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Effects of early respiratory physiotherapy on spontaneous respiratory activity of preterm infants: study protocol for
Alessia Di Polito1, Arianna Del Vecchio1, Milena Tana2
1Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Insights
Early respiratory physiotherapy using tactile stimulation can help preterm infants achieve spontaneous breathing, potentially reducing the need for mechanical ventilation. This technique aids in minimizing invasive respiratory support for newborns.
Area of Science:
- Neonatal Medicine
- Respiratory Physiology
- Physiotherapy
Background:
- Tactile maneuvers to stimulate spontaneous respiration in preterm infants are recommended but underutilized in clinical practice.
- Most preterm infants with respiratory failure are managed with non-invasive support and respiratory stimulation to avoid intubation risks.
- Data on the application frequency and methods of these tactile maneuvers remain scarce.
Purpose of the Study:
- To assess the effectiveness of early respiratory physiotherapy in reducing intubation and mechanical ventilation within the first week of life for preterm infants.
- To investigate the impact of respiratory facilitation technique on respiratory support needs.
Main Methods:
- A randomized study involving preterm infants (gestational age < 31 weeks) not intubated at birth but requiring non-invasive respiratory support.
- The study group received respiratory facilitation (tactile stimulation) within 24 hours of life, repeated 3 times daily until spontaneous breathing was achieved.
- The control group received standard individualized postural care, including respiratory facilitation and autogenous drainage.
Main Results:
- The study aims to evaluate the primary outcome of reduced intubation and mechanical ventilation incidence.
- Further analysis will determine the efficacy of respiratory facilitation compared to standard care.
Conclusions:
- Respiratory facilitation involves early reflex stimulation via digital pressure on hemithorax trigger points in preterm infants.
- This technique aims to increase ipsilateral pulmonary ventilation and contralateral lung expansion, promoting spontaneous respiration.
- The goal is to reduce the work of breathing and minimize the need for invasive respiratory support.
Background:
Tactile maneuvers stimulating spontaneous respiratory activity in preterm infants are recommended since birth, but data on how and how often these maneuvers are applied in clinical practice are unknown. In the last years, most preterm newborns with respiratory failure are preferentially managed with non-invasive respiratory support and by stimulating spontaneous respiratory activity from the delivery room and in neonatal intensive care unit (NICU), in order to avoid the risks of intubation and prolonged mechanical ventilation.
Methods:
Preterm infants with gestational age < 31 weeks not intubated in the delivery room and requiring non-invasive respiratory support at birth will be eligible for the study. They will be randomized and allocated to one of two treatment groups: (1) the study group infants will be subject to the technique of respiratory facilitation within the first 24 h of life, according to the reflex stimulations, by the physiotherapist. The newborn is placed in supine decubitus and a slight digital pressure is exerted on a hemithorax. The respiratory facilitation technique will be performed for about three minutes and repeated for a total of 4/6 times in sequence, three times a day until spontaneous respiratory activity is achieved; thus, no respiratory support is required; (2) the control group infants will take part exclusively in the individualized postural care program. They will perform the technique of respiratory facilitation and autogenous drainage.
Objective:
To evaluate the efficacy of early respiratory physiotherapy in reducing the incidence of intubation and mechanical ventilation in the first week of life (primary outcome).
Discussion:
The technique of respiratory facilitation is based on reflex stimulations, applied early to preterm infant. Slight digital pressure is exerted on a "trigger point" of each hemithorax, to stimulate the respiratory activity with subsequent increase of the ipsilateral pulmonary minute ventilation and to facilitate the contralateral pulmonary expansion. This mechanism will determine the concatenation of input to all anatomical structures in relation to the area being treated, to promote spontaneous respiratory activity and reducing work of breathing, avoiding or minimizing the use of invasive respiratory support.
Trial Registration:
UMIN-CTR Clinical Trial UMIN000036066. Registered on March 1, 2019. Protocol 1. https://www.umin.ac.jp/ctr.
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