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ѕрогноз после остановки кровообращени€



Ќесмотр€ на множество факторов, вли€ющих на исход после остановки кровообращени€ и —Ћ– [41, 60, 385, 386, 387, 388, 389], нет однозначных указаний на прекращение реанимационных меропри€тий.

„ерез 20 минут —Ћ– руководитель реанимационной бригады должен убедитьс€ в необходимости продолжени€ проведени€ —Ћ– [273, 390, 391, 392, 393, 394]. –ешение о прекращении —Ћ– должно основыватьс€ на р€де показателей: причина остановки кровообращени€ и дыхани€ [60, 395], имеюща€с€ патологи€, возраст [41, 389], место остановки кровообращени€, наблюдалась ли остановка кровообращени€ [60, 394], продолжительность отсутстви€ оказани€ реанимационной помощи (врем€ без кровообращени€), количество введений адреналина, значение etCO2, наличие ритма сердца, подлежащего электроимпульсной терапии [386, 387], наличие аппаратов дл€ экстракорпоральной поддержки [396, 397, 398], а также дополнительные факторы (например, утопление в лед€ной воде [277, 399, 400] или отравление).

ѕрисутствие родителей

¬ р€де западных обществ большинство родителей желали бы присутствовать при оказании реанимационной помощи их дет€м [401, 402, 403, 404, 405, 406, 407, 408, 409, 410]. ѕри этом родители как правило медработникам не мешали [403, 411, 412, 413, 414, 415] и не вызывали дополнительный стресс [401, 403, 412]. –одители, изъ€вл€ющие желание присутствовать при проведении —Ћ–, считают, что их присутствие окажет положительное вли€ние на ребенка [401, 402, 403, 410, 414, 415, 416, 417]. ≈сли родители наход€тс€ с ребенком во врем€ —Ћ–, то они могут легче оценить реальные старани€ медработников и лучше свыкнутьс€ с мыслью о смерти ребенка.  роме того, им может быть предоставлена возможность дл€ прощани€ с ребенком. “е семьи, которые присутствовали при оказании —Ћ–, легче чувствуют себ€ в ходе траурного процесса [402, 403, 404, 414, 415, 417, 418].

ѕрисутствие родителей может также оказать поддержку медработникам в сохранении профессионализма в ходе —Ћ– и расценивании ребенка, как человеческого существа и члена семьи [411]. Ќекоторые медработники все же чувствуют себ€ некомфортно в присутствии родителей. ќни полагают, что родственники могут мешать проведению реанимационных меропри€тий [419]. Ќаучно обоснованные рекомендации относительно присутстви€ родителей в ходе —Ћ– касаютс€ р€да выбранных стран, поэтому не могут распростран€тьс€ на все страны ≈вропы, в которых могут быть различные социокультурные и этические нормы поведени€.



–екомендации по присутствию родственников в ходе —Ћ–

≈сли присутствие родственников в ходе —Ћ– было одобрено, то один из членов реанимационной бригады всегда должен быть в их распор€жении. ќн должен давать соответствующим образом объ€снени€ реанимационных действий и следить за тем, чтобы родственники не мешали проведению —Ћ–. ≈сли присутствие родственников будет мешать проведению —Ћ–, то их необходимо попросить покинуть помещение. ѕри возможности желательно разрешить родител€м проститьс€ с умершим ребенком [411, 420, 421, 422, 423].

–уководитель реанимационной бригады принимает решение об окончании реанимационных меропри€тий. Ёто решение должно быть тактично и обоснованно передано родител€м ребенка. ѕосле проведени€ —Ћ– необходимо провести общее собрание (дебрифинг) членов реанимационной бригады, чтобы каждый из них мог поделитьс€ своими впечатлени€ми.

ѕеревод: якшин ƒмитрий ћихайлович

e-mail: dimedrol03@yandex.ru

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