zabmedvestnikЗабайкальский медицинский вестникTransbaikalian Medical Bulletin1998-6173Читинская государственная медицинская академия10.52485/19986173_2026_1_103zabmedvestnik-558Research ArticleНАУЧНЫЕ ОБЗОРЫSCIENTIFIC REVIEWSОстрый респираторный дистресс-синдром у детей как системный патологический процессAcute respiratory distress syndrome in children as a systemic pathological processhttps://orcid.org/0000-0003-4705-3823БыковЮ. В.BykovYu. V.

Юрий Витальевич Быков, к. м. н., доцент

кафедра анестезиологии, реаниматологии с курсом ДПО

355017; ул. Мира, 310; Ставрополь

Candidate of Medical Sciences, Assistant

Department of Anesthesiology and Intensive Care with a course of additional professional education

355017; 310 Mira st.; Stavropol

yubykov@gmail.comhttps://orcid.org/0000-0002-9990-7272ОбединА. Н.ObedinA. N.

Александр Николаевич Обедин, д. м. н., заведущий кафедрой

кафедра анестезиологии, реаниматологии с курсом ДПО

355017; ул. Мира, 310; 355002; ул. Семашко, 3/1; Ставрополь

Doctor of Medical Sciences, Head of the Department

Department of Anesthesiology, Intensive Care with the course of additional professional education

355017; 310 Mira st.; 355002; 3/1 Semashko st.; Stavropol

volander@mail.ruhttps://orcid.org/0000-0003-4729-5101ЗинченкоО. В.ZinchenkoO. V.

Олег Васильевич Зинченко, к. м. н., доцент

кафедры анестезиологии, реаниматологии с курсом ДПО

355017; ул. Мира, 310; Ставрополь

Candidate of Medical Sciences, Associate Professor

Department of Anesthesiology, Intensive Care with the course of additional professional education

355017; 310 Mira st.; Stavropol

regionar2008@yandex.ruhttps://orcid.org/0000-0001-5482-8581ЯцукИ. В.YatsukI. V.

Иван Викторович Яцук, к. м. н., доцент

кафедра анестезиологии, реаниматологии с курсом ДПО

355017; ул. Мира, 310; 355032; ул. Тухачевского, 17; Ставрополь

Candidate of Medical Sciences, Associate Professor

Department of Anesthesiology, Intensive Care with the course of additional professional education

355017; 310 Mira st.; 355032; 17 Tukhachevsky st.; Stavropol

yatsukiv@gmail.comhttps://orcid.org/0000-0002-9841-6930ВолковЕ. В.VolkovE. V.

Евгений Владимирович Волков, к. м. н., доцент

кафедра анестезиологии, реаниматологии с курсом ДПО

355017; ул. Мира, 310; 355002;  ул. Семашко, 1; Ставрополь

Candidate of Medical Sciences, Associate Professor

Department of Anesthesiology, Intensive Care with the course of additional professional education

355017; 310 Mira st.; 355002; 1 Semashko st.; Stavropol

volkov26@mail.ruhttps://orcid.org/0000-0003-1494-1613ФишерВ. В.FischerV. V.

Василий Владимирович Фишер, к. м. н., доцент

кафедра анестезиологии, реаниматологии с курсом ДПО

355017; ул. Мира, 310; 356240; ул. Ленина, 1; Ставрополь

Candidate of Medical Sciences, Associate Professor

Department of Anesthesiology, Intensive Care with the course of additional professional education

355017; 310 Mira st.; 356240; 1 Lenin st.; Stavropol

vvfisher26@gmail.comФГБОУ ВО «Ставропольский государственный медицинский университет» Министерства здравоохранения РФРоссияStavropol State Medical UniversityRussian FederationФГБОУ ВО «Ставропольский государственный медицинский университет» Министерства здравоохранения РФ; ГБУЗ Ставропольского края «Ставропольский краевой клинический перинатальный центр № 1» Министерства здравоохранения РФРоссияStavropol State Medical University; Stavropol Regional Clinical Perinatal Center No. 1Russian FederationФГБОУ ВО «Ставропольский государственный медицинский университет» Министерства здравоохранения РФ; ГБУЗ Ставропольского края «Городская клиническая больница скорой медицинской помощи города Ставрополя» Министерства здравоохранения РФРоссияStavropol State Medical University; Stavropol City Clinical Emergency HospitalRussian FederationФГБОУ ВО «Ставропольский государственный медицинский университет» Министерства здравоохранения РФ; ГБУЗ Ставропольского края «Ставропольская краевая клиническая больница» Министерства здравоохранения РФРоссияStavropol State Medical University; Stavropol Regional Clinical HospitalRussian FederationФГБОУ ВО «Ставропольский государственный медицинский университет» Министерства здравоохранения РФ; ГБУЗ Ставропольского края «Шпаковская районная больница» Министерства здравоохранения РФРоссияStavropol State Medical University; Shpakovskaya District HospitalRussian Federation20261905202601103119Copyright © Быков Ю.В., Обедин А.Н., Зинченко О.В., Яцук И.В., Волков Е.В., Фишер В.В., 20262026Быков Ю.В., Обедин А.Н., Зинченко О.В., Яцук И.В., Волков Е.В., Фишер В.В.Bykov Y.V., Obedin A.N., Zinchenko O.V., Yatsuk I.V., Volkov E.V., Fischer V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.zabmedvestnik.ru/jour/article/view/558

   Педиатрический острый респираторный дистресс-синдром (ПОРДС) остаётся одной из наиболее сложных и клинически значимых форм острой дыхательной недостаточности (ОДН) в педиатрической интенсивной терапии. Высокая вариабельность клинического течения, ограниченность эффективности стандартных респираторных стратегий и неблагоприятные исходы у части пациентов указывают на неполноту традиционных патогенетических представлений, основанных преимущественно на альвеолярно-воспалительной модели. В статье рассматривается ПОРДС как системный патологический процесс, в основе которого лежит последовательное вовлечение микроциркуляторных, энергетических и регуляторных механизмов.

   Особое внимание уделено роли эндотелиальной дисфункции, нарушению тканевой перфузии и митохондриальной недостаточности как ключевым факторам формирования энергетического дефицита и ограничения обратимости патологического процесса.

   Показано, что гипоксемия и ОДН в данной парадигме выступают клиническими проявлениями более глубинного гипоксически-ишемического каскада с поражением лёгких и центральной нервной системы. Представленная концепция имеет практическое значение для углублённого понимания патогенеза, стратификации тяжести состояния и оценки прогноза при ПОРДС.

   Pediatric acute respiratory distress syndrome (PARDS) remains one of the most complex and clinically significant forms of acute respiratory failure (ARF) in pediatric intensive care. High variability of the clinical course, limited effectiveness of standard respiratory strategies, and unfavorable outcomes in a subset of patients indicate the insufficiency of traditional pathogenetic concepts predominantly based on the alveolar-inflammatory model. This article considers PARDS as a systemic pathological process driven by the sequential involvement of microcirculatory, energetic and regulatory mechanisms.

   Particular attention is paid to endothelial dysfunction, impaired tissue perfusion, and mitochondrial dysfunction as key factors underlying the development of energy deficiency and the limitation of process reversibility.

   It is shown that hypoxemia and ARF within this paradigm represent clinical manifestations of a deeper hypoxic-ischemic cascade affecting both the lungs and the central nervous system. The proposed concept has practical significance for improving the understanding of pathogenesis, stratifying disease severity, and assessing prognosis in PARDS.

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