[Isamsonova]

Концепция "безопасной" ИВЛ - это малый объем,но почему обязательно по давлению?
Surviving Sepsis Campaign: International guidelines for
management of severe sepsis and septic shock: 2008
R. Phillip Dellinger, MD; Mitchell M. Levy, MD; Jean M. Carlet, MD; Julian Bion, MD;и др.for the International Surviving Sepsis Campaign Guidelines Committee
Mechanical ventilation of sepsis-induced ALI/ARDS
● Target a tidal volume of 6 mL/kg (predicted) body weight in patients with ALI/ARDS (1B)
● Target an initial upper limit plateau pressure
30 cm H2O. Consider chest wall compliance when assessing plateau pressure (1C)
● Allow PaCO2 to increase above normal, if needed, to minimize plateau pressures and tidal volumes (1C)
● Set PEEP to avoid extensive lung collapse at end-expiration (1C)
 Consider using the prone position for ARDS patients requiring potentially injurious levels of FIO2 or plateau pressure, provided they are not put
at risk from positional changes (2C)
● Maintain mechanically ventilated patients in a semirecumbent position (head of the bed raised to 45°) unless contraindicated (1B), between 30°
and 45° (2C)
 Noninvasive ventilation may be considered in the minority of ALI/ARDS patients with mild to moderate hypoxemic respiratory failure. The
patients need to be hemodynamically stable, comfortable, easily arousable, able to protect/clear their airway, and expected to recover rapidly (2B)