Posição prona e diminuição da assincronia toracoabdominal em recém-nascidos prematuros

Abstract

IntroductionIn newborn infants, the configuration and complacency of the chest wall puts the respiratory system at a clear mechanical disadvantage with relation to adults. 1 The more horizontal position of the ribs makes the chest wall more rounded, rather than elliptical as is seen in adults, AbstractObjective: To assess the effect of prone and supine positions on breathing pattern variables, thoracoabdominal motion and peripheral oxygen saturation of hemoglobin of premature newborn infants recovering from respiratory distress syndrome, while breathing spontaneously and in rapid eye movement sleep. Methods:This was a quasi-experimental study. Twelve preterms weighing > 1,000 g at enrollment were studied in both positions, in random order. Respiratory inductive plethysmography was used to analyze breathing pattern (tidal volume, respiratory rate, minute ventilation, mean inspiratory flow) and thoracoabdominal motion (labored breathing index, phase relation in inspiration, phase relation in expiration, phase relation in total breath and phase angle). Pulse oximetry was used to evaluate peripheral oxygen saturation. Student's t test for paired samples or the Wilcoxon test were used for statistical analysis. Significance was set at p < 0.05. Results:

Response of oxygen saturation in preterm infants receiving rib cage stabilization with an elastic band in two body positions: a randomized clinical trial

“…Thus, the studied group was classified as eupneic. Another point that may explain the difference between the mean respiratory rate values of our study and those found by Oliveira et al 16 is that, despite the prematurity, our newborns did not suffer from respiratory distress syndrome.…”

“…The study by Leipälä et al 15 highlighted prone as the body position with the lowest mean respiratory rate for the group of preterm newborns dependent on oxygen therapy. In contrast, the study by Oliveira et al 16 showed that, in spontaneously breathing and clinically stable newborns after respiratory distress syndrome, the respiratory rate had a higher mean value in supine than in prone (74.22 vs. 68.67 rpm). In our study, the mean value in supine without elastic band was higher than in prone without elastic band (51.5 vs. 48.7 rpm), and supine and prone with elastic band (48.2 rpm vs. 48.4 rpm) were very similar to the value of prone without elastic band.…”

“…Another study assessed 12 spontaneously breathing and clinically stable preterm newborns weighing less than 1,000g after respiratory distress syndrome. The SatO 2 variable had better mean values in the prone position compared to supine (95.1% vs. 93.4%) 16 .…”

Importance of physiotherapy/nursing multidisciplinary integration about update newborn position in the neonatal intensive care unit

“…One of the important care for hospitalized NB in NICU is the decubitus change, that is, avoiding to keep them in only one posture. The correct positioning is beneficial both to the respiratory system, preventing accumulation of secretions, optimizing the function and thoracoabdominal biomechanics and facilitating lung expansion (8)(9)(10)(11)(12) as for the psychomotor and behavioral development and providing greater comfort preventing pressure ulcers (1,(13)(14)(15).…”

Influência da posição prona, em maca para gestantes, nos parâmetros hemodinâmicos materno-fetais e no conforto da gestante

“…O DLE foi indicado por diversos estudos como o melhor posicionamento para se colocar a gestante na maca tradicional (Suonio et al, 1976;Ohashi et al, 2010;Rossi et al, 2011). (Guyton, 1999 Esses trabalhos foram realizados com recém-nascidos pré-termo (Oliveira et al, 2009), crianças submetidas a correção de escoliose idiopática (Brown et al, 2013), adultos jovens submetidos a cirurgias eletivas de hérnia de disco (Pelosi et al, 1995), pacientes obesos durante anestesia geral (Pelosi et al, 1996), adultos com síndrome da angústia respiratória aguda (SARA) ou com doenças pulmonares obstrutivas (Rival et al, 2011), adultos submetidos a circulação extracorpórea (Masuda et al, 2014) e pacientes que apresentam sintomas de agitação ao serem admitidos no hospital, sendo, por esse motivo, colocados na PP no setor de emergência médica (Savaser et al, 2013). Pela pesquisa realizada, verificou-se que esses importantes achados com a posição prona não abrangeram, no entanto, estudos sobre os parâmetros hemodinâmicos materno-fetais com várias gestantes sendo colocadas nesse posicionamento.…”