12 марта 2020 года, ЗОКБ. 

Мастер-класс по ИВЛ провел к.мед.н. Сатишур Олег Евгеньевич (г. Минск, Республика Беларусь).

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  1. Признанный европейский ИВЛ-авторитет, сокращения интуитивно понятны 🙂
    PAOLO PELOSI
    All pts very similar:
    1) dont use niv too much — if sato2 less than 95 or paO2/FiO2 less 200 with/without RR higher than 25-30 b/min at fiO2 60 per cent with cpap by helmet after 15-30 min — intubate immediately
    2) low tidal volume 6-4 ml/kg pbw with minimal rr to achieve pH above 7.2
    3) peep relatively high 13-15 cmh2O
    4) minimal RM
    5) compliance is good so pplat is usually below 25-27 cmH2O (lungs are easy to ventilate) — with driving P below 13 cm H2O
    6) increase FiO2 even higher than 0.5 if needed
    7) they star with usual very low paO2/FiO2 when intubated — than can slightly improve — dont worry is normal
    8)chest Xray usually is very bad bilateral — than use Rx and Echo — dont use CT scan for monitoring — make also a cardio echo for cardiac function and cardic effusion
    9) low medium use of Noradrenaline — since pts are sedated almost for 4-7 days initially this maintains pressure and reduce the need for entrance in the room)
    9) prone is very much useful and patients may be well responsive — but be very well organized snce consider time to dress before entering the rooms
    10) stay patient weaning is later — if you start earlier you can have problems
    11) make a BAL at entrance and once a week — remember that swamp may be negative while BAL positive !
    12) treat with antiviral cocktail (Darunavir o lopinavir) + ritonavir + oseltamivir + idrossiclorochina 200×2 + ceftarolina — in agreement with infectilogists
    13) limit fluids and increase NA)
    14) no corticosteroids — in case of NA higher than 0.7 use only hydrocortisone 50 x4 (very few days)
    15) use of ecmo is rare

    Paolo Pelosi

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