Efeito da aplicação do método reequilíbrio toracoabdominal (RTA) em prematuros moderados: ensaio clínico randomizado e controlado.

Abstract

The preterm newborn (PTNB) presents functional and structural immaturity of organs and tissues with repercussions on respiratory biomechanics. In addition, the thoracoabdominal mobility of the newborn (NB) is directly related to alveolar ventilation. Among several techniques for respiratory rehabilitation, the Thoracoabdominal Rebalancing (RTA) method shows promise. The objective was to analyze the effect of the RTA method in relation to respiratory biomechanics, respiratory distress, pain sensation, physiological parameters and sleep and wakefulness state in moderate PTNB, in comparison with the slow expiratory flow acceleration technique (AFEL). This was a randomized clinical trial, carried out in the neonatal intensive care unit (NICU) of a hospital in the south of Minas Gerais. After analyzing the inclusion and exclusion criteria and signing the Informed Consent Form (TCLE), the PTNBs were evaluated using the pain assessment scale for newborns (NIPS), physiological parameters (HR, FR, SpO2, BP), sleep-wake status assessment scale adapted from Brazelton, Silverman-Andersen bulletin, thoracic cirtometry and Charpy angle. They were randomly randomized into two groups according to the intervention: experimental group (G1), application of the RTA method and control group (G2), AFEL technique. In both groups, a single visit was performed by the same physiotherapist. The PTNBs were assessed by a professional blinded to the randomization, in three moments: before (assessment 1), after (assessment 2) and 30 minutes after the intervention (assessment 3). The sample consisted of 30 PTNBs, all of whom were on spontaneous ventilation. G1 was composed of 17 patients, with a corrected gestational age of 34.52 ± 1.10 and who received the RTA method, and G2 was composed of 13 patients with a corrected gestational age of 35.00 ± 1.51, who received the technique AFEL. In the intergroup comparison, there was a significant difference in the respiratory rate 30 minutes after the intervention (p=0.03). As for pain and respiratory distress, there were no significant differences in intra and intergroup comparisons, at any time. In G1, there was difference in the intragroup comparison for the Charpy angle between assessments 1 and 2 (p=0.01) and in G2 there was no difference. G1 also showed a significant difference in the comparison between assessments 1 and 3 for axillary line cirtometry (p=0.03) and in the comparison between assessments 2 and 3 for xiphoid process cirtometry (p=0.03), indicating reduction in thoracic diameter. In group G2, there was a significant difference in axillary line cirtometry between assessments 1 and 2 (p=0.04) and between assessments 2 and 3 (p=0.00), indicating an increase in chest diameter. As for the state of sleep and wakefulness in G1, the number of PTNBs in deep sleep and light sleep increased, totaling 23.52% and 52.94% at the end of the evaluation, respectively. In G2, most PTNBs (46.15%) remained in light sleep in the three evaluation moments. The RTA method had a positive effect on respiratory rate, respiratory biomechanics and the state of sleep and wakefulness, but did not show superiority to AFEL in terms of pain, respiratory distress and other physiological parameters.