB as
the initial treatment in order to avoid
consequences such as hospitalization in
intensive care units and mechanical
ventilation

 Physical therapy aims to remove secretions from

the airways. To date, three randomized controlled
trials have reported using conventional chest
physical therapy in hospitalized patients with
bronchiolitis. In those studies, no clinical benefit
was found using vibration and percussion
techniques3-5. Each study used clapping
performed with the cupped hand for 3 minutes in
5 positions of drainage with assisted cough
and/or suction. These maneuvers may not have
been enough to reduce discomfort in infants.

 The forced expiratory technique should be

avoided in children under 24 months of age
due to high compliance tracheal and chest,
because the rapid chest compression
promotes an interruption of expiratory flow26
thus demonstrating the importance of
creating a modulated flow so that there is an
appropriate extension of the expiratory phase
and a subsequent clearance of the distal
airways

 Postiaux et al.12 showed short-term benefits

with PSE to some respiratory symptoms of
bronchial obstruction in infants with AVB.

 Therefore, maneuvers such as tapping and

postural drainage may not have been effective in
pulmonary clearance of these infants because
these techniques did not create a sufficient flow
and forced expiratory technique for interrupting
the expiratory flow, and they may increase the
risk of vomiting and gastro esophageal reflux
disease (GERD)27-29. These techniques may not
have influenced the reduction in hyperinflation
and respiratory distress in the studies cited

 The primary goal of CP in these infants is to

reduce secretion obstruction and secondly
respiratory distress which is a consequence of
obstruction with subsequent improvement on
hyperinflation and respiratory distress

SINDROME BRONQUIAL OBSTRUCTIVO

(SBO)

SBOR

GRACIAS!!!