Искусственная 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 медицине

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

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. 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.

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