Diaphragmatic dysfunction and systemic repercussions in critically ill and postoperative patients, and implications for functional recovery: An integrative literature review

Abstract

Introduction: Diaphragmatic dysfunction in critically ill and postoperative patients is associated with important clinical and functional consequences, including reduced respiratory muscle strength, weaning failure, prolonged mechanical ventilation, and impaired global ventilatory capacity. These changes result from the interaction between prolonged mechanical ventilation, immobility, systemic inflammatory response, and disease severity, requiring an interdisciplinary approach integrating physiotherapy, medicine, and multiprofessional strategies aimed at preserving respiratory function. Objective: This paper describes diaphragmatic dysfunction and its systemic repercussions in critically ill and post-operative patients, with an emphasis on the role of physiotherapy within a multidisciplinary approach to preventing functional decline and improving respiratory and clinical outcomes. Methods: This is a descriptive and analytical literature review, conducted through an integrative review of the literature. The following databases were used: the Virtual Health Library (VHL), the Latin American and Caribbean Health Sciences Literature (LILACS), the National Library of Medicine (PubMed) and SciVerse Scopus (Scopus). Sixteen studies published between 2000 and 2017 were included, selected based on their relevance to the association between diaphragmatic dysfunction, mechanical ventilation, postoperative outcomes, and functional outcomes, as well as physiotherapeutic interventions and multiprofessional care. Results: The analyzed evidence indicates that diaphragmatic dysfunction is associated with worse clinical outcomes, including prolonged mechanical ventilation, weaning failure, increased respiratory complications, and impaired functional recovery. Physiotherapeutic interventions such as early mobilization, respiratory exercises, inspiratory muscle training, and lung expansion techniques, combined with continuous medical monitoring, demonstrate a positive impact on preserving diaphragmatic function and reducing respiratory complications. Multiprofessional integration was essential to optimize weaning, reduce complications, and improve functional recovery. Conclusion: The interdisciplinary approach between physiotherapy and medicine is fundamental for the management of diaphragmatic dysfunction in critically ill and postoperative patients. Early and structured evidence-based protocols contribute to the preservation of respiratory function, reduction of complications, and improvement of clinical and functional outcomes.