Prolonged mechanical ventilation causes impaired inspiratory muscle strength and resistance. Inspiratory muscle weakness delays ventilatory weaning or exacerbes dyspnea in patients with prolonged IMV. Diaphragmatic atrophy occurs in 18-69 h of IMV.
Increasing inspiratory muscle strength accelerates ventilatory weaning improving quality of life.
Aim: evaluate the impact of rehabilitation nurses' (RN) intervention using inspiratory muscle training (IMT) on ventilatory weaning in critical patients.
Four studies multi-case studies, in different clinical contexts, with prolonged stay in intensive care unit (ICU), with requirements for IMT. Adding to RN?s respiratory rehabilitation interventions, IMT was performed using PowerbreatheŽ.
Case 1, a maximum inspiratory pressure (MIP) of 26 cmH2O was obtained after extubating. Three days after, a decline in respiratory function occur, requiring non-invasive ventilation (NIV) 14 hours a day.
Case 2, after extubating, MIP is 20 cmH20. Due to respiratory stress, ventilatory weaning on NIV was continued for 14 hours daily. After initiating IMT, patient 1 improved respiratory function reducing dependence on NIV in 15 days; in case 2, in 8 days.
Case 3, IMT was initiated 12 days before decannulation. The MIP assessed at 26 cmH20 increases to 45 cmH20.
Case 4, multiple surgeries with "deficient" diaphragmatic positioning, and inadequate function. Two days after surgery, MIP was 21 cmH2O. Four days after IMT, was 35 cmH2O, improving ventilatory mechanics.
Conclusion: RN?s intervention can be optimized with IMT devices. A larger study is recommended to consolidate the results.