Procedimentos dolorosos e alterações nos parâmetros fisiológicos em recém-nascidos sob oxigenoterapia

Abstract

Newborn infants that have impaired lung function because of prematurity or any other diagnosis that interferes in the respiratory system, usually need some type of oxigenotherapy. The objectives of this study were to evaluate physiological parameters (RR, HR, Pulse, SpO2) in neonates submitted to oxigenotherapy in a Neonatal Intensive Care Unit (NICU) during the execution of some painful procedures carried out by nurses (orotracheal suction, upper airway suction, blood collectium to gasometry, insertion of a Peripherally Inserted Central Catheter – PICC - and withdrawing of curative). For this purpose, it was developed a before and after longitudinal and quantitative study in a Neonatal Intensive Care Unit of a public institution of reference in the city of Fortaleza-Ceara, in the period of December 2008 to June 2009. The sample was composed of 125 clinically stable newborns hospitalized in high-risk beds with at least six hours of life, and submitted to some type of oxigenotherapy for at least six hours. The data collecting was accomplished by systematic observation and the data were recorded in research forms that contained some independent variables, such as painful procedures carried out by nurses and some dependent variables such as the physiological parameters, like RR, HR and others that were visualized in the cardiac monitor during the procedures (pulse, SpO2). Additionally to these variables, it was studied both characteristics of the newborns regarding the birth conditions (birth weight, gender, type of labour, Apgar score, capurro) and regarding the period of hospitalization in the NICU (date and time of hospitalization, date and type of oxigenotherapy when the baby was admitted in the NICU, oxigenotheray modality and newborn weight at the time of the data collection, accommodation, diet and medication). These data were obtained through the medical charts, with the purpose of correlating them to those variables. The results showed that 92,8% of the neonates were preterm infants and 7,3% were term infants. Regarding the type of labor, 56,8% of the babies were delivered by caesarean section and 43,2% of them born by vaginal labor. According to the weight of the babies under the study, 92,0% weighted below 2500g while only 7,2% were above 2500g. The most common diagnostic hypotheses founded were prematurity (93,6%) and Respiratory Distress Syndrome - RDS (52,8%). The evaluation of the physiological parameters of the four procedures accessed in this study showed some variations (p<0,05) of RR and HR in the newborns using hood and CPAP, and variation of pulse (p<0,05) for the newborns in hood, CPAP and MV; however, the SpO2 was the only parameter that did not suffer any significant variation (p>0,05) regarding the suction of either orotracheal tube or upper airway. Concerning the gasometry, variations were found (p<0,05) in all physiological parameters; nevertheless, the alterations related to this procedure were different for each oxigenotherapy modality, occurring changes in HR, pulse and SpO2 in newborn using hood, and alterations in RR and pulse in neonates under MV; however, regarding the insertion of a PICC and the withdrawing of curative, no statistically significance alterations were found (p>0,05). It is proposed to the nurses to develop interventions that can keep the variations of the parameters of RR, HR, pulse and SpO2 in normal levels during the execution of these procedures.