RESUMO
OBJECTIVES: To systematically review the literature regarding the effectiveness of different positioning methods for procedural pain relief in neonates admitted to the Neonatal Intensive Care Unit (NICU). DESIGN: A systemized search of the literature was carried out by means of two independent evaluators through the systematic search of electronic index databases. DATA SOURCES: A search for relevant studies was performed in four databases (Medline, Web of Science, Scopus, and BVS-BIREME). REVIEW/ANALYSIS METHODS: Manual searches were conducted on suitable references from the included articles, and 1,941 publications were eligible for the analysis. The flowchart for the articles' selection was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, and in relation to bias risks according to the Physiotherapy Evidence Database (PEDro) scale. RESULTS: Based on the inclusion criteria, only 20 publications remained. According to the PEDro scale, 75% of the studies presented good methodological quality, with scores between 6 and 8, and 5% scored ≤4 points. None of them were blinded in relation to the therapies, but all of them performed intergroup statistical comparisons. According to the results of this review, we recommend facilitated tucking by parents (FTP) in NICU of at least 30 minutes duration, starting 15 minutes before, during the painful procedure, and 15 minutes after to relieve pain and to stabilize the physiological, hormonal, and behavioral responses of the newborns. CONCLUSIONS: Positioning should be used as a nonpharmacological strategy for procedural pain relief in newborns. This review showed that facilitated tucking by parents for 30 minutes was the best position for pain relief in premature newborns during procedures in the NICU. Positioning is recommended as a nonpharmacological method for pain relief; FTP of at least 30 minutes duration should be the first positioning choice during procedures in the NICU.
Assuntos
Unidades de Terapia Intensiva Neonatal , Dor Processual , Humanos , Recém-Nascido , Dor/prevenção & controle , Manejo da Dor , Dor Processual/prevenção & controleRESUMO
Recomendações para a atuação do fisioterapeuta em unidade de terapia intensiva pediátrica e neonatal são fundamentais, pois esses profissionais são responsáveis pela reabilitação de pacientes graves. A reabilitação inclui desde a avaliação e prevenção de alterações cinético funcionais às intervenções de tratamento (fisioterapia respiratória e/ou motora), controle e aplicação de gases medicinais, cuidados da ventilação pulmonar mecânica invasiva e não invasiva, protocolos de desmame e extubação, insuflação traqueal de gás, protocolo de insuflação/desinsuflação do balonete intratraqueal, aplicação de surfactante, entre outros. Com o objetivo de propiciar a recuperação do doente e seu retorno às atividades funcionais. Nesse contexto, essas recomendações têm o objetivo de orientar os fisioterapeutas sobre algumas intervenções de prevenção/tratamento de fisioterapia respiratória (desobstrução das vias aéreas; reexpansão pulmonar; posicionamento no leito; aspiração das vias aéreas; inaloterapia; tosse assistida), que auxiliam no processo de reabilitação de pacientes pediátricos e neonatais em unidade de terapia intensiva em ventilação pulmonar mecânica e até 12 horas após a extubação.
Developing guidelines for the role of the physiotherapist in neonatal and pediatric intensive care units is essential because these professionals are responsible for the rehabilitation of critically ill patients. Rehabilitation includes the evaluation and prevention of functional kinetic alterations, application of treatment interventions (respiratory and/or motor physiotherapy), control and application of medical gases, care of mechanical ventilation, weaning and extubation, tracheal gas insufflation, inflation/deflation of the endotracheal cuff protocol, and surfactant application, aiming to allow patients to have a full recovery and return to their functional activities. In this article, we present guidelines that are intended to guide the physiotherapist in some of the prevention/treatment interventions in respiratory therapy (airway clearance, lung expansion, position in bed, airway suction, drug inhalation, and cough assist), which help in the rehabilitation process of newborns and children in intensive care units during mechanical ventilation and up to 12 hours following extubation.
RESUMO
Developing guidelines for the role of the physiotherapist in neonatal and pediatric intensive care units is essential because these professionals are responsible for the rehabilitation of critically ill patients. Rehabilitation includes the evaluation and prevention of functional kinetic alterations, application of treatment interventions (respiratory and/or motor physiotherapy), control and application of medical gases, care of mechanical ventilation, weaning and extubation, tracheal gas insufflation, inflation/deflation of the endotracheal cuff protocol, and surfactant application, aiming to allow patients to have a full recovery and return to their functional activities. In this article, we present guidelines that are intended to guide the physiotherapist in some of the prevention/treatment interventions in respiratory therapy (airway clearance, lung expansion, position in bed, airway suction, drug inhalation, and cough assist), which help in the rehabilitation process of newborns and children in intensive care units during mechanical ventilation and up to 12 hours following extubation.
