Современные подходы к диагностике, лечению и профилактике тяжелой внебольничной пневмонии у взрослых: обзор литературы
№ 3 (2021) , ВЕДЕНИЕ ПАЦИЕНТОВ С ВНЕБОЛЬНИЧНОЙ ПНЕВМОНИЕЙ
№ 3 (2021)
ВЕДЕНИЕ ПАЦИЕНТОВ С ВНЕБОЛЬНИЧНОЙ ПНЕВМОНИЕЙ

Современные подходы к диагностике, лечению и профилактике тяжелой внебольничной пневмонии у взрослых: обзор литературы

https://doi.org/10.21320/1818-474X-2021-3-27-46
Опубликован 26.10.2021
С.Н. Авдеев
ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
https://orcid.org/0000-0002-5999-2150
Борис Зиновьевич Белоцерковский
ФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава России, Москва, Россия; АНО ЦКБ Святителя Алексия, Москва, Россия
https://orcid.org/0000-0002-5758-5703
А.В. Дехнич
ФГБОУ ВО «Смоленский государственный медицинский университет» Минздрава России, Смоленск, Россия
https://orcid.org/0000-0001-6897-5486
А.А. Зайцев
ФГБУ «Главный военный клинический госпиталь имени академика Н.Н. Бурденко» МО РФ, Москва, Россия
https://orcid.org/0000-0002-0934-7313
Р.С. Козлов
ФГБОУ ВО «Смоленский государственный медицинский университет» Минздрава России, Смоленск, Россия
https://orcid.org/0000-0001-8728-1113
Д.Н. Проценко
ФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава России, Москва, Россия; ГБУЗ «Городская клиническая больница № 40 Департамента здравоохранения города Москвы», Москва, Россия
https://orcid.org/0000-0002-5166-3280
С.А. Рачина
ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
https://orcid.org/0000-0002-3329-7846
А.И. Синопальников
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
https://orcid.org/0000-0002-1990-2042
С.В. Яковлев
ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия; ГБУЗ «Городская клиническая больница им. С.С. Юдина Департамента здравоохранения города Москвы», Москва, Россия
https://orcid.org/0000-0001-7606-8608
А.И. Ярошецкий
ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия; ФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава России, Москва, Россия
https://orcid.org/0000-0002-1484-092X
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Ключевые слова

внебольничные инфекции
пневмония
антибактериальные препараты
респираторная терапия

Как цитировать

Авдеев С.Н., Белоцерковский Б.З., Дехнич А.В., Зайцев А.А., Козлов Р.С., Проценко Д.Н., Рачина С.А., Синопальников А.И., Яковлев С.В., Ярошецкий А.И. Современные подходы к диагностике, лечению и профилактике тяжелой внебольничной пневмонии у взрослых: обзор литературы. Вестник интенсивной терапии имени А.И. Салтанова. 2021;(3):27–46. doi:10.21320/1818-474X-2021-3-27-46.
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Аннотация

Обзор литературы по проблеме тяжелой внебольничной пневмонии (ТВП). Приведены актуальные данные об эпидемиологии и этиологии этой формы заболевания, охарактеризована антибиотикочувствительность ведущего возбудителя — Streptococcus pneumoniae. Обсуждаются доказательные данные по диагностике, подчеркнута необходимость раннего определения насыщения артериальной крови кислородом по пульсоксиметру, динамической оценки концентрации воспалительных маркеров, комплексного микробиологического обследования. Обоснованы преимущества компьютерной томографии перед рентгенологическим методом, указано на целесообразность применения ультразвукового метода для диагностики и динамической оценки состояния легочной ткани в процессе лечения. Подробно представлены современные рекомендации по дифференцированной антибиотикотерапии пациентов с ТВП в зависимости от наличия у них факторов риска инфицирования определенными микроорганизмами, приведены схемы этиотропной терапии при установленном возбудителе. Подчеркнута необходимость своевременного назначения комбинированной антибиотикотерапии внутривенными (в/в) формами препаратов, указано на возможность деэскалации на основании микробиологических данных в случае отчетливой положительной динамики. Значительный раздел обзора посвящен респираторной терапии при ТВП, сформулирован ступенчатый алгоритм лечения острой дыхательной недостаточности в зависимости от ее стадии. Детально охарактеризованы наиболее эффективные и безопасные режимы инвазивных и неинвазивных способов респираторной поддержки. В качестве методов адъювантной терапии названы глюкокортикостероиды при невозможности стабилизировать показатели гемодинамики на фоне адекватной гидратации и вазопрессорной поддержки, а также парентеральные антикоагулянты с целью предупреждения тромбоэмболических осложнений. Для профилактики ТВП у пациентов высокого риска предложены антипневмококковые и противогриппозные вакцины. Настоящая публикация призвана осветить принципиальные моменты проекта обновленной версии клинических рекомендаций по ТВП и призвать сообщество российских анестезиологов-реаниматологов к его широкому обсуждению.
https://doi.org/10.21320/1818-474X-2021-3-27-46
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