Современный взгляд на лечение острого бронхиолита в педиатрических ОРИТ: обзор литературы
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Ключевые слова

бронхиолит
отделение интенсивной терапии
интенсивная терапия
инфузионная терапия
респираторная терапия
ребенок

Как цитировать

Цыганков А.Е., Овсянников Д.Ю., Афуков И.И., Солодовникова О.Н., Гостева О.М., Костин Д.М., Тюрин И.Н., Проценко Д.Н. Современный взгляд на лечение острого бронхиолита в педиатрических ОРИТ: обзор литературы. Вестник интенсивной терапии имени А.И. Салтанова. 2022;(3):111–123. doi:10.21320/1818-474X-2022-3-111-123.

Статистика

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Статистика с 21.01.2023

Аннотация

АКТУАЛЬНОСТЬ. В литературе накоплено достаточно данных по лечению детей с острым бронхиолитом (ОБ). Однако данная информация сформирована в основном на общей популяции пациентов с ОБ и часто неприменима к пациентам с тяжелым течением заболевания. С позиции доказательной медицины в современных согласительных документах не рекомендовано рутинное применение лекарственных препаратов, а также отсутствуют четкие рекомендации по респираторной поддержке и отдельным аспектам интенсивной терапии у детей с ОБ. ЦЕЛЬ ИССЛЕДОВАНИЯ. Провести анализ подходов к терапии у детей с ОБ тяжелого течения, нуждающихся в интенсивной терапии, и оценить обоснованность, эффективность и безопасность применения анализируемых групп препаратов и респираторных стратегий. МАТЕРИАЛЫ И МЕТОДЫ. Проведен анализ публикаций в электронных базах PubMed и Российского индекса научного цитирования по ключевым словам «bronchiolitis», «intensive care units», «critical care», «fluid therapy», «respiratory therapy», «ventilation», «co-morbidity», «respiratory syncytial virus», «hypertonic saline», «corticosteroids», «epinephrine», «high-flow oxygen therapy», «inhalation», «infant», «бронхиолиты у детей». Дата последнего поиска — 15 января 2022 г. РЕЗУЛЬТАТЫ. В данном систематическом обзоре приведены сведения об этиологии и факторах риска тяжелого течения ОБ у детей, с позиций доказательной медицины охарактеризованы исследования о терапии ОБ тяжелого течения, в том числе в условиях отделения реанимации и интенсивной терапии с помощью глюкокортикостероидов, ингаляций бронхолитиков, эпинефрина, 3 % гипертонического раствора натрия хлорида, высокопоточной оксигенации, неинвазивной вентиляции легких, искусственной вентиляции легких, антибиотиков, воздушно-гелиевой смеси. ВЫВОДЫ. В настоящее время появляется больше сведений о том, что младенцы с ОБ проявляют высокую степень гетерогенности, при этом основная неопределенность заключается в недопонимании процессов, какие пациенты в наибольшей степени получат пользу от того или иного метода лечения. Для восполнения дефицита исследований у детей с тяжелым течением ОБ необходимы дальнейшие исследования.

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