Importancia del tratamiento de Fisioterapia en el síndrome de dificultad respiratoria y en la displasia broncopulmonar / Importance of Physiotherapy in respiratory distress syndrome and bronchopulmonary dysplasia

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Efeitos da fioterapia neonatal sobre a freqüência cardíaca em recém-nascidos pré-termos com doença pulmonar das membranas hialinas pós-reposição de surfactante exógeno / Effects of the neonatal physiotherapy in the heart rate in preterm infant with respiratory distress syndrome aftaer replacement of exogenous surfactant therapeutic

Introdução: o recém-nascido acometido pela doença pulmonar das membranas hialinas (DPMH) poderá cursar com alterações hemodinâmicas, constituindo uma população submetida a extremo cuidado na Unidade de Terapia Intensiva Neonatal e, por acreditar-se que a manipulação poderá comprometer tal estabilidade ficam reservados dos procedimentos intervencionistas de fisioterapia neonatal. Isto ocorre por inferir que as alterações sobre bomba cardíaca influenciam no inotropismo cardíaco, no ciclo cardíaco e no aumento da freqüência cardíaca. Por si só, a DPMH, constitui-se numa patologia pulmonar desencadeante, dentre outros fatores, de alteração das variáveis pressóricas intrapulmonar, fato este que reflete na perfusão pulmonar e no débito cardíaco. Objetivo: analisar os efeitos da prática de fisioterapia neonatal sobre a FC em recém-nascidos pré-termos (RNPT) com DPMH, submetidos à reposição de surfactante exógeno. Método: realizou-se um estudo intervencionista e prospectivo na população neonatal do Hospital Leonor Mendes de Barros, no período de agosto de 2000 a junho de 2002. A amostra foi constituída de 44 recém-nascidos pré-termo, acometidos pela doença pulmonar das membranas hialinas, suporte ventilatório mecânico invasivo com cânula orotraqueal e tratados com surfactante pulmonar exógeno. Estes recém-nascidos foram submetidos a três procedimentos intervencionistas de fisioterapia neonatal (PIFN), enquanto permaneceram em ventilação mecânica. Esses PIFN são de fisioterapia motora, respiratória e motora, como únicos procedimentos. A monitoração foi realizada por monitor da Dixtal® para oximetria de pulso, imediatamente antes e após 2 minutos dos procedimentos intervencionistas de fisioterapia neonatal. Resultados: para análise dos resultados foram utilizados testes não paramétricos, levando-se em conta a natureza das distribuições dos valores ou a variabilidade das medidas efetuadas. Utilizou-se um modelo de análise de variância - ANOVA35 e aplicou-se os seguinte...

Introduction: The primary function of the cardiovascular system is carried blood for tissues, supplying, the necessaryand essential nutrients to the cellular metabolism and concomitantly removing the catabolites. The heart, as a part of this system, acts as a bomb, contracting it generates the pressure necessary to dislocate the blood for a sequence of the sanguine vases. As a parameter offunctioning of this bomb it is had heart rate (HR) there is a biophysical variable of great importance to the integrityof this system, due to the cardiac output and the hemodynamic stability. The respiratory distress syndrome (RDS)consists in a causal factor pulmonary pathology which to an alteration of the pressure variable to intrapulmonary,fact this that reflects in the pulmonary perfusion and out put. In this way, it is inferred that the newborn with RDSwill development hemodynamic alterations, constituting a population without the suitable care physiotherapy in the unit of intensive therapy neonatal, since the manipulation of them may hemodynamic stability. Objective:This paper deals with the effect of a practical of neonatal physiotherapy on the heart rate in newborn long-termwith RDS, submitted to the replacement of exogenous surfactant. Method: An interventionist study was becomefulfilled, in the neonatal population of the Hospital Leonor Mendes de Barros, in the period from august 2000 tojune 2002. The sample was constituted of 44 newborn in the RDS, treated with exogenous pulmonary surfactant,ventilation support (ventilation invasive mechanics) and interventionist procedures of physiotherapy. Results: For analysis of the results distribution free tests had been used, taking in account the nature of the distributionsof the values or the variability of the effected measures. A model of analysis of variance (ANOVA) was used andwas applied to the following statistical methods: descriptive analysis with measure-summary and tests-t. It was...

Cost-effectiveness of surfactant replacement therapy in a developing country.

A comparison study was conducted to evaluate the cost effectiveness of surfactant replacement therapy in the treatment of hyaline membrane disease (HMD). Study population included neonates admitted because of HMD severe enough to require assisted ventilation with FiO2 greater that 0.4 per cent. This group (n = 44) was compared with the outcome for neonates treated in the same centre 1 year before surfactant became available (n = 39). Comparison between the two groups was made in relation to cost of care depending on the duration of hospitalization. The duration of hospitalization in the survivors of the treated group was shorter (P = 0.06); accordingly, the cost of care was less. A savings of US $11,880 per patient survived in the treated group was expected, the nationwide financial impact of this treatment modality is discussed.