DOI: https://doi.org/10.25284/2519-2078.2(71).2015.84821

Штучна вентиляція легенів при черепно-мозковій травмі

В. І. Снiсарь, О. Р. Лацинський

Анотація


Представленi данi щодо особливостей проведення механiчної вентиляцiї легень у хворих з черепно-мозковою травмою. Показано, що при черепно-мозковiй травмi, ускладненiй екстрацеребральними порушеннями, зокрема гострим респiраторним синдромом легень, створюються надзвичайно складнi умови для проведення респiраторної пiдтримки та керування механiчною вентиляцiєю. Вториннi гiпоксично-iшемiчнi ушкодження мозку внаслiдок гiпоксемiї/гiпоксiї та гiперкапнiї потребують швидкої корекцiї та стратегії безпечної штучної вентиляцiї легень. Необхiдно дотримуватися принципiв вентиляцiї, спрямованих на запобiгання в олюмотравмi i баротравмi. Усi захиснi стратегiї штучної вентиляцiї легень повиннi суворо виконуватися, особливо у цiєї категорiї хворих. Пiдтримання адекватної оксигенацiї тканин мозку має важливе значення для досягнення успiшного результату. Створення позитивного тиску в кiнцi видиху полiпшує оксигенацiю шляхом залучення i розкриття додаткових альвеол, збiльшення функціональної залишкової ємностi та запобiгає виникненню ателектазiв. Однак це може мати несприятливi неврологiчнi наслiдки в певних клiнiчних обставинах. Наведено данi про роль контролю РаСО2, монiторингу внутрiшньочерепного тиску. при черепно-мозковiй травмi пiд час проведення штучної вентиляцiї легень, нетрадицiйнi стратегiї вентиляцiйної пiдтримки, припинення штучної вентиляцiї легень при гострiй черепно-мозковiй травмi, проведення трахеостомiї, вплив санацiї та аспiрацiї з трахеї i бронхiв на внутрiшньочерепний тиск.

Ключові слова


черепно-мозкова травма; механiчна вентиляцiя легень

Повний текст:

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Посилання


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