The use of invasive mechanical ventilatory support has been increasingly used in the treatment of respiratory insufficiency, since it replaces the respiratory work while reversing the pathological processes that led to its necessity, allowing the recovery of respiratory function. The critical patient's ventilatory weaning requires a rigorous assessment by qualified professionals to reduce complications and the eventual need for (re) intubation, referring to the design and implementation of rehabilitation nursing programs. The nurse specialist in rehabilitation nursing intervenes in an early, autonomous, and differentiated way, avoiding complications and incapacities, promoting effective ventilatory weaning. This integrative review of the literature made evident the gains obtained in the critical patient undergoing invasive mechanical ventilation and included in an early rehabilitation program, revealing significant impact for both the patient and the hospital institution.
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Scientific and technological advances in medicine have resulted in the ability to prolong life. One of the consequences of this progress is the significant increase in patients requiring prolonged invasive mechanical ventilation (IMV), which is defined by the need to maintain mechanical ventilatory support for 21 days or more for more than six hours daily (MacIntyre, Epstein, Carson, Scheinhorn, Christopher & Muldoon, 2005).
Ventilatory weaning corresponds to a gradual reduction of ventilatory support until it is no longer necessary, and this process is considered a priority, taking into account that, although it is a fundamental technique for maintaining life, it can cause physiological and psychological complications that should be minimized (Cederwall, Plos, Rose, Dübeck & Ringdal, 2014). In this context, it is important to perform an early ventilatory weaning, either to promote the occurrence of spontaneous ventilation after extubating or to avoid the occurrence of complications associated with this therapy.
In general, for all persons undergoing invasive mechanical ventilation, 40% to 50% of the total time of this ventilatory support is spent in the ventilatory weaning process (Cederwall et al., 2014). This period contributes significantly to the total cost of intensive care hospitalization, with some authors pointing to around 50% of the total costs of an ICU (Cederwall et al., 2014). This factor raises questions regarding occupancy rates, use of resources and, consequently, costs for hospital institutions. The attempt to reduce and minimize the impact caused by these aspects should be taken into account as a matter of priority, both for health professionals and for those institutions.
The negative consequences associated with immobility are commonly associated with patients who require IMV and are widely recognized. The establishment of early rehabilitation protocols are reported as evident in reducing length of stay in the intensive care unit (ICU), increasing muscle strength and functional capacity, as well as reducing the duration of effective ventilatory weaning (Dunn, Quinn, Corbrigde, Eldeirawi, Kapella & Collins, 2017).
The need for ventilatory weaning protocols is transversal to several authors, advocating the implementation of strategies aimed at decreasing IMV time, its pathophysiological consequences and its hospital cost (MacIntyre et al., 2005).
Associated with the implementation of early ventilatory weaning protocols, rehabilitation programs aimed at patients, hospitalized in the ICU; aim to improve residual capacity, preventing complications associated with decreased muscle strength due to ventilatory dependence and prolonged immobility. The application of these rehabilitation protocols also aims to reduce the need for rehospitalization and contributes to a lower functional deficit after hospital discharge (Ambrosino, Venturelli, Vagheggini & Clini, 2012).
It is in this sense that the presence of specialized multidisciplinary teams is pointed out as these professionals have the competencies to perform, implement and evaluate autonomous and differentiated care plans to intervene in the real and potential problems of patients. Their knowledge enables them to act in an early manner, implementing preventive measures, in order to avoid complications and disabilities. It also allows therapeutic interventions aimed at regaining independence in the various functions of the body, namely respiratory function (Order of Nurses, 2011).