Thoracoabdominal rebalancing is not superior to manual hyperinflation to increase the amount of pulmonary secretion removed in preterm newborns: A randomized crossover trial

Abstract

Background and Aims: Respiratory physical therapy is recommended to prevent complications of accumulated secretion in mechanical ventilated infants, but no consensus about the best technique is available. Aims: To evaluate the effects of manual hyperinflation maneuver (MHM) and thoracoabdominal rebalancing method (TRM) in preterm newborns (PTNB) for bronchial hygiene. Methods: Single-blind randomized crossover trial with intention-to-treat analysis was carried out with 24 PTNB (<37 weeks of gestation) under invasive ventilatory support via orotracheal cannula received both interventions (MHM and TRM) with an interval of 4 h, followed by tracheal suctioning. The primary outcome was the amount of pulmonary secretion, while secondary outcomes were the response of the autonomous (heart rate, respiratory rate [RR], tidal volume [TV], and oxygen saturation [SpO2]), motor (classification of general movements), and regulatory (pain and respiratory discomfort) systems pre and postintervention. Results: Although the amount of secretion was not different after the MHM and TRM interventions (0.10 and 0.09 g, respectively, p = 0.47), a difference was observed in the increase of SpO2 (p ≤ 0.001), and in the decrease of RR (p ≤ 0.001) for TRM. The poor repertoire pattern was predominant (23 PTNB), and it did not alter after interventions. Pain was not observed during interventions, the respiratory discomfort decreased after both interventions (p = 0.50). Conclusion: The amount of secretion removed was similar after MHM and TRM and both maneuvers did not negatively alter the response of the autonomous, motor, and regulatory systems.