Возможные исходы лечения ОРДС

       Госпитальная летальность у пациентов с ОРДС во многом зависит от основного заболевания и составляет для ОРДС лёгкой степени 25-35%, для среднетяжелого ОРДС 40-50% и для тяжёлого ОРДС 46-60% [24,372–375].

       В течение от полугода до 2-х лет после выписки из ОРИТ у пациента, перенесшего ОРДС, нарушены другие функции (мышечная сила, физическая активность)[376]. По сравнению с бывшими пациентами хирургических ОРИТ без ОРДС стандартная реабилитационная терапия в течение раннего восстановительного периода после критического состояния не показывает значимых улучшений физической выносливости и силы. Более того, часть пациентов также страдает от депрессии (26–33%), тревоги (38–44%) или посттравматического расстройства психики (22–24%). В целом, уровень физической активности и функциональной автономности после перенесенного ОРДС снижен по сравнению с пациентами, перенесшими критическое состояние без ОРДС. Общее качество жизни у пациентов, перенесших ОРДС, значительно снижено по сравнению с похожими пациентами, не перенесшими ОРДС [376]. Около 50% пациентов, перенесших ОРДС, могут вести нормальный или почти нормальный образ жизни [377–380].

У больных с ОРДС механика внешнего дыхания возвращается к норме в течение 1 года после выписки из клиники. Снижение диффузионной способности, увеличение мертвого пространства при физических нагрузках, а также легочная гипертензия могут сохраняться длительно [379,380].

Условия оказания медицинской помощи

Медицинская помощь, регламентируемая данным протоколом, осуществляется в условиях стационара. Профиль – анестезиолого-реанимационный. Функциональное назначение медицинской помощи – лечебно-диагностическая.

 

Кодирование по номенклатуре медицинских услуг

Кодирование по номенклатуре медицинских услуг, согласно приказа Министерства здравоохранения РФ от 13 октября 2017 года № 804н «Об утверждении номенклатуры медицинских услуг».

A16.09.011	Искусственная вентиляция легких
A16.09.011.001	Искусственная вентиляция легких с раздельной интубацией бронхов
A16.09.011.002	Неинвазивная искусственная вентиляция легких
A16.09.011.003	Высокочастотная искусственная вентиляция легких
A16.09.011.004	Синхронизированная перемежающаяся принудительная вентиляция легких
A16.09.011.005	Вспомогательная искусственная вентиляция легких
A16.09.011.006	Неинвазивная вентиляция с двухуровневым положительным давлением
A25.09.001	Назначение лекарственных препаратов при заболеваниях нижних дыхательных путей и легочной ткани
A25.09.002	Назначение диетического питания при заболеваниях нижних дыхательных путей и легочной ткани
A25.09.003	Назначение лечебно-оздоровительного режима при заболеваниях нижних дыхательных путей и легочной ткани
A25.30.011	Назначение лекарственных препаратов врачом-анестезиологом-реаниматологом
B01.003.001	Осмотр (консультация) врачом-анестезиологом-реаниматологом первичный
B01.003.002	Осмотр (консультация) врачом-анестезиологом-реаниматологом повторный
B02.003.001	Процедуры сестринского ухода за пациентом, находящимся в отделении интенсивной терапии и реанимации
B02.003.002	Процедуры сестринского ухода за пациентом, находящимся на искусственной вентиляции легких
B02.003.003	Процедуры сестринского ухода за фиксированным пациентом
B02.003.004	Процедуры сестринского ухода за пациентом в критическом состоянии

 

Клинические рекомендации подготовлены рабочей группой в составе:

       Ярошецкий А.И. (Москва) (отв.редактор), Грицан А.И. (Красноярск) (отв.редактор), Авдеев С.Н. (Москва), Власенко А.В. (Москва), Заболотских И.Б. (Краснодар), Еременко А.А. (Москва), Зильбер А.П. (Петрозаводск), Киров М.Ю. (Архангельск), Лебединский К.М. (Санкт-Петербург), Лейдерман И.Н. (Санкт-Петербург), Мазурок В.А. (Санкт-Петербург), Николаенко Э.М. (Москва), Проценко Д.Н. (Москва), Солодов А.А. (Москва)

 

Критерии оценки качества медицинской помощи

Таблица 3.

№	Критерий качества	Уровень достоверности доказательств	Уровень убедительности рекомендаций
1	Своевременно установлены показания к началу ИВЛ и начата ИВЛ	3	В
2	Достигнуты целевые значения PaO2 и PaCO2 в соответствии рекомендациями	2	В
3	Использован дыхательный объем 6-8 мл/кг идеальной массы тела	1	А
4	Выполнена оценка рекрутабельности легочной ткани одним из методов	2	В
5	Выполнена КТ легких	3	С
6	У пациентов с высокой рекрутабельностью альвеол уровень РЕЕР и FiO2 установлен в соответствии с рекомендациями, но не ниже 10 мбар	1	A
7	Выполнена прон-позиция в соответствии с рекомендациями	1	А
8	Выполнена оценка риска острого легочного сердца по шкале острого легочного сердца	3	В
9	Использована «лёгкая» седация у пациентов с ОРДС лёгкой и средней степени (RASS -1-2 балла) или глубокая седация (RASS -4 балла) и миоплегия у пациентов с ОРДС тяжелой степени	2	В

 

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