Diana Castaneda
Latin News Agency for Medicine and Public Health
The study ‘Early mobilization of babies intubated for acute respiratory failure’, carried out at the Children’s Hospital of Mercy in the United States, gives a piece of reassurance in the face of existing concerns about mobility interventions in the Pediatric Intensive Care Unit (PICU) .
Neonatal patient safety, removal of medical devices, lack of resources, and disagreement about when they are stable enough are some of the barriers to mobilizing intubated infants, which were taken into account in the research in which 23 preterm infants were involved, observed during 158 episodes in a pediatric intensive care unit.
Normally, when a physiological delivery occurs, the newborn’s lungs (RN) go from being an organ occupied by liquid, to filling with air due to intermittent compression of the chest, in this way, homeostasis is achieved. This natural process begins with the redistribution of cardiac output and the reduction of body temperature, produced by the interruption of the placental circulation, which stimulates the active tense agent to lower the pH and the pressure of oxygen in arterial blood (PaO2 ), therefore, the arterial carbon dioxide pressure (PaCo2) necessary for the alveoli to open and fill the lungs with gas rises at the same time, giving way to the newborn’s first breath. All this normal physiological process accompanied by specific and effective care from health professionals, favor the adaptation and satisfactory evolution of the newborn. It is worth mentioning that some RN can present respiratory problems, which require assistance with mechanical ventilation.
“By the time the 16-month study was completed, the practice of keeping babies in the PICU was no longer a rare occurrence and had expanded to a wide variety of other critical babies, including newborns recovering from surgical procedures to complex congenital heart disease “, said co-author Laura Ortmann, who conducted the study during her residency at Hospital Infantil de la Misericordia.
Early mobility is now integrated into the care of critically ill patients, from preterm infants to adults, but has been slower to gain acceptance from younger ones. Babies intubated in the PICU do not have access to their normal calming mechanisms and often require sedation to treat agitation and prevent extubation, News Medical notes.
For its part, the magazine El Hospital published that, in the study, patients were examined daily to identify newborns intubated for secondary acute respiratory failure, or any viral or bacterial disease of the lower respiratory tract, with an expected duration of mechanical ventilation of more than 48 hours. Babies were screened to ensure they met 10 different criteria related to their individual health, including defined levels of inspired oxygen, inspiratory pressure, and sedative doses.
On the days when each patient met the intervention criteria, the goal was for the baby to be held a minimum of two times for at least one hour. There was no limit to the number of times per day or the time. Infants were sustained more frequently and for longer than the minimum established in the protocol, and half of the sessions lasted more than 90 minutes. The vital signs were not different, which shows that the stimulation was physiologically well tolerated.
The results were compared with the medical records of a historical control group matched for age and other measures. There were no differences between control and intervention groups in length of intubation, length of stay in the PICU, or total length in hospital. Sedative use was significantly different between the two groups, but this probably has more to do with changes in sedation practices than with the intervention.
The study was limited by a small sample size of babies intubated for primary respiratory failure. The researchers are calling for more studies that focus on outcomes for both children and parents and that assess the sharper patient populations.
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