pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2018-28-4-399-410pulmo-1025Research ArticleКЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИCLINICAL GUIDELINESИскусственная вентиляция легких у взрослых пациентов с острым респираторным дистресс-синдромом. Официальные клинические рекомендации Американского торакального общества, Европейского общества интенсивной терапии и Общества критических состояний в медицинеMechanical Ventilation in Adults with Acute Respiratory Distress Syndrome An Official Clinical Guideline of American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care MedicineстатьяРедакционнаяArticleEditorial201818102018284399410Copyright © статья Р., 20182018статья Р.article E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/1025По материалам

По материалам: Fan E., Del Sorbo L., Goligher E.C., Hodgson C.L., Munshi L., Walkey A.J., Adhikari N.K.J., Amato M.B.P., Branson R., Brower R.G., Ferguson N.D., Gajic O., Gattinoni L., Hess D., Mancebo J., Meade M.O., McAuley D.F., Pesenti A., Ranieri V.M., Rubenfeld G.D., Rubin E., Seckel M., Slutsky A.S., Talmor D., Thompson B. T., Wunsch H., Uleryk E., Brozek J., Brochard L.J. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am. J. Respir. Crit. Care Med.2017; 195 (9): 1253–1263. DOI: 10.1164/rccm.201703-0548ST.

В представленном документе собрана доказательная информация об использовании искусственной вентиляции легких (ИВЛ) у взрослых пациентов с острым респираторным дистресс-синдромом (ОРДС).

Методы

Методы. Многопрофильным коллективом выполнены систематический обзор и метаанализ исследований по данной теме. Для разработки клинических рекомендаций использовалась система GRADE.

Результаты

Результаты. Всем больным с ОРДС настоятельно рекомендуется ИВЛ с низкими дыхательными объемами (4–8 мл / кг должного массы тела) и низким инспираторным давлением (плато давления < 30 см вод. ст.) (средняя уверенность в оценке результата). Пациентам с тяжелым ОРДС настоятельно рекомендуется принимать положение тела лежа на животе в течение > 12 ч в сутки (средняя уверенность в оценке результата). Для больных со среднетяжелым или тяжелым ОРДС настоятельно не рекомендуется использовать высокочастотную осцилляторную вентиляцию в повседневной практике (высокая уверенность в оценке результата); желательно применять более высокое положительное давление в конце выдоха (средняя уверенность в оценке результата) и маневры рекрутирования альвеол (низкая уверенность в оценке результата). Необходимы дополнительные доказательства для разработки однозначных рекомендаций по использованию экстракорпоральной мембранной оксигенации при тяжелом ОРДС.

Заключение

Заключение. Коллективом авторов сформулирована целесообразность рекомендаций по отдельным методам вентиляционной коррекции у взрослых пациентов с ОРДС. Врачи, занимающиеся лечением больных с ОРДС, должны индивидуально подходить к выбору терапии у каждого пациента, особенно по вопросам, в отношении которых разработаны условные рекомендации.

Adopted from

Adopted from: Fan E., Del Sorbo L., Goligher E.C., Hodgson C.L., Munshi L., Walkey A.J., Adhikari N.K.J., Amato M.B.P., Branson R., Brower R.G., Ferguson N.D., Gajic  O., Gattinoni L., Hess D., Mancebo J., Meade M.O., McAuley D.F., Pesenti A., Ranieri  V.M., Rubenfeld G.D., Rubin E., Seckel M., Slutsky A.S., Talmor D., Thompson B. T.,  Wunsch H., Uleryk E., Brozek J., Brochard L.J. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical  Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients  with Acute Respiratory Distress Syndrome. Am. J. Respir. Crit. Care Med. 2017; 195 (9): 1253–1263. DOI: 10.1164/rccm.201703-0548ST

The aim of this guideline is to provide clinical recommendation on the use of mechanical ventilation in adult patients with acute respiratory distress syndrome (ARDS).

Methods

Methods. This guideline is based on systematic review and metaanalysis of available literature on the use of mechanical ventilation in adult patients with ARDS.

Results

Results. All patients with ARDS should be mechanically ventilated with the use of lower tidal volumes (4–8 ml/kg predicted bodyweight) and lower inspiratory  pressures (plateau pressure, 30 cm H2O). In severe ARDS, the prone positioning for more than 12 h/d is strongly recommended. In patients with moderate to  severe ARDS, routine use of high-frequency oscillatory ventilation is not  recommended; a conditional recommendation has been developed for the use of  higher positive end-expiratory pressure and recruitment maneuvers. CuОР –  ently, there is not enough evidence for the use of extracorporeal membrane oxygenation in patients with severe ARDS.

Conclusions

Conclusions. Practical recommendations on selected methods to coОР – ect  ventilation disturbances in adult patients with ARDS have been developed.  Clinicians involved in the management of patients with ARDS should use personalized approach to the treatment of these patients.

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The authors declare that there are no conflicts of interest present.