pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2017-27-2-232-249pulmo-847Research ArticleОБЗОРЫREVIEWНеинвазивная вентиляция легких у пациентов с хронической обструктивной болезнью легких в стационаре и домашних условияхNon invasive ventilation in patients with chronic obstructive pulmonary disease in a hospital and at homeАвдеевС. Н.AvdeevS. N.

Авдеев Сергей Николаевич – доктор медицинских наук, член-корр. Российской академии наук, профессор, руководитель клинического отдела 

105077, Россия, Москва, ул. 11-я Парковая, 32, корп. 4

Sergey N. Avdeev, Doctor of Medicine, Professor, Corresponding Member of Russian Academy of Sciences, Head of Clinical Division 

Odinnadtsataya Parkovaya ul. 32, build. 4, Moscow, 105077

serg-avdeev@list.ruФедеральное государственное бюджетное учреждение «Научно-исследовательский институт пульмонологии Федерального медико-биологического агентства России»РоссияFederal Pulmonology Research Institute, Federal Medical and Biological Agency of RussiaRussian Federation201705072017272232249Copyright © Авдеев С.Н., 20172017Авдеев С.Н.Avdeev S.N.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/847

Существенное улучшение ведения пациентов с хронической обструктивной болезнью легких (ХОБЛ) как при обострении, так и в стабильный период обусловлено широким применением в течение 2 последних десятилетий неинвазивной вентиляции легких (НВЛ). В настоящее время НВЛ рассматривается как терапия первой линии у пациентов с обострением ХОБЛ при развитии гиперкапнической острой дыхательной недостаточности. Данный метод респираторной поддержки также оказался эффективным у больных после экстубации: при его использовании не только облегчается процесс отлучения от респиратора, но и установлено положительное влияние при профилактике и лечении постэкстубационной дыхательной недостаточности. НВЛ также успешно применяется при сочетаниях ХОБЛ и синдрома апноэ сна, ХОБЛ и пневмонии, а также в раннем послеоперационном периоде после вмешательств в области грудной клетки. НВЛ также может использоваться у пациентов с ХОБЛ при хронической дыхательной недостаточности. Наиболее обоснованными показаниями для назначения длительной НВЛ в домашних условиях при ХОБЛ является гиперкапния в дневное время. По-видимому, наиболее эффективной стратегией респираторной поддержки при ХОБЛ является снижение парциального давления углекислого газа в артериальной крови – т. н. высокоинтенсивная НВЛ. Применение недавно разработанных переносных портативных аппаратов НВЛ позволяет значительно повысить физическую активность пациентов с ХОБЛ тяжелого течения

Last two decades, active use of non-invasive ventilation (NIV) has provided a significant improvement in the management of chronic obstructive pulmonary disease (COPD), both in patients with acute exacerbation and in stable patients. Currently, NIV is the first-line treatment for patients with acute exacerbation of COPD and acute hypercapnic respiratory failure. This method of respiratory support is also effective after extubation, as it could facilitate weaning from the ventilator and affects positively prevention and treatment of postextubation respiratory failure. Also, NIV has been successfully used in co-morbidity of COPD and sleep apnea syndrome, COPD and pneumonia, and in early postoperative period after thoracic surgery. NIV can be used in COPD patients with chronic respiratory failure. Long-term NIV at home is more reasonable in patients with daytime hypercapnia. The most effective strategy of respiratory support in COPD is thought to be decrease in the partial pressure of carbon dioxide in the arterial blood, i.e. high-intensity NIV. Currently available portable non-invasive ventilators could improve significantly physical activity of patients with severe COPD.

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