Comparison of the Acute Effects of Chest Physiotherapy Methods Applied in Different Positions in Preterm Newborns
Condition: Preterm Birth; Premature; Bronchopulmonary Dysplasia; Respiratory Distress Syndrome; Mechanical Ventilation Complication; Mechanical Ventilation Pressure High; Oxygen Toxicity; Neonatal Respiratory Failure; Atelectasis Neonatal; Pneumonia Neonatal; Lobar Collapse; Chronic Liver Disease; Hyaline Membrane Disease
MeSH terms: Liver Diseases; Respiratory Distress Syndrome; Respiratory Distress Syndrome, Newborn; Respiratory Insufficiency; Bronchopulmonary Dysplasia; Pulmonary Atelectasis; Hyaline Membrane Disease; Premature Birth
Study type: Interventional

Summary: 
      Infants in the neonatal intensive care unit (NICU) may be lost due to risks such as being
      sensitive, frequent exposure to birth complications and being prone to infection. The most
      common causes of mortality in newborn babies in the world; Complications due to preterm
      delivery (28%), infections (26%) and perinatal asphyxia (23%) were reported. Respiratory
      problems are observed in 4-6% of newborns. These problems are also important causes of
      mortality in the neonatal period. Newborn infants are more likely to have respiratory
      distress due to difficulties in airway calibration, few collateral airways, flexible chest
      wall, poor airway stability, and low functional residual capacity.Invasive mechanical
      ventilation (IMV) is frequently used in the treatment of newborns with respiratory failure.
      Various ventilation modes and strategies are used to optimize mechanical ventilation and
      prevent ventilator-induced lung injury. Among the important issues to be considered in
      newborns connected to mechanical ventilator (MV); Choosing an appropriately sized
      endotracheal tube to reduce airway resistance and minimize respiratory workload, correct
      positioning, regular nursing care, chest physiotherapy, sedation-analgesia, and infection
      prevention are also included.
    

Detailed description: 
      Infants in the neonatal intensive care unit (NICU) may be lost due to risks such as being
      sensitive, frequent exposure to birth complications and being prone to infection. The most
      common causes of mortality in newborn babies in the world; Complications due to preterm
      delivery (28%), infections (26%) and perinatal asphyxia (23%) were reported. Respiratory
      problems are observed in 4-6% of newborns. These problems are also important causes of
      mortality in the neonatal period. Newborn infants are more likely to have respiratory
      distress due to difficulties in airway calibration, few collateral airways, flexible chest
      wall, poor airway stability, and low functional residual capacity.Invasive mechanical
      ventilation (IMV) is frequently used in the treatment of newborns with respiratory failure.
      Various ventilation modes and strategies are used to optimize mechanical ventilation and
      prevent ventilator-induced lung injury. Among the important issues to be considered in
      newborns connected to mechanical ventilator (MV); Choosing an appropriately sized
      endotracheal tube to reduce airway resistance and minimize respiratory workload, correct
      positioning, regular nursing care, chest physiotherapy, sedation-analgesia, and infection
      prevention are also included.The preference for using non-invasive mechanical ventilation
      (NIMV) modes in NICUs is also increasing. Despite this, the use of IMV is still often
      required in preterm infants in the need for respiratory support and in the treatment of
      respiratory failure. Today, extremely preterm infants are extubated quickly. Because
      prolonged IMV can be a very important risk factor in the development of Bronchopulmonary
      Dysplasia (BPD). The reason for this is the physiological characteristics of newborns such as
      airway maintenance and cleanliness, smaller airway calibration, reduction in collaterals,
      flexible chest wall, poor airway stability, and low functional residual capacity. A small
      amount of secretion in preterm infants can produce a large increase in airway resistance.
      This reduces airflow and without expiratory flow, secretions cannot be expelled. With chest
      physiotherapy (CP), adequate expiratory flow can be achieved without causing airway
      closure.Chest physiotherapy techniques (CP) create mechanical effects in the lung, increasing
      ventilation, facilitating the removal of secretions and preventing bronchial obstruction.
      This ensures correct protection of the airways and facilitates extubation. Prolonged
      intubation and increased length of stay in NICUs can also lead to complications such as
      atelectasis, respiratory infections and chronic lung disease. Decreased oxygenation and
      excessive accumulation of secretions cause widespread increase in airway resistance, leading
      to prolonged ventilation or oxygen support. Oxygen therapy is an integral part that is
      frequently used as respiratory support in NICUs. However, long-term oxygen therapy may cause
      excessive accumulation of bronchial secretions. This makes CP mandatory. Traditional CP has
      become an indispensable part of airway management in NICU settings to remove excess bronchial
      secretions and thereby increase oxygenation. There are many studies on CP in the
      literature.In some of these studies, it was found that it did not prevent atelectasis, that
      CP had no effect, or that CP accelerated weaning from MV. The role of CP in reducing
      respiratory morbidity in infants and neonates continues to be debated and more studies are
      needed. CP needs to be supported by well-controlled studies with large sample sizes,
      particularly regarding the techniques used and specific protocols. Therefore, in this study,
      it is aimed to compare the acute effects of CP methods applied in different positions in
      preterm newborns.
    

Intervention name(s): chest physiotherapy
Intervention type(s): Other
Intervention description(s): diffferent chest physiotherapy methods
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: 2 groups; different chest physitherapy approach and 1 grup(control): routine medical care for newborns and neonatal intensive care unit's routin daily care
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Newborn; preterm; chest physiotherapy; neonatal intensive care unit; mechanical ventilation