Efeitos de duas técnicas de fisioterapia nas trocas gasosas e mecânica respiratória em crianças com insuficiência respiratória: estudo randomizado

Abstract

Children are particularly susceptible to the development of acute respiratory failure and the use of invasive mechanical ventilation can lead to respiratory complications with the accumulation of secretions. Physiotherapy aims to minimize these accumulations through bronchial hygiene maneuvers. The effects of these maneuvers are little known in the pediatric population and studies are needed to give answers to the following frequent questions: Do the respiratory physiotherapy maneuvers promote changes in respiratory mechanics of children? Is there any superiority of the effects of one technique over the other? We developed a randomized prospective clinical study and evaluated twelve children aged 31.17 ± 17.28 months, randomized into two groups: six in the Bag Squeezing group (BS) and six in thoracic vibrocompression group (TVC). The BS maneuver comprised ten manual hyperinflation maneuvers interspersed with ten vibrocompression maneuvers followed by tracheal aspiration. For the VCT maneuver, we applied ten vibrocompression maneuvers in each lateral position followed by aspiration. The variables were analyzed in the moments before and after 30, 60 and 120 min. For statistical analysis, the T-Student test for intra group analysis and ANOVA for inter group analysis. Statistical analysis showed that the groups were homogeneous. There was increased exhaled CO2 in the VCT group in the post-maneuver moment (p = 0.00) when compared to the pre, 30, 60 and 120 min moments. The other respiratory variables behaved similarly not showing inter or intra group differences. Comparing the BS and VCT techniques, we found higher values of PIP (95% CI 0.33 to 5.80, p = 0.02) and Peep (95% CI 0:08 to 1:06, p = 0.02) in the BS group. The VCT group showed higher resistance values (95% CI -22.03 to -1.63, p = 0.02) in the post maneuver moments. Static compliance remained stable or showed improvement in 83.33% of children undergoing the BS maneuver.Therefore, the VCT maneuver showed higher resistance values in the respiratory system and the BS maneuver showed the best response in other variables of respiratory mechanics. Clinic Testing Registration: NCT01747954