Abstract:ResumoObjetivo: Proporcionar elementos valiosos e um pouco de humor nesta chamada era da "prática baseada em evidências" com o objetivo de ajudar os clínicos a fazer escolhas melhores no cuidado que eles provêem com base em evidências, e não simples ou exclusivamente com base em um ensaio clínico randomizado (ECR) ou meta-análise (o que pode não ser evidência).
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“…In the studies we found that newborn infants on music therapy group showed clinically less variability of all physiological variables during the physiotherapy procedures. A clinical important result cannot always be considered statistically significant 14 . This difference is particularly important considering the procedure performed in the two groups, it is considered invasive 15 .…”
Introduction: Previous studies have shown music therapy as a way to improve the clinical status of premature infants, improving vital signs and decreasing crying episodes. Objective: Compare the effects of music on vital signs of premature infants undergoing respiratory physiotherapy. Methods: We performed a randomized clinical trial consisting of 26 premature infants, divided into control group (N=12) and study group (N=14), carried out in a Neonatal Intensive Care Unit. All newborn infants undergone standard practice physiotherapy for 15 minutes: vibration and aspiration. On the study group they were exposed to classical music three minutes before the standard physiotherapy, and finished three minutes after the end of these procedures. A recorder was placed inside the incubator with an intensity of 25 decibels. Measurements of heart and respiratory rate and oxygen saturation were measured before, during and after each sessions of respiratory physiotherapy for two groups. Results: When comparing control and study groups regarding heart rate frequency and oxygen saturation, there was no statistically significant difference, but the inclusion of music determined clinically the variability of these data and 30% of the variation in respiratory rate was due to the inclusion of music during and after the physiotherapy, and the neonatal noninvasive ventilation showed less variation in their respiratory rate when compared to the neonatal on oxygen therapy. Conclusion: The results have showed a beneficial effect of music, showing lower respiratory rate in newborn infants during and after respiratory physiotherapy procedure.
“…In the studies we found that newborn infants on music therapy group showed clinically less variability of all physiological variables during the physiotherapy procedures. A clinical important result cannot always be considered statistically significant 14 . This difference is particularly important considering the procedure performed in the two groups, it is considered invasive 15 .…”
Introduction: Previous studies have shown music therapy as a way to improve the clinical status of premature infants, improving vital signs and decreasing crying episodes. Objective: Compare the effects of music on vital signs of premature infants undergoing respiratory physiotherapy. Methods: We performed a randomized clinical trial consisting of 26 premature infants, divided into control group (N=12) and study group (N=14), carried out in a Neonatal Intensive Care Unit. All newborn infants undergone standard practice physiotherapy for 15 minutes: vibration and aspiration. On the study group they were exposed to classical music three minutes before the standard physiotherapy, and finished three minutes after the end of these procedures. A recorder was placed inside the incubator with an intensity of 25 decibels. Measurements of heart and respiratory rate and oxygen saturation were measured before, during and after each sessions of respiratory physiotherapy for two groups. Results: When comparing control and study groups regarding heart rate frequency and oxygen saturation, there was no statistically significant difference, but the inclusion of music determined clinically the variability of these data and 30% of the variation in respiratory rate was due to the inclusion of music during and after the physiotherapy, and the neonatal noninvasive ventilation showed less variation in their respiratory rate when compared to the neonatal on oxygen therapy. Conclusion: The results have showed a beneficial effect of music, showing lower respiratory rate in newborn infants during and after respiratory physiotherapy procedure.
“…In addition to all of the above, it has been identified that good care should not be based solely on the findings of RCTs (15,(26)(27)(28)(50)(51)(52)(53)(57)(58)(59). Acknowledging that evidence may still be misinterpreted or distorted by recalcitrant proponents of entrenched practices and other biases, the authors state that rational, quantitative evidence may not necessarily be the only, or even the main, factor driving healthcare decisions.…”
Section: Brief Comments On the Rctsmentioning
confidence: 99%
“…The correctable weaknesses that still persist in the design, conduct, and analysis of biomedical and public health research studies, produce misleading results and waste valuable resources. Statistical precision is often used in a misleading way, and the arbitrary choice of analyses might affect the reported findings . Unfortunately, consensus building groups and bedside care providers remember the novel findings of some studies, despite significant flaws, when taking care of patients.…”
Oxygen is a neonatal health hazard that should be avoided in clinical practice. In this review, an international team of neonatologists and nurses assessed oxygen saturation (SpO2) targeting in preterm infants and evaluated the potential weaknesses of randomised clinical trials.ConclusionSpO2 of 85–89% can increase mortality and 91–95% can cause hyperoxia and ill effects. Neither of these ranges can be recommended, and wider intermediate targets, such as 87–94% or 88–94%, may be safer.
“…Apesar de as variáveis estudadas terem apresentado significância estatística em alguns dos momentos avaliados, todos os valores permaneceram em intervalos considerados fisiológicos. Contudo, a não-equivalência da significância estatística e da importância clínica destes resultados deve ser considerada criteriosamente; um resultado significativo estatisticamente muitas vezes pode não ser considerado clinicamente importante, assim como é verdadeiro o inverso (28) . Desta forma, torna-se imprescindível que o papel do fisioterapeuta dentro das unidades neonatais seja reformulado, deixando de ser somente o profissional que aplica técnicas para a manutenção da higiene brônquica e passe a ser também o profissional que pesquise e questione o real valor da fisioterapia respiratória, procurando respostas para questões como: em que situações clínicas os recursos de fisioterapia podem ser deletérios?…”
OBJETIVO: Avaliar as repercussões da fisioterapia respiratória sobre a função cardiopulmonar em recém-nascidos pré-termo (RNPT) submetidos à ventilação mecânica. MÉTODOS: Estudo prospectivo de RNPT com peso de nascimento menor que 1500g, sendo verificados os valores de frequência cardíaca (FC), saturação de oxigênio (SatO2), frequência respiratória (FR) e pressão arterial sistêmica (PA) antes e após a fisioterapia respiratória e a aspiração endotraqueal. Os RNPT incluídos foram avaliados em sessões sequenciais entre o 3º-7º dias de vida por dois fisioterapeutas da unidade neonatal. Os valores de FC, SatO2 e PA foram coletados por monitorização eletrônica e a FR, por cronômetro. Na análise estatística, foi utilizado o teste de ANOVA para medidas repetidas, sendo significante p<0,05. RESULTADOS: Foram estudados 42 recém-nascidos, 57% do sexo feminino, com peso de nascimento médio de 1024g e idade gestacional média de 29,5 semanas. Somente 3 RNPT apresentaram Apgar de 5º minuto menor que 5 e a Doença das Membranas Hialinas foi o principal diagnóstico respiratório (88%). Foram realizadas 252 sessões de fisioterapia. A FC, FR, SatO2 e PA atingiram valores considerados fisiológicos após os procedimentos fisioterapêuticos e a aspiração endotraqueal. CONCLUSÕES: Os procedimentos de fisioterapia respiratória e de aspiração endotraqueal não apresentaram influências significativas na função cardiopulmonar, sugerindo que, quando bem indicados e realizados, não comprometem a estabilidade clínica de RNPT.
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