Модель механической мощности искусственной вентиляции и концепция алгоритма управления риском вентилятор-индуцированного повреждения легких

Авторы:

Дмитрий Сергеевич Кодацкий,

Дмитрий Васильевич Маршалов,

Кирилл Адольфович Софронов,

Иван Юрьевич Шолин,

Михаил Валерьевич Кецкало

Журнал: Анестезиология и реаниматология. 2026;(4):96-105.

DOI: 10.17116/anaesthesiology202604196

Прочитано: 151 раз

Резюме

ЦЕЛЬ ИССЛЕДОВАНИЯ

Выполнить нарративный обзор и концептуальный синтез данных о механической мощности искусственной вентиляции, оценить ее значение как интегрального показателя энергетической нагрузки, рассмотреть концепции распределения и диссипации энергии в дыхательной системе и на этой основе сформировать клинико-физиологическую модель управления риском вентилятор-индуцированного повреждения легких.

МАТЕРИАЛ И МЕТОДЫ

Выполнен нарративный обзор с элементами концептуального синтеза в соответствии с рекомендациями SANRA и с применением элементов PRISMA 2020. Систематический поиск проведен в PubMed/MEDLINE, Scopus, Web of Science и Embase (1990—2025). Проанализированы публикации, посвященные механической мощности (ММ), эластической мощности (elastic power), повреждающей эластической мощности (hazardous elastic power), рассеиваемой энергии (dissipated energy), пороговому давлению открытия, микродеформации и макродеформации (micro-strain и macro-strain), статической и динамической деформации (static и dynamic strain), нормализации ММ, а также влиянию ожирения, пневмоперитонеума и положения Тренделенбурга на механику дыхания. Первичный скрининг выявил 87 уникальных источников; для детального анализа отобраны 37 публикаций. Синтез выполнен в контексте механизмов вентилятор-индуцированного повреждения легких (ВИПЛ); сформирована двухсекторная концепция управления ММ.

РЕЗУЛЬТАТЫ

Выделены два качественно различных детерминанта роста ММ: повышение метаболического запроса на вентиляцию (минутный объем дыхания) и ухудшение механических свойств респираторной системы (давления, положительного давления конца выдоха, порогового давления открытия). Концепции рассеиваемой энергии, эластической мощности, порогового давления открытия, рассеивания энергии рекрутмента/дерекрутмента и легочной деформации уточняют, в какие структуры и каким образом распределяется энергия, что определяет риск ВИПЛ. Нормализация ММ по отношению к податливости (комплайнсу) респираторной системы или идеальной массе тела повышает прогностическую точность показателя. На основе синтеза данных предложена двухсекторная клинико-физиологическая модель управления ММ, в которой первичный приоритет отдан коррекции управляемых внереспираторных факторов с последующей оптимизацией параметров вентиляции.

ЗАКЛЮЧЕНИЕ

Механическая мощность и связанные с ней характеристики распределения и диссипации энергии могут служить операциональными индикаторами риска вентилятор-индуцированного повреждения легких. Предложенная двухсекторная модель представляет собой концептуальную рамку для индивидуализации протективной вентиляции; необходима проспективная валидация ее клинической эффективности и влияния на исходы.

Ключевые слова

механическая мощность
эластическая мощность
повреждающая эластическая мощность
протективная вентиляция
вентилятор-индуцированное повреждение легких
движущее давление
ПДКВ
допустимая гиперкапния
рассеиваемая энергия
легочная деформация
нормализация механической мощности

Дата поступления: 29.12.2025

Дата принятия в печать: 18.03.2026

Дата публикации: 24.08.2026

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