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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

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