Обеспечение проходимости верхних дыхательных путей в стационаре. Клинические рекомендации Федерации анестезиологов и реаниматологов России (второй пересмотр, 2018 г.)
№ 2 (2019) , КЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИ
№ 2 (2019)
КЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИ

Обеспечение проходимости верхних дыхательных путей в стационаре. Клинические рекомендации Федерации анестезиологов и реаниматологов России (второй пересмотр, 2018 г.)

https://doi.org/10.21320/1818-474X-2019-2-7-31
Опубликован 26.03.2019
Александр Александрович Андреенко
ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» МО РФ, Санкт-Петербург
https://orcid.org/0000-0002-5542-9280
Е.Л. Долбнева
ФГБНУ РНЦХ им. акад. Б.В. Петровского, Москва
https://orcid.org/0000-0003-3825-4949
В.И. Стамов
УКБ № 2 ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» МЗ РФ, Москва
https://orcid.org/0000-0001-8524-6840
#2019-2
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Ключевые слова

интубация трахеи
трудные дыхательные пути
трудная масочная вентиляция
трудная ларингоскопия
трудная интубация
надгортанные воздуховоды
крикотиреотомия
неудачная интубация

Как цитировать

Андреенко А.А., Долбнева Е.Л., Стамов В.И. Обеспечение проходимости верхних дыхательных путей в стационаре. Клинические рекомендации Федерации анестезиологов и реаниматологов России (второй пересмотр, 2018 г.). Вестник интенсивной терапии имени А.И. Салтанова. 2019;(2):7–31. doi:10.21320/1818-474X-2019-2-7-31.
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Аннотация

В обзоре представлены клинические рекомендации Федерации анестезиологов-реаниматологов России, пересмотренные в 2018 г. В основу рекомендаций положен обзор публикаций и современные международные руководства Общества по проблемам трудных дыхательных путей (DAS, 2015), Американского общества анестезиологов (ASA, 2013), Европейского общества анестезиологов (ESA, 2018).

Ситуации «трудных дыхательных путей» (ТДП) встречаются в современной анестезиологической практике относительно нечасто, но в случае невозможности обеспечения адекватной оксигенации пациентов они приводят к постгипоксическому повреждению головного мозга или остановке кровообращения. Современные требования к безопасности пациентов во время анестезии определяют необходимость проведения тщательной оценки пациентов перед операцией, выявления прогностических признаков трудной вентиляции через лицевую маску или надгортанные воздуховоды, трудной ларингоскопии и интубации, трудной крикотиреотомии. В результате обследования анестезиолог обязан сформулировать основной и резервный планы действий, подготовить необходимое оборудование, привлечь в случае необходимости специалистов.

В рекомендациях представлены доказательные данные об эффективности современных устройств для вентиляции и интубации трахеи (ИТ). Предложены алгоритмы принятия решения и действий в различных ситуациях при прогнозируемых и непрогнозируемых ТДП у пациентов с различным риском аспирации. Также предложен алгоритм подготовки, прогнозирования возможных осложнений и выполнения экстубации трахеи. Представленные в обзоре рекомендации направлены на достижение цели — повышения безопасности пациентов во время общей анестезии за счет снижения риска развития критических нарушений газообмена вследствие нарушений проходимости верхних дыхательных путей.

https://doi.org/10.21320/1818-474X-2019-2-7-31
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