ENTRENAMIENTO DIAFRAGMÁTICO EN PACIENTES ADULTOS POST VENTILACIÓN MECÁNICA

The respiratory musculature is responsible for inspiratory and expiratory activity, it is composed of the diaphragm and the external intercostals which contract and improve the expansion of the rib cage which in turn allows to improve or increase lung volume. For its effective functioning, the patient must have a complete nervous control, which ensures the functioning of the phrenic nerve and also have a good nutritional status, in order to have sufficient energy substrates for optimal functioning (Garcia-Talavera et al., 1992). There are three (3) types of respirations, four (4) alterations of the respiratory frequency and four (4) of the respiratory rhythm and pattern.

Taking into account that the diaphragm is the most important respiratory muscle and is part of the group of muscles that facilitate inspiration, it is also a fundamental part of the respiratory pump; in the inspiratory phase it contracts, descends and sends the abdominal pressure to the lower part of the thoracic cage, producing an increase in flow, thus increasing the thoracic volume and a negative intrathoracic pressure, on the other hand, in the expiratory phase these flows decrease thanks to its elastic recoil (Hannan et al..., 2021) (Dres et al., 2017).

In addition to facilitating breathing mainly through the costal portion, the diaphragm contributes to gastroesophageal functions, antireflux barrier, esophageal emptying and emesis through the crural portion; it also acts in defense mechanisms such as coughing, crying, laughter, sphincter control, provides anatomical stability to thoracic and abdominal organs and participates in postural control (Anraku, M et al., 2009).

For this reason, in recent years, it is considered fundamental and of utmost importance to have knowledge about the functioning and state of the respiratory musculature in order to understand the alterations that can be generated by the use of mechanical ventilation (Jubran, 2006). Through a meticulous evaluation, it is possible to determine the need to resort to mechanical ventilation and to identify the severity of the compromise, which allows the timely implementation of interventions that contribute to its improvement (Ruiz et al., 2012). Despite the knowledge about the implications of DDIVM and the importance of diaphragmatic training in adult patients who are subjected to this type of ventilatory support, there is no documented consensus on the recommendations on the implementation of different diaphragmatic training techniques in specific respiratory care contexts; however, some interventions that can improve this complication are known. It is for this reason that the present investigation proposes an expanded review of the specialized literature, based on the recommendations of the Cochrane group for systematic literature reviews, with the aim of identifying diaphragmatic training strategies in the rehabilitation of adult patients subjected to invasive mechanical ventilation. With this, we expect the organized compilation of scientific evidence, according to the classification (author, title, year, objective, type of study, thematic axis, results and conclusions) that will allow the implementation of the necessary recommendations for the physiotherapeutic approach in DDIVM.