Non-invasive ventilation is, nowadays, a well received, successful therapeutic strategy for the treatment of different varieties of respiratory failure. Associated to respiratory rehabilitation and exercise training, NVI brings numerous advantages to the person, namely in the control of symptoms, in the quality of life, in the reduction of the perception of dyspnea, in the increase of the tolerance to the activity, and in the decrease in the use of health services. The intervention of the specialist nurse in rehabilitation nursing is essential in order to maximize health gains. However, the bibliography that supports these gains with the intervention of the EEER needs greater investment in the research area.
TopIntroduction
Non-Invasive Ventilation (NIV) is a method of ventilatory support applied to the upper airway, using an interface and without the presence of an invasive method, such as the endotracheal tube or the laryngeal mask (Keenan et al, 2011), partially or totally replacing the person’s ventilatory function.
The use of NIV has as mains objectives to increase alveolar ventilation; correct and improve gas exchange in order to reverse/prevent respiratory failure; reduce signs/symptoms such as dyspnea and ventilatory work; decrease the mortality rate; avoid tracheal intubation and hospitalization time (Keenan et al., 2011).
NIV is indicated in cases of acute or chronic respiratory failure. In case of respiratory failure in which clinical degradation is foreseen, ventilatory support must be started early, requiring great availability and dedication from the professional, with frequent reassessments, especially in the initial phase (first 4 to 8 hours), and should not be delayed until it becomes an emerging measure (Ferreira, 2009). Gasometry helps in the decision to start ventilatory support; however the final decision must be based on clinical judgment (Windisch, 2010).
The main contraindications to the use of NIV are: cardiorespiratory arrest; hemodynamic instability; myocardial ischemia or arrhythmias, non-participation or agitation of the person; the inability to protect the airway; the high risk of aspiration; recent surgery and / or burns; active bleeding from the upper gastrointestinal tract; severe hypoxemia; severe encephalopathy; upper airway obstruction; facial trauma and inability to drain tracheobronchial secretions (Ferreira et al., 2009; Society of Critical Care Medicine, 2008). NIV has been considered an alternative to conventional mechanical ventilation in people with acute respiratory failure, as it is a safe and effective ventilation mode, more comfortable for the person, as the orotracheal intubation is avoided, the need for sedation is reduced and the appearance of lesions in the airway, thus decreasing the risk of infection associated with health care. It allows the person to maintain speech, swallowing and the defense mechanisms of the airways, allowing the elimination of secretions, in a physiological way because it allows it to be used intermittently. It also requires shorter hospital stay, lower cost, easier weaning, and causes less mortality (Conti et al., 2004; Felgueiras et al, 2006; Ferreira et al, 2009; Sousa & Duque, 2012). However, there may be some adverse effects such as nasal congestion, dryness of mucous membranes, erythema / pressure ulcers, conjunctivitis, leakage, gastric distension and aspiration pneumonia. (Ferreira et al, 2009).
Respiratory Rehabilitation (RR) is a global and multidisciplinary intervention program, aimed at symptomatic people with chronic respiratory disease, and often with reduced participation in their ADL (Daily Life Activity) in order to contribute to improving their ability to exercise, to reduce dyspnea, to improve quality of life, to reduce levels of depression and anxiety (Cordeiro & Menoita, 2012; General Directorate of Health, 2009; Global Obstructive Lung Disease, 2019).