Современные методы неинвазивной вентиляции легких у недоношенных с респираторным дистресс-синдромом: возможности, преимущества и ограничения

Актуальность. Респираторный дистресс-синдром новорожденных (РДС) остается основной причиной дыхательной недостаточности у недоношенных детей, а бронхолегочная дисплазия (БЛД) — самым частым и тяжелым осложнением респираторной терапии. Применение неинвазивной вентиляции легких (NIV) является основой стратегии «защитной вентиляции легких», направленной на предотвращение ятрогенного повреждения и снижение риска развития БЛД.

Цель обзора. Обобщить и проанализировать современные данные о методах NIV у недоношенных новорожденных с РДС, делая акцент на клинические возможности каждого метода, их преимущества и ограничения для оптимизации респираторной тактики.

Материалы и методы. Поиск проводился в следующих зарубежных и российских электронных библиографических базах данных и реестрах: PubMed, Cochrane Central Register of Controlled Trials, научная электронная библиотека eLibrary.ru и «КиберЛенинка». Основной период поиска, охватывал публикации за последнее десять лет (2015–2025 гг.).

Результаты. Эволюция методов неинвазивной респираторной поддержки направлена на достижение максимальной синхронизации с дыханием пациента и обеспечение стабильного давления в дыхательных путях. Сравнительные исследования и метаанализы демонстрируют превосходство синхронизированных режимов SNIPPV над базовым NСРАР в предотвращении интубации, а NHFOV может быть наиболее эффективным методом постэкстубационной поддержки. Однако применение этих методов сопряжено с рисками, включая назальные повреждения, баротравму и влияние на гемодинамику.

Заключение. Успешное внедрение NIV требует персонализированного подхода, основанного на гестационном возрасте, тяжести состояния и постоянной оценке клинических исходов, таких как развитие БЛД, потребность в инвазивной вентиляции легких и выживаемости. 

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