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Протокол респираторной поддержки при тяжелом сепсисе

Таким образом, методы коррекции ОДН при тяжелом сепсисе могут быть разделены на высокоэффективные, приводящие к снижению летальности и уменьшению вентилятор-индуцированного повреждения легких – терапия выбора (доказательства категории А и В) и дополнительные, положительное влияние на летальность которых имеет невысокую категорию доказательности – терапия резерва.

Терапия выбора:

1. Применение дыхательного объема менее 10 мл/кг массы тела (рекомендуется 6 мл/кг)

2. Оптимальное ПДКВ (выше 10 см вод.ст.)

3. Предпочтительно применение вспомогательных режимов респираторной поддержки

4. Применение маневров открытия альвеол

5. При отсутствии эффекта от изложенного в пп.1-4 применение вентиляции в положении лежа на животе

Терапия резерва:

6. При отсутствии эффекта от изложенного в пп.1-5 применение инверсного соотношения вдоха к выдоху.

7. При отсутствии эффекта от изложенного в пп.1-6 ингаляционное введение NO в дозе 5 ppm

8. При снижении респираторного индекса менее 70 мм рт.ст. и отсутствии эффекта от изложенного в пп.1-6 применение экстракорпоральной мембранной оксигенации

Литература:

1. Багдатьев В.Е., Гологорский В.А., Гельфанд Б.Р. и др. Нарушения фибринолитической функции легких при респираторном дистресс-синдроме у больных перитонитом // Анест. и реаниматол. – 1991 - №5. - с.9-12.

2. Багдатьев В.Е., Гологорский В.А., Гельфанд Б.Р. и др. Содержание в крови и агрегация тромбоцитов при респираторном дистресс-синдроме взрослых // Анест. и реаниматол. – 1990 - №4. - с.8-11.

3. В кн.: Хирургические инфекции, под редакцией Ерюхина И.А., Гельфанда Б.Р., Шляпникова С.А., СПб, 2003, стр. 371-372)

4. Гологорский В.А., Багдатьев В.Е., Гельфанд Б.Р. и др. Изменение метаболической функции легких и содержание биологически активных веществ в крови больных респираторным дистресс-синдромом // Анест. и реаниматол. – 1992 - №1. - с.20-22.

5. Гологорский В.А., Гельфанд Б.Р., Стамов В.И., Лапшина И.Ю. Прекращение длительной искусственной вентиляции легких («отлучение» от аппарата ИВЛ). Функциональные критерии и методические принципы// Анест. и реаниматол. – 1995 - №6.

6. Кассиль В.Л., Выжигина М.А., Лескин Г.С. Искусственная и вспомогательная вентиляция легких. - М.: Медицина, 2004.- 480 с.

7. Кассиль В.Л., Золотокрылина Е.С. Острый респираторный дистресс-синдром.- М.: Медицина, 2003.- 224 с.

8. Abraham E, Baughman R, Fletcher E, et al. Liposomal prostaglandin E1 (TLC C-53) in acute respiratory distress syndrome: a controlled, randomized, double-blind, multicenter clinical trial. Crit Care Med 1999;27:1478-1485.

9. Abraham E, Matthay MA, Dinarello CA, et al. Consensus conference definitions for sepsis, septic shock, acute lung injury, and acute respiratory distress syndrome: time for a reevaluation. Crit Care Med 2000;28:232-235.

10. Amato et al. Beneficial effects of the “open lung approach” with low distending pressures in ARDS. A prospective randomized trial on mechanical ventilation. Am J Respir Crit Care Med 1995;152:1835-46.

11. Amato MBP, Barbas CSV, Medeiros DM, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998;338:347-354.

12. Antonelli M et al. A comparision of non-invasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl J Med 339:429-35, 1998.

13. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet 1967;2:319-323.

14. Bachofen M, Weibel ER. Structural alterations of lung parenchyma in the adult respiratory distress syndrome. Clin Chest Med 1982;3:35-56.

15. Bernard GR, Artigas A, Brigham KL, et al. The American-European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial сoordination. Am J Respir Crit Care Med 1994;149:818-824.

16. Bernard GR, Luce JM, Sprung CL, et al. High-dose corticosteroids in patients with the adult respiratory distress syndrome. N Engl J Med 1987;317:1565-1570.

17. Brochard L, Roudot-Thoraval F, Roupie E, et al. Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. Am J Respir Crit Care Med 1998;158:1831-1838.

18. Burns S. Mechanical ventilation: weaning. Pathways and protocols for weaning: science and practice. Program and abstracts of the 32nd Critical Care Congress; January 28-February 2, 2003; San Antonio, Texas.

19. Carlton et al. Lung overexpansion increases pulmonary microvascular protein permeability in young lambs. J Appl Physiol 69:577-83, 1990

20. Chao DC, Scheinhorn DJ. Weaning from mechanical ventilation. Crit Care Clin. 1998;14:799-817.

21. Corbridge TC, Wood LDH, Crawford GP, Chudoba MJ, Yanos J, Sznajder JI. Adverse effects of large tidal volumes and low PEEP in canine acid aspiration. Am Rev Respir Dis 1990;142:311-315.

22. Dellinger RP, Zimmerman JL, Taylor RW, et al. Effects of inhaled nitric oxide in patients with acute respiratory distress syndrome: results of a randomized phase II trial. Crit Care Med 1998;26:15-23.

23. Dreyfuss D, Soler P, Basset G, Saumon G. High inflation pressure pulmonary edema: respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis 1988;137:1159-1164.

24. Dreyfuss et al. High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume and positive end-expiratory pressure. Am Rev Resp Dis 135: 1159-64, 1988

25. Ely EW, Baker AM, Dunagan DP, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med. 1996;335:1864-1869.

26. Epstein SK, Ciubotaru RL. Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med. 1998;158:489-493.

27. Esteban A, Alia I, Gordo F, et al. Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med. 1997;156(2 Pt 1):459-465.

28. Esteban A, Frutos F, Tobin MJ, et al. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med. 1995;332:345-350.

29. Fort P, Farmer C, Westerman J, et al. High-frequency oscillatory ventilation for adult respiratory distress syndrome -- pilot study. Crit Care Med 1997;25:937-947

30. Fu et al. High lung volume increases stress failure in pulmonary capillaries. J Appl Physiol 73: 123-33, 1992

31. Gattinoni et al. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med 345:568-573, 2001

32. Gattinoni L, Bombino M, Pelosi P, et al. Lung structure and function in different stages of severe adult respiratory distress syndrome. JAMA 1994;271:1772-1779.

33. Gattinoni L, Pelosi P, Suter PM et al. ARDS caused by pulmonary and extrapulmonary disease. Am J Respir Crit Care Med 1998;158:3-11

34. Gattinoni L, Pesenti A, Bombino M. Relationships between lung computed tomographic density, gas exchange and PEEP in acute respiratory failure. Anesthesiology 1988; 69:824-832.

35. Gattinoni L, Presenti A, Bombino M, et al. Relationships between lung computed tomographic density, gas exchange, and PEEP in acute respiratory failure. Anesthesiology 1988;69:824-832.

36. Goodman et al. Radiology 1999;213:545-552

37. Gunther A, Mosavi P, Heinemann S, et al. Alveolar fibrin formation caused by enhanced procoagulant and depressed fibrinolytic capacities in severe pneumonia: comparison with the acute respiratory distress syndrome. Am J Respir Crit Care Med 2000;161:454-462.

38. Hickling et al. Crit Care Med 1994; 22: 1568-1578.

39. Hickling et al. Intensive Care Med 1990; 16: 372-377.

40. Kirby RR, Downs JB, Civetta JM, et al. High level positive end expiratory pressure (PEEP) in acute respiratory insufficiency. Chest 1975;67:156-163.

41. Kolla S, Awad S, Rich P et al. Extracorporeal Life Support for 100 Adult Patients With Severe Respiratory Failure. Annals of Surgery 1997; 226(4):544-566

42. Kolobow et al. Severe impairment in lung function induced by high peak airway pressuring during mechanical ventilation. An experimental study. Am Rev Resp Dis 135: 312-5, 1987.

43. Lachmann B. Intensive Care Med 1992;18:319-321

44. Lessard MR, Guerot E, Lorino H, Lemaire F, Brochard L. Effects of pressure-controlled with different I:E ratios versus volume-controlled ventilation on respiratory mechanics, gas exchange, and hemodynamics in patients with adult respiratory distress syndrome. Anesthesiology 1994;80:983-991.

45. Lewandowski K, Rossaint R, Pappert D et al. High survival rates in 122 ARDS patients managed according to a clinical algorithm including extracorporal membrane oxygenation. Intensive Care Med 1997; 23: 819-835.

46. Lindgon V, Palmgor K, Reinhard J. et al. High survival in adult patients with acute respiratory distress syndrome treated by extracorporeal membrane oxygenation, minimal sedation, and pressure supported ventilation. Intensive Care Med 2000; 26:1630-1637.

47. Loick et al. J Appl Physiol 75: 301-6, 1993

48. Luce JM, Montgomery AB, Marks JD, Turner J, Metz CA, Murray JF. Ineffectiveness of high-dose methylprednisolone in preventing parenchymal lung injury and improving mortality in patients with septic shock. Am Rev Respir Dis 1988;136:62-68.

49. Luhr OR, Antonsen K, Karlsson M, et al. Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. Am J Respir Crit Care Med 1999;159:1849-1861.

50. Matthay MA. Conference summary: acute lung injury. Chest 1999;116:Suppl:119S-126S.

51. Matute-Bello G, Liles WC, Radella F II, et al. Neutrophil apoptosis in the acute respiratory distress syndrome. Am J Respir Crit Care Med 1997;156:1969-1977.

52. Meduri GU, Belenchia JM, Estes RJ, Wunderink RG, el Torky M, Leeper KV Jr. Fibroproliferative phase of ARDS: clinical findings and effects of corticosteroids. Chest 1991;100:943-952.

53. Meduri GU, Chinn AJ, Leeper KV, et al. Corticosteroid rescue treatment of progressive fibroproliferation in late ARDS: patterns of response and predictors of outcome. Chest 1994;105:1516-1527.

54. Meduri GU, Headley AS, Golden E, et al. Effect of prolonged methylprednisolone therapy in unresolving acute respiratory distress syndrome: a randomized controlled trial. JAMA 1998;280:159-165.

55. Mehta S et al. Prospective trial of HFO in adults with ARDS. Crit Care Med 29: 1360-69, 2001

56. Messerole et al. The pragmatics of prone positioning. Am J Respir Crit Care Med 165: 1359-63, 2002

57. Michael JR, Barton RG, Saffle GR. Inhaled nitric oxide versus conventional therapy. Am J Respir Crit Care Med 1998; 157:1372-1380.

58. Mure M, Martling C-R, Lindahl SGE. Dramatic effect on oxygenation in patients with severe acute lung insufficiency treated in the prone position. Crit Care Med 1997;25:1539-1544.

59. Murray JF, Nadel JA. Respiratory Medicine. – Philadelphia: SaundersCo., 1994. – 560 p.

60. Omlor et al. J Appl Physiol 74: 3068-72, 1993

61. Parker JC, Townsley MI, Rippe B, Taylor AE, Thigpen J. Increased microvascular permeability in dog lungs due to high peak airway pressures. J Appl Physiol 1984;57:1809-1816.

62. Payen D, Vallet B, Genoa Group. Results of the French prospective multicentric randomized double-blind placebo-controlled trial on inhaled nitric oxide in ARDS. Intensive Care Med 1999;25:Suppl:S166-S166.abstract

63. Pelosi et al. Sigh in ARDS. Am J Respir Crit Care Med 1999;159:872-88

64. Prescott SM, McIntyre TM, Zimmerman G. Two of the usual suspects, platelet-activating factor and its receptor, implicated in acute lung injury. J Clin Invest 1999;104:1019-1020.

65. Pugin J, Ricou B, Steinberg KP, Suter PM, Martin TR. Proinflammatory activity in bronchoalveolar lavage fluids from patients with ARDS, a prominent role for interleukin-1. Am J Respir Crit Care Med 1996;153:1850-1856.

66. Pugin J, Verghese G, Widmer M-C, Matthay MA. The alveolar space is the site of intense inflammatory and profibrotic reactions in the early phase of acute respiratory distress syndrome. Crit Care Med 1999;27:304-312.

67. Putensen et al. Spontaneous breathing during ventilatory support improves ventilation-perfusion distribution in patients with ARDS. Am J Respir Crit Care Med 1999;159:1241-1248.

68. Ranieri VM, Suter PM, Tortorella C, et al. Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. JAMA 1999;282:54-61.

69. Rossaint R, Falke KJ, López F, Slama K, Pison U, Zapol WM. Inhaled nitric oxide for the adult respiratory distress syndrome. N Engl J Med 1993;328:399-405.

70. Schnapp LM, Chin DP, Szaflarski N, Matthay MA. Frequency and importance of barotrauma in 100 patients with acute lung injury. Crit Care Med 1995;23:272-278.

71. Seeger et al. Internist 1995;36:785-801

72. Sloane PJ, Gee MH, Gottlieb JE, et al. A multicenter registry of patients with acute respiratory distress syndrome: physiology and outcome. Am Rev Respir Dis 1992;146:419-426.

73. Slutsky AS, Drazen JM Ventilation with small tidal volumes. N Engl J Med 347: 630-31, 2002

74. Slutsky AS, Tremblay LN. Multiple system organ failure: is mechanical ventilation a contributing factor? Am J Respir Crit Care Med 1998;157:1721-1725.

75. Slutsky AS. The ARDS, mechanical ventilation and the prone position. N Engl J Med 345: 610-612, 2001

76. Sprung CL, Caralis PV, Marcial EH, et al. The effects of high-dose corticosteroids in patients with septic shock: a prospective, controlled study. N Engl J Med 1984;311:1137-1143.

77. Stewart TE, Meade MO, Cook DJ, et al. Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk of acute respiratory distress syndrome. N Engl J Med 1998;338:355-361.

78. Taylor RW, Zimmerman JL, Dellinger RP et al. Low dose inhaled nitric oxide in patients with acute lung injury. JAMA 2004; 291:1603-1609.

79. The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000;342:1301-1308.

80. Thomsen GE, Morris AH. Incidence of the the adult respiratory distress syndrome in the state of Utah. Am J Respir Crit Care Med 1995;152:965-971.

81. Tremblay et al. Injurious ventilatory strategies increase cytokines and c-fos m-RNA expression in an isolated rat lung model. J Clin Invest 1997; 99: 944-952.

82. Troncy E, Collet J-P, Shapiro S. Inhaled nitric oxide in acute respiratory distress syndrome. Am J Respir Crit Care Med 1998; 157:1483-1488.

83. Villar J, Slutsky AS. The incidence of the adult respiratory distress syndrome. Am Rev Respir Dis 1989;140:814-816.

84. Ware LB, Matthay MA. The Acute Respiratory Distress Syndrome. N Engl J Med 2000; 348: 1334-1349.

85. Webb HH, Tierney DF. Experimental pulmonary edema due to intermittent positive pressure ventilation with high inflation pressures: protection by positive end-expiratory pressure. Am Rev Respir Dis 1974;110:556-565.

86. Weg JG, Anzueto A, Balk RA, et al. The relation of pneumothorax and other air leaks to mortality in the acute respiratory distress syndrome. N Engl J Med 1998;338:341-346.

87. Wood K, Kollef M et al. Chest 113:1339-46,1998.

88. Zapol WM, Snider MT, Hill JD, et al. Extracorporeal membrane oxygenation in severe acute respiratory failure: a randomized prospective study. JAMA 1979;242:2193-2196.

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