Structured Respiratory Physiotherapy protocol for resolution of Atelectasis in pediatric intensive care
试验速览
- 阶段
- Unknown
- 状态
- 已完成
- 发起方
研究概览
简要总结
Introduction: The developing lungs are predisposed to collapse. Children are at greater risk of atelectasis due to their anatomophysiological particularities. Interventions used to treat pulmonary atelectasis in intubated children are limited and include respiratory physiotherapy. Several respiratory physiotherapy techniques and interventions are routinely used to treat atelectasis, but there are only four studies that cite different respiratory physiotherapy methods aimed at resolving atelectasis in pediatric patients on invasive mechanical ventilation (IMV). Objectives: To evaluate the application of a Structured Respiratory Physiotherapy Protocol (SRPP) for lower airway clearance and lung reexpansion for infants on IMV with a clinical and imaging diagnosis of unilateral pulmonary atelectasis. Methods: This is a randomized and controlled clinical trial, including 30 infants with a mean age of 8.9 + 8.0 months; 7.5 + 3.0 kg; BMI 15.8 + 1.6 kg/cm2 and IMV time 7.7 + 4.3 days. The sample was randomized into a control group (CG), which underwent routine respiratory physiotherapy and an intervention group (IG), which underwent PEFR (postural drainage, mechanical chest vibration, manual hyperinflation with a self-inflating bag, stretching of the accessory respiratory muscles and functional positioning) . Both groups were evaluated immediately before and after respiratory physiotherapy regarding respiratory effort using the Wood Downes score (WD) and lung aeration using lung ultrasound (images classified using the Lung Ultrasound Score - LUS). The result of the intervention was evaluated by the magnitude of the effect using the Hedges'g test (interpretation: small (0.2 < Hedges' g < 0.5), moderate (0.5 < Hedges' g < 0.8) and large effect (Hedges' g > 0.8)); being: WD with an important effect on reducing the CG score after physiotherapy (Hedges’ g = -1.53) and a greater effect on the GI (Hedges’ g = -2.2). Results: Regarding LUS, there was a moderate effect on reducing the score in the CG after physiotherapy (Hedges’ g = -0.64) and a much greater effect in the GI (Hedges’ g = -1.88). Conclusion: The application of PEFR resulted in a significant reduction in the degree of respiratory distress and pulmonary atelectasis compared to the CG in this study.
研究设计
- 研究类型
- Interventional
入排标准
- 年龄范围
- 28D 至 2Y（—）
入选标准
- •Infants with 28 days to 24 months of age; both genders; on invasive mechanical ventilation for a period greater than or equal to 12 hours through an orotracheal cannula; diagnosed with Atelectasis by a pediatric intensive care physician through clinical and imaging examination (chest x-ray and lung ultrasound); whose legal guardians have authorized the child's participation in the study through the Free and Informed Consent Form
排除标准
- •Patients with bilateral atelectasis; any type of air leak syndrome (such as: subcutaneous emphysema, pneumothorax, pneumatocele, pneumomediastinum); pulmonary hemorrhage; diseases that cause bone fragility (costal osteoporosis and osteomyelitis); chest and/or lung bruises; subcutaneous pacemaker; treatment with anticoagulants for more than 72 continuous hours; hemodynamic instability; thrombocytopenia (<50,000 platelets); using a chest tube; with underlying neuromuscular or cardiac diseases and spinal deformities (kyphoscoliosis)