Structured Respiratory Physiotherapy Protocol for Atelectasis in Pediatrics
- Conditions
- ung AtelectasisC08.381
- Registration Number
- RBR-106bhfwy
- Lead Sponsor
- Faculdade de Medicina da Universidade de São Paulo
- Brief Summary
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.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Data analysis completed
- Sex
- Not specified
- Target Recruitment
- Not specified
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
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)
Study & Design
- Study Type
- Intervention
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Expected outcome 1: It is expected that the application of the Structured Respiratory Physiotherapy Protocol (PEFR) in the intervention group will promote a reduction in the Lung Ultrasound Score (LUS) with values ??of p<0.05, based on the observation of a variation in pre- and post-intervention measurements when compared to the control group;Outcome found 1: Significant differences were observed when comparing CG and GI before versus after intragroup respiratory physiotherapy. Regarding the LUS score in the CG, the difference between the medians (IQ25-75%) before respiratory physiotherapy [ 2 (1-3) ] and after respiratory physiotherapy [ 1 (1 -2.5)] in the CG was 1 , (p= 0.01) while in the GI, the difference between the medians (IQ25-75%) before respiratory physiotherapy [3 (2-3)] and after respiratory physiotherapy [1(0.5 -2)] was of 2 (p< 0.001).
- Secondary Outcome Measures
Name Time Method Expected outcome 2: It is expected that the application of the Structured Respiratory Physiotherapy Protocol (PEFR) in the intervention group (IG) will promote a greater reduction in the time of invasive mechanical ventilation, pneumonia associated with mechanical ventilation, length of stay in the pediatric and hospital ICU, with p values ??<0.05 when compared to the control group (CG).;Outcome found 2: The groups presented similar characteristics (p > 0.05) regarding time on invasive mechanical ventilation, pneumonia associated with mechanical ventilation, length of stay in the pediatric ICU and hospital.