Da mobilização precoce à reabilitação diafragmática: novas evidências da fisioterapia intensiva na recuperação funcional de pacientes críticos.

Abstract

Admission to the Intensive Care Unit (ICU) is frequently associated with accelerated muscle mass loss, intensive care unit-acquired weakness, respiratory dysfunction, and reduced functional capacity, factors that may prolong mechanical ventilation and increase morbidity and mortality. In this context, critical care physiotherapy has evolved considerably, incorporating therapeutic strategies that extend beyond early mobilization, with particular emphasis on diaphragmatic rehabilitation and more accurate functional assessment methods. This study aimed to analyze the scientific evidence regarding the evolution of physiotherapeutic interventions in the ICU, focusing on the transition from early mobilization to diaphragmatic rehabilitation and its impact on the functional recovery and clinical outcomes of critically ill patients. An integrative literature review was conducted using the PubMed/MEDLINE, Scopus, Web of Science, PEDro, Embase, SciELO, and LILACS databases. Studies published between 2015 and 2026 in English, Portuguese, and Spanish were considered. After applying the eligibility criteria, 24 studies were included in the final sample. The findings demonstrated that early mobilization remains an essential strategy for preventing intensive care unit-acquired weakness and improving functional recovery. However, there has been an increasing incorporation of diaphragmatic ultrasonography and inspiratory muscle training as valuable tools for the early identification of respiratory muscle dysfunction, supporting individualized therapeutic interventions and improving the success of weaning from mechanical ventilation. The selected studies also reported reductions in the duration of mechanical ventilation, shorter ICU length of stay, and improvements in functional capacity and quality of life after hospital discharge. It is concluded that integrating early mobilization, diaphragmatic functional assessment, and respiratory rehabilitation represents an evidence-based approach capable of optimizing clinical outcomes and strengthening the role of physiotherapy in the multidisciplinary care of critically ill patients. Nevertheless, further multicenter studies with standardized protocols are required to strengthen current evidence and support more consistent clinical recommendations.