smpСкорая медицинская помощьEMERGENCY MEDICAL CARE2072-6716Northwest State Medical University named after II Mechnikov10.24884/2072-6716-2017-18-4-53-59smp-296Research ArticleОБЗОРЫREVIEWSРЕСПИРАТОРНАЯ ПОДДЕРЖКА В УСЛОВИЯХ ОКАЗАНИЯ СКОРОЙ МЕДИЦИНСКОЙ ПОМОЩИ: СОВРЕМЕННОЕ СОСТОЯНИЕ ПРОБЛЕМЫ И ПЕРСПЕКТИВЫ РАЗВИТИЯRESPIRATORY SUPPORT AT PREHOSPITAL STAGE OF EMERGENCY MEDICAL CARE: CURRENT STATUS, PROBLEMS AND PROSPECTS OF DEVELOPMENTЕршовА. Л.ErshovA. L.

доцент  кафедры  скорой  медицинской  помощи;

191015,  СанктПетербург, Кирочная ул., д. 41

 

andyershov@yandex.ruСеверо-Западный государственный медицинский университет им. И. И. Мечникова, Санкт-ПетербургРоссияNorth-Western State Medical University named after I.I Mechnikov, St. PetersburgRussian Federation2017231120181845359Copyright © Ершов А.Л., 20182018Ершов А.Л.Ershov A.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://smp.spb.ru/jour/article/view/296

Пациенты с острой дыхательной недостаточностью (ОДН) составляют существенную долю в структуре обращений за скорой медицинской помощью, большинство таких вызовов завершается госпитализацией. У части больных данной группы имеются показания к проведению экстренной искусственной вентиляции легких (ИВЛ). Однако многие аспекты выполнения догоспитальной респираторной поддержки до настоящего времени остаются плохо изученными. Данный обзор литературы дает представление о частоте и исходах вызовов бригад скорой помощи к пациентам с ОДН в разных странах; ближайших и отдаленных результатах их лечения; частоте и особенностях применения ИВЛ, а также рассматривает некоторые современные тенденции в оказании экстренной респираторной поддержки на догоспитальном этапе.

Patients with respiratory distress often seek emergency medical care and are frequently transported by emergency medical services (EMS). Some of them are in need of urgent respiratory support.EMSencounters with patients in respiratory distress and the role of mechanical ventilation (MV) in their treatment have not been well documented. The study objective was to characterize the epidemiology of prehospital respiratory distress and the impact of MV at subsequent patient outcomes. Some of the new trends in prehospital respiratory therapy have also been described.

скорая медицинская помощь острая дыхательная недостаточность респираторная поддержка в условиях скорой помощиеmergency medical services аcute respiratory insufficiency рrehospital respiratory supportReferencesNielsen V. M.L., Madsen J., Aasen A. et al. Prehospital treatment with continuous positive airway pressure in patients with acute respiratory failure: a regional observational study. Scand. J. of Trauma, Resusc. and Emerg. Med., 2016, Vol. 24, рр. 121–131.Nielsen V. M.L., Madsen J., Aasen A. et al. Prehospital treatment with continuous positive airway pressure in patients with acute respiratory failure: a regional observational study. Scand. J. of Trauma, Resusc. and Emerg. Med., 2016, Vol. 24, рр. 121–131.Centers for Disease Control and Prevention. National Hospital Ambulatory Medical Care Survey (NHAMCS)-2009 emergency department summary tables. Доступно на сайте: http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2009_ed_web_tables.pdf.Centers for Disease Control and Prevention. National Hospital Ambulatory Medical Care Survey (NHAMCS)-2009 emergency department summary tables. Доступно на сайте: http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2009_ed_web_tables.pdf.Prekker M. E., Feemster L. C., Hough C. L. The Epidemiology and Outcome of Prehospital Respiratory Distress. Acad. Emerg. Med., 2014, Vol. 21, No 5, рр. 543–550.Prekker M. E., Feemster L. C., Hough C. L. The Epidemiology and Outcome of Prehospital Respiratory Distress. Acad. Emerg. Med., 2014, Vol. 21, No 5, рр. 543–550.Hall M. J., Levant S., DeFrances C. J. Trends in inpatient hospital deaths: National Hospital Discharge Survey, 2000–2010. NCHS Data Brief., 2013, Vol. 118, рр. 1–8.Hall M. J., Levant S., DeFrances C. J. Trends in inpatient hospital deaths: National Hospital Discharge Survey, 2000–2010. NCHS Data Brief., 2013, Vol. 118, рр. 1–8.Sanghavi P., Jena A. B., Newhouse J. P., Zaslavsky A. M. Outcomes of Basic Versus Advanced Life Support for Out-of-Hospital Medical Emergencies. Ann. Intern. Med., 2015, Vol. 163, No 3, рр. 681–690.Sanghavi P., Jena A. B., Newhouse J. P., Zaslavsky A. M. Outcomes of Basic Versus Advanced Life Support for Out-of-Hospital Medical Emergencies. Ann. Intern. Med., 2015, Vol. 163, No 3, рр. 681–690.Tarpgaard M., Hansen T. M., Rognas L. Anaesthetist-provided pre-hospital advanced airway management in children: a descriptive study. Scand. J. Trauma Resusc. Emerg. Med., 2015, Vol. 27, рр. 23–61.Tarpgaard M., Hansen T. M., Rognas L. Anaesthetist-provided pre-hospital advanced airway management in children: a descriptive study. Scand. J. Trauma Resusc. Emerg. Med., 2015, Vol. 27, рр. 23–61.Chanques G., Riboulet F., Molinari N. et al. Fraction of mask pressure transmitted to the trachea using the Boussignac’s CPAP facemask (letter to editor). Minerva Anestesiologica, 2014, Vol. 80, No 3, рр. 397.Chanques G., Riboulet F., Molinari N. et al. Fraction of mask pressure transmitted to the trachea using the Boussignac’s CPAP facemask (letter to editor). Minerva Anestesiologica, 2014, Vol. 80, No 3, рр. 397.Prekker M. E., Feemster L. C., Hough C. L. et al. The Epidemiology and Outcome of Prehospital Respiratory Distress. Acad. Emerg. Med., 2014, Vol. 21, No 5, рр. 543–550.Prekker M. E., Feemster L. C., Hough C. L. et al. The Epidemiology and Outcome of Prehospital Respiratory Distress. Acad. Emerg. Med., 2014, Vol. 21, No 5, рр. 543–550.Ershov A. L., Shhurov A. Ju. Analiz primenenija IVL pri okazanii specializirovannoj skoroj medicinskoj pomoshhi (Evaluation of mechanical ventilation performed by prehospitalcardiological brigades). Vrach skoroj pomoshhi, 2014, Nо 7, рр. 23–31.Ershov A. L., Shhurov A. Ju. Analiz primenenija IVL pri okazanii specializirovannoj skoroj medicinskoj pomoshhi (Evaluation of mechanical ventilation performed by prehospitalcardiological brigades). Vrach skoroj pomoshhi, 2014, Nо 7, рр. 23–31.Ershov A. L., Shhurov A. Ju. Iskusstvennaja ventiljacija legkih pri okazanii skoroj medicinskoj pomoshhi v megapolise Rossii (Emergency mechanical ventilation in Russian megapolis ambulance practice). Skoraja pomoshh’, 2016, No 2, рр. 27–32.Ershov A. L., Shhurov A. Ju. Iskusstvennaja ventiljacija legkih pri okazanii skoroj medicinskoj pomoshhi v megapolise Rossii (Emergency mechanical ventilation in Russian megapolis ambulance practice). Skoraja pomoshh’, 2016, No 2, рр. 27–32.Pandor A., Thokala P., Goodacre S. et al. Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation. Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation. Health Technol Assess, 2015, Vol. 42, No 19, рр. 1–101.Pandor A., Thokala P., Goodacre S. et al. Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation. Pre-hospital non-invasive ventilation for acute respiratory failure: a systematic review and cost-effectiveness evaluation. Health Technol Assess, 2015, Vol. 42, No 19, рр. 1–101.Fevang E., Lockey D., Thompson J. et al. Research collaboration. The top five research priorities in physicianprovided pre-hospital critical care: a consensus report from a European research collaboration. Scand. J. Trauma Resusc. Emerg. Med., 2011, Vol. 19, рр. 57.Fevang E., Lockey D., Thompson J. et al. Research collaboration. The top five research priorities in physicianprovided pre-hospital critical care: a consensus report from a European research collaboration. Scand. J. Trauma Resusc. Emerg. Med., 2011, Vol. 19, рр. 57.Joshi N., Estes M. K., Shipley K., Lee H. D. Noninvasive Ventilation For Patients In Acute Respiratory Distress: An Update. Emerg. Med. Pract. 2017, Vol. 19, No 2 (Feb.), рр. 1–20.Joshi N., Estes M. K., Shipley K., Lee H. D. Noninvasive Ventilation For Patients In Acute Respiratory Distress: An Update. Emerg. Med. Pract. 2017, Vol. 19, No 2 (Feb.), рр. 1–20.Allison M. G., Winters M. E. Noninvasive Ventilation for the Emergency Physician. Emerg. Med. Clin. North Am. 2016, Vol. 34, No 1, рр. 51–62.Allison M. G., Winters M. E. Noninvasive Ventilation for the Emergency Physician. Emerg. Med. Clin. North Am. 2016, Vol. 34, No 1, рр. 51–62.Van Tulder R., Schriefl C., Roth D. et al. Laryngeal Tube Practice in a Metropolitan Ambulance Service: A Fiveyear Retrospective Observational Study (2009–2013). Prehosp. Emerg. Care, 2016, Apr. 26, рр. 1–7.Van Tulder R., Schriefl C., Roth D. et al. Laryngeal Tube Practice in a Metropolitan Ambulance Service: A Fiveyear Retrospective Observational Study (2009–2013). Prehosp. Emerg. Care, 2016, Apr. 26, рр. 1–7.Bledsoe B. E., Slattery D. E., Lauver R. et al. Can emergency medical services personel effectively place and use the supraglottic airway laryngopharyngeal tube (SALT) airway? Prehosp. Emerg. Care. 2011, Vol. 15, No 3, рр. 359–365.Bledsoe B. E., Slattery D. E., Lauver R. et al. Can emergency medical services personel effectively place and use the supraglottic airway laryngopharyngeal tube (SALT) airway? Prehosp. Emerg. Care. 2011, Vol. 15, No 3, рр. 359–365.Sharma B., Sahai C., Sood J. Extraglottic airway devices: technology update. Med. Devices (Auckl), 2017, No 10, рр. 189–205.Sharma B., Sahai C., Sood J. Extraglottic airway devices: technology update. Med. Devices (Auckl), 2017, No 10, рр. 189–205.Deakin C. D., Peters R., Tomlinson P., Cassidy M. Securing the prehospital airway: a comparison of laryngeal mask insertion and endotracheal intubation by UK paramedics. Emerg. Med. J., 2005, Vol. 22, рр. 64–67.Deakin C. D., Peters R., Tomlinson P., Cassidy M. Securing the prehospital airway: a comparison of laryngeal mask insertion and endotracheal intubation by UK paramedics. Emerg. Med. J., 2005, Vol. 22, рр. 64–67.Doppler R. Noninvasive ventilation in out-of-hospital emergency medicine. Med. Klin. Intensivmed Notfmed., 2014, Vol. 109 (2), рр. 109–114.Doppler R. Noninvasive ventilation in out-of-hospital emergency medicine. Med. Klin. Intensivmed Notfmed., 2014, Vol. 109 (2), рр. 109–114.Saeedi M., Hajiseyedjavadi H., Seyedhosseini J. et al. Comparison of endotracheal intubation, combitube, and laryngeal mask airway between inexperienced and experienced emergency medical staff: A manikin study. Int. J. Crit. Illn. Inj. Sci. 2014. v.4, No 4, рр. 303–308.Saeedi M., Hajiseyedjavadi H., Seyedhosseini J. et al. Comparison of endotracheal intubation, combitube, and laryngeal mask airway between inexperienced and experienced emergency medical staff: A manikin study. Int. J. Crit. Illn. Inj. Sci. 2014. v.4, No 4, рр. 303–308.Gałazkowski R. New possibilities in emergency medical transportation and emergency services of Polish Medical Air Rescue. Anestezjol. Intens. Ter. 2010, Vol. 42, No 3, рр. 174–178.Gałazkowski R. New possibilities in emergency medical transportation and emergency services of Polish Medical Air Rescue. Anestezjol. Intens. Ter. 2010, Vol. 42, No 3, рр. 174–178.Blakeman T. C., Branson R. D. Evaluation of 4 new generation portable ventilators. Respir Care, 2013, Vol. 58, No 2, рр. 264–272.Blakeman T. C., Branson R. D. Evaluation of 4 new generation portable ventilators. Respir Care, 2013, Vol. 58, No 2, рр. 264–272.Boussen S., Gainnier M., Michelet P. Evaluation of ventilators used during transport of critically ill patients: a bench study. Respir Care. 2013, Vol. 58, No 11, рр. 1911–1922.Boussen S., Gainnier M., Michelet P. Evaluation of ventilators used during transport of critically ill patients: a bench study. Respir Care. 2013, Vol. 58, No 11, рр. 1911–1922.Luiz T., Kumpch M., Grüttner J. et al. Prehospital CPAP Therapy by Emergency Physicians in Patients with Acute Respiratory Failure due to Acute Cardiogenic Pulmonary Edema or Acutely Exacerbated COPD. In Vivo. 2016, Vol. 30, No 2, рр. 133–139.Luiz T., Kumpch M., Grüttner J. et al. Prehospital CPAP Therapy by Emergency Physicians in Patients with Acute Respiratory Failure due to Acute Cardiogenic Pulmonary Edema or Acutely Exacerbated COPD. In Vivo. 2016, Vol. 30, No 2, рр. 133–139.Williams B., Boyle M., Robertson N., Giddings C. When pressure is positive: a literature review of the prehospital use of continuous positive airway pressure. Prehosp Disaster Med., 2013, Vol. 28, No 1, рр. 52–60.Williams B., Boyle M., Robertson N., Giddings C. When pressure is positive: a literature review of the prehospital use of continuous positive airway pressure. Prehosp Disaster Med., 2013, Vol. 28, No 1, рр. 52–60.Moritz F., Benichou J., Vanheste M. et al. Boussignac continuous positive airway pressure device in the emergency care of acute cardiogenic pulmonary oedema: a randomized pilot study. Eur. J. Emerg. Med., 2003, Vol. 10 (3), рр. 204–208.Moritz F., Benichou J., Vanheste M. et al. Boussignac continuous positive airway pressure device in the emergency care of acute cardiogenic pulmonary oedema: a randomized pilot study. Eur. J. Emerg. Med., 2003, Vol. 10 (3), рр. 204–208.Arlt M., Philipp A., Zimmermann M., et al. Emergency use of extracorporeal membrane oxygenation in cardiopulmonary failure. Artif. Organs., 2009, Vol. 33, No 9, рр. 696–703.Arlt M., Philipp A., Zimmermann M., et al. Emergency use of extracorporeal membrane oxygenation in cardiopulmonary failure. Artif. Organs., 2009, Vol. 33, No 9, рр. 696–703.Munshi L., Telesnicki T., Walkey A., Fan E. Extracorporeal life support for acute respiratory failure. A systematic review and metaanalysis. Ann. Am. Thorac. Soc., 2014, Vol. 11, No 5, рр. 802–810.Munshi L., Telesnicki T., Walkey A., Fan E. Extracorporeal life support for acute respiratory failure. A systematic review and metaanalysis. Ann. Am. Thorac. Soc., 2014, Vol. 11, No 5, рр. 802–810.Guirand D. M., Okoye O. T., Schmidt B. S. et al. Venovenous extracorporeal life support improves survival in adult trauma patients with acute hypoxemic respiratory failure: a multicenter retrospective cohort study. Trauma Acute Care Surg., 2014, Vol. 76, No 5, рр. 1275–1281.Guirand D. M., Okoye O. T., Schmidt B. S. et al. Venovenous extracorporeal life support improves survival in adult trauma patients with acute hypoxemic respiratory failure: a multicenter retrospective cohort study. Trauma Acute Care Surg., 2014, Vol. 76, No 5, рр. 1275–1281.Meng-Yu Wu, Pyng-Jing Lin, Yuan-His Tseng et al. Venovenous extracorporeal life support for posttraumatic respiratory distress syndrome in adults: the risk of major hemorrhages. Scand. J. Trauma Resusc Emerg. Med., 2014, Vol. 22, р. 56. http://www.sjtrem.com/content/22/1.Meng-Yu Wu, Pyng-Jing Lin, Yuan-His Tseng et al. Venovenous extracorporeal life support for posttraumatic respiratory distress syndrome in adults: the risk of major hemorrhages. Scand. J. Trauma Resusc Emerg. Med., 2014, Vol. 22, р. 56. http://www.sjtrem.com/content/22/1.Biscotti M., Agerstrand C., Abrams D. et al. One Hundred Transports on Extracorporeal Support to an Extracorporeal Membrane Oxygenation Center. Ann. Thorac. Surg. 2015, Vol. 100, No 1, рр. 34–39.Biscotti M., Agerstrand C., Abrams D. et al. One Hundred Transports on Extracorporeal Support to an Extracorporeal Membrane Oxygenation Center. Ann. Thorac. Surg. 2015, Vol. 100, No 1, рр. 34–39.Sheluhin D. A., Pavlov A. I., Ershov A. L. Jekstrakorporal’naja membrannaja oksigenaci u pacientov s tjazheloj dyhatel’noj nedostatochnost’ju i pervyj opyt ee primennija vo vremja aviacionnoj medicinskoj jevakuacii v Rossii (Extracorporeal membrane oxygenation for patients with severe respiratory failure. Case report: first time in Russia inter-hospital aeromedical transportation of the patient with severe acute respiratory failure on extracorporeal membrane oxygenation). Mediko-biologicheskie i social’no-psihologicheskie problemy bezopasnosti v chrezvychajnyh situacijah, 2015, No 3, рр. 19–29.Sheluhin D. A., Pavlov A. I., Ershov A. L. Jekstrakorporal’naja membrannaja oksigenaci u pacientov s tjazheloj dyhatel’noj nedostatochnost’ju i pervyj opyt ee primennija vo vremja aviacionnoj medicinskoj jevakuacii v Rossii (Extracorporeal membrane oxygenation for patients with severe respiratory failure. Case report: first time in Russia inter-hospital aeromedical transportation of the patient with severe acute respiratory failure on extracorporeal membrane oxygenation). Mediko-biologicheskie i social’no-psihologicheskie problemy bezopasnosti v chrezvychajnyh situacijah, 2015, No 3, рр. 19–29.

The authors declare that there are no conflicts of interest present.