Manual vibrocompression and nasotracheal suctioning in post-operative period of infants with heart deffects

Maíra Seabra De Assumpção,Camila Isabel S Schivinski,Lúcia Cristina Krygierowicz,Renata Maba Gonçalves,Ana Cristina T Orlando

doi:10.1590/s0103-05822013000400014

Maíra Seabra De Assumpção, Camila Isabel S Schivinski + Show 3 more

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https://doi.org/10.1590/s0103-05822013000400014

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Abstract

OBJECTIVE: To evaluate the impact of manual vibrocompression and nasotracheal suctioning on heart (hr) and respiratory (rr) rates, peripheral oxygen saturation (SpO2), pain and respiratory distress in infants in the postoperative period of a cardiac surgery. METHODS: Randomized controlled trial, in which the assessments were performed by the same physiotherapist in two moments: before and after the procedure. The infants were randomly divided into two groups: Intervention (IG), with manual chest vibrocompression, nasotracheal suctioning and resting; and Control CG), with 30 minutes of rest. Cardiorespiratory data (SpO2; hr; rr) were monitored and the following scales were used: Neonatal Infant Pain Scale (NIPS), for pain evaluation, and Bulletin of Silverman-Andersen (BSA), for respiratory distress assessment. The data were verified by analysis of variance (ANOVA) for repeated measures, being significant p<0.05. RESULTS: 20 infants with heart disease, ten in each group (seven acyanotic and three cyanotic) were enrolled, with ages ranging from zero to 12 months. In the analysis of the interaction between group and time, there was a significant difference in the variation of SpO2 (p=0.016), without changes in the other variables. Considering the main effect on time, only rr showed a significant difference (p=0.001). As for the group main effect, there were no statistical differences (SpO2 - p=0.77, hr - p=0.14, rr - p=0.17, NIPS - p=0.49 and BSA - p=0.51 ). CONCLUSIONS: The manual vibrocompression and the nasotracheal suctioning applied to infants in postoperative of cardiac surgery did not altered SpO2 and rr, and did not trigger pain and respiratory distress. [Brazilian Registry of Clinical Trials (ReBEC): REQ: 1467].

Highlights

Congenital hearts diseases are one of the main causes of death in newborn infants[1] and, in most cases, their etiology is not known yet
In the pediatric population with heart disease, there are still few studies on the impact of conventional respiratory techniques, described in the 1994 Consensus of Lyon[9] as those designed to remove bronchial secretions, notably manual vibration, nasotracheal suctioning, postural drainage, chest percussion, chest compression, and cough. These are routine techniques in intensive care units[10], i.e., the indication for physiotherapy in these patients is found in the literature[11,12,13], the impact of these techniques is little discussed or addressed when it comes to infants diagnosed with acyanotic or cyanotic heart diseases, in the postoperative period of cardiac surgery. In view of these factors, the present study evaluated the impact of manual vibrocompression and nasotracheal suctioning on cardiorespiratory parameters, such as heart rate, respiratory rate, and peripheral oxygen saturation (SpO2), as well as on respiratory distress and pain, in infants in the postoperative period of cardiac surgery
There was no significant difference in SpO2 (p=0.77), hr (p=0.146), rr (p=0.166), Neonatal Infant Pain Scale (NIPS) (p=0.4.88) and Boletim de Silvermann-Andersen (BSA) (p=0.512) between Tpre and Tpost, in any of the groups

Summary

Introduction

Congenital hearts diseases are one of the main causes of death in newborn infants[1] and, in most cases, their etiology is not known yet. In the last two decades, technological advances and improvements, both in the identification and treatment of congenital heart diseases, contributed to the knowledge of their pathophysiology and their impact. In this sense, it is currently known that cardiac surgical corrections lead to a number of complications in the newborn and the infant, especially respiratory alterations. It is currently known that cardiac surgical corrections lead to a number of complications in the newborn and the infant, especially respiratory alterations These complications are related to poor pulmonary and cardiac function in the preoperative period, prolonged extracorporeal circulation, and high degree of sedation[4]

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