1173 Comparison of Chest Physiotherapy Techniques in Infants With HMD

Abstract

(Spon. by L.J. Butterfield). The pressure in an infant's airway when CPAP is delivered by nasal prongs has not been previously repor ted. Using air-filled catheters and differential pres sure transducers we have measured simultaneous pressures in nasal prongs (Ppr) and pharynx(Ppx) in 1 8 newborns. After a steady state was achieved, end expi ratory pressure in five consecutive breaths was measured: these were usually identical but otherwise were averaged. The pressure difference (Ppr-PpXsAP) was lo in infants with visual evidence of tight palato-glossal apposition. Though there was much variation, babies whose mouths were a) spontaneously open without tonguelpalate seal had a %AP=48% + 4% (weighted average + SEM), b) spontaneously closed or who had a demonstrable seal had a %AP-8% 2 3%; these are significantly different means (p=<.001). In the latter group there was a close correlation between P p r and Ppx (r-0.965). The ability to maintain a good seal was not related to gestational age, post natal a g e , severity or type of disease. However, babies who maintained a good seal frequently had an active gag reflex (Fisher exact test p=.04). Spontaneous closure o f the mouth usually indicated a good seal but forcible closure di rut r o n q l q t p n t l v A~r r a * c -~m~a m m e r s m l t n H o s p~t a l m e e n hllzabeth osp ta for Children, London. England. . -Godfrey and Mearns have shown that exercise intolerance in children with C.F. is related to airway obstruction. Recently Campbell et a1 suggested that poor nutrition leads to abnormal serum lipids which may lead to tissue hypoxia. Our study investigated the roles of hypoxia, lung mechanics, nutritional status and serum lipids in limiting exercise tolerance. Twenty children with C.F. of varying severity performed two progressive exercise tests on a cycle ergometer, once breathing air, once 02. The body mass percentile,(EMP), as a measure of appropriateness of weight for height, was calculated from the body mass index.Serum lipids, maximal mid-expiratory flow rate (MMT) and maximum voluntary ventilation were measured. In five, end tidal C02 (PETC02) was monitored throughout the test. 0 had very little effect on the work accomplished by each child. '?he mean percent work expected from height (Wmax) was 75 and the heart rate at the final work load was 175/min.,20 less in normal children suggesting adequate car3iovascular reserve at the final work load. Wmax correlated with the MMF,the BMP and the Shwachman score. The children with the lower MMF's had little respiratory reserve at the final work load. Despite this,no child at any time had an elevated PETCO .jerum lipids,while abnormal in every case,did not correlate with ny parameter measured.We conclude that nutritional status and C irway obstruction are closely correlated with exercise tolerance n C.F. and that,unlike the adult with chronic disease,exercise imiting dyspnea occurs with a normal PETC02. Fetal lung maturation is typified by independent increases in both lecithin (TL) and disaturated lecithin (DS...

Physical Therapy for Neonates with Respiratory Dysfunction

“…37 A study comparing four different combinations of CPT techniques found slightly higher systolic blood pressure in infants treated in the head down position. 38 In that study, neither heart rate nor blood pressure increased beyond normal ranges.…”

“…Crane and co-workers compared percussion with vibration in two different drainage positions. 38 No significant difference in TCPO 2 was found 30 minutes before and 5, 15, and 60 minutes after CPT. When percussion was used, there was a trend toward higher TCPO 2 values up to one hour after treatment.…”

“…33 Crane and associates found no significant difference in TCPO 2 between two groups who were treated in the Trendelenburg's position (20-30°) and two groups who were treated with the bed flat. 38 Neither study included infants with unilateral lung disease. Zack and co-workers, however, found that position may have an effect on blood gas values in acutely ill patients with specific unilateral lung involvement.…”

Efeitos da fisioterapia respiratória em bebês de risco sob cuidados especiais

“…O estudo de Gava e Picanço 42 aponta que a tapotagem por si só não é capaz de promover eliminação das secreções, mas aumenta a velocidade de eliminação do muco 37,43,44 . Retificando o estudo anterior, Crane et al 44 observaram em sua pesquisa realizada com 24 RNPT com síndrome do desconforto respiratório e em oxigenoterapia, sendo que 16 neonatos estavam sob uso da ventilação mecânica. Os autores compararam a tapotagem e a vibração em duas posições de drenagem postural.…”

Chest Physiotherapy in the Pediatric Intensive Care Unit

“…Head-down positioning may, however, increase systemic blood pressure with the potential for intraventricular hemorrhage in neonates, increase gastroesophageal reflux and intracranial pressure, place the diaphragm at mechanical disadvantage, and may increase venous return, thereby increasing the work of the heart. 23,[40][41][42][43] Conversely, the upright position has been shown to improve end-expiratory lung volumes (keeping the functional residual capacity above closing capacity and therefore preventing airway closure) and oxygenation, and may protect against ventilator-associated pneumonia. [44][45][46][47] Considering the lack of supporting evidence and the potential for adverse events, the inverted position should not be used in pediatric practice.…”