Turkiye Klinikleri Journal of Health Sciences

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Chest Physiotherapy in a Neonatal Infant After Congenital Diaphragmatic Hernia Surgery
Konjenital Diyafragmatik Herni Cerrahisi Sonrası Yenidoğanda Göğüs Fizyoterapisi
Hatice ADIGÜZELa, Mehmet EĞİLMEZa, Ünal SARIKABADAYIb, Bülent ELBASANc, Arzu DEMİRGÜÇa, Nevin ERGUNa
aDepartment of Physiotherapy and Rehabilitation, SANKO University Faculty of Health Sciences, Gaziantep, TURKEY
bDepartment of Pediatrics, SANKO University Faculty of Medicine, Gaziantep, TURKEY
cDepartment of Physiotherapy and Rehabilitation, Gazi University Faculty of Health Sciences, Ankara, TURKEY
Turkiye Klinikleri J Health Sci. 2021;6(1):179-86
doi: 10.5336/healthsci.2020-74044
Article Language: EN
Full Text
ABSTRACT
 Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly. It is characterized with the structural defect of the diaphragm in the intrauterine period. A male neonate with diagnosis of CDH was hospitalized after vaginal delivery at 39 weeks' gestation. The case was resuscitated and referred to our Neonatal Intensive Care Unit (NICU) on the second day, diagnosed with Bochdalek hernia and underwent surgery. Chest physiotherapy (CP) was started on postoperative 24th day. CP was applied for a total of 24 sessions, twice a day, four days/week, for three weeks, each 30-40 minutes. CP was started with bilateral vibration to the upper apical lobes in modified drainage positions and passive mobilization of the upper limb. CP, performed by positioning the lung lobes in need, consisted of vibration and gentle percussion for 3-5 minutes with distal finger phalanges. Due to the chest X-ray findings, the posterior or lower basal lobes were studied more intensively. Aspiration was performed after physiotherapy in each session. The sessions were ended by placing the patient in side-lying position or a prone position to increase oxygenation. The patient's vital signs, the type and color of secretion, chest radiography, respiratory sounds, nutritional type, and respiratory pattern were evaluated before, during, and after CP. No complications were observed during CP. It was observed that secretion excretion improved, weaning from the mechanical ventilator accelerated, drainage in the chest tube got easier, oral feeding increased, and vital signs didn't change. Respiratory sounds and chest X-rays showed that the infiltration and atelectasis areas decreased towards the discharge process.

Keywords: Congenital diaphragmatic hernia; chest physiotherapy; Bochdalek
ÖZET
 Konjenital diyafragmatik herni (KDH) nadir görülen bir konjenital anomalidir. KDH intrauterin dönemde diyafragmanın yapısal defekti ile karakterizedir. KDH tanısı alan erkek olgu, gebeliğin 39. haftasında vaginal yoldan doğurtulduktan sonra hastaneye yatırıldı. Dış serviste doğum sonrasında resusitasyon yapılarak, hastanemiz yenidoğan yoğun bakım ünitesi'ne (YYBÜ) sevk edilen hasta 2. gün Bochdalek herni tanısı alarak cerrahiye alınmıştır. Post operatif 24. günde başlanarak üç hafta boyunca günde iki defa 30-40 dk, toplam 12 gün/24 seans, haftada dört gün göğüs fizyoterapisi (GF) uygulanmıştır. GF'ne modifiye drenaj pozisyonlarında üst apikal loblara proprioseptif stimülasyonlarla bilateral vibrasyon ve üst ekstremitenin pasif mobilizasyonu ile başlandı. Akciğer loblarına göre pozisyonlamayla yapılan GF'si, distal parmak falanksı ile 3-5 dakika boyunca vibrasyon ve nazik perküsyondan oluştu. Akciğer röntgen sonucuna göre arka veya alt bazal loblara yoğunlaşıldı. Her GF seans sonrasında aspirasyon yapıldı. Seanslar, hastanın yan yatış pozisyonuna veya oksijenlenmeyi arttırmak için yüzüstü pozisyona getirilmesiyle sonlandırıldı. Hastanın vital bulguları, sekresyonun tipi ve rengi, akciğer grafisi, solunum sesleri, nutrisyon şekli ve solunum tipi GF öncesi, esnası ve sonrasında değerlendirilmiştir. GF sırasında hastanın hiçbir komplikasyon gelişmedi. Sekresyon atılımının kolaylaştığı, mekanik ventilatörden ayrılma sürecinin hızlandığı, göğüs tüpünde drenajın kolaylaştığı, oral beslenmesinin arttığı ve vital bulgularında ani değişimlerin olmadığı gözlenmiştir. Solunum sesleri ve akciğer filmleri değerlendirildiğinde olgunun taburculuk sürecine doğru infiltrasyon ve atelektazik alanlarının azaldığı gözlenmiştir.

Anahtar Kelimeler: Konjenital diyafragma hernisi; göğüs fizyoterapisi; Bochdalek
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