Штучна вентиляція легенів при черепно-мозковій травмі

В. І. Снiсарь; О. Р. Лацинський

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

Автор(и)

В. І. Снiсарь Днiпропетровська медична академiя МОЗ України, Україна
О. Р. Лацинський КЗ «Днiпропетровська дитяча обласна клiнiчна лiкарня», Україна

DOI:

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

Ключові слова:

черепно-мозкова травма, механiчна вентиляцiя легень

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.

Біографії авторів

В. І. Снiсарь, Днiпропетровська медична академiя МОЗ України

Snisar V.I.

О. Р. Лацинський, КЗ «Днiпропетровська дитяча обласна клiнiчна лiкарня»

Latsinsky A.R.

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