mamuka CxaiZe

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+

filtvebis xelovnuri ventilaciis

Tanamedrove meTodebi da reJimebi

Tbilisi 2003

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 winamdebare gamocema miznad isaxavs: gaaerTianos da mkiTxvels
warudginos Tanamedrove sasunTqi aparatebis gamoyenebis praqtikuli
gamocdileba da respiratoruli Terapiis zogierTi zogadi debuleba, rac
imedia, daexmarebaT anesTeziologebs, reanimatologebs da pulmonologebs,
yvelas maT, visac yoveldRiurad uwevs am problemebTan Sexeba. aq moyvanili
Tanamedrove Sexedulebebi da meTodebi kidev ufro mniSvnelovania Cvens
dRevandelobaSi, roca axali sasunTqi aparatura da xelovnuri ventilaciis
axali koncefciebi sul ufro farTod ikidebs fexs saqarTveloSi.
madlobas vuxdi jo enis samedicino centris xelmZRvanelobas, Cems
kolegebs, gaweuli daxmarebisaTvis.

sakontaqto misamarTi: jo enis samedicino centri, gulis qirurgia

/kardiologiis klinika, lublianas q.NN 21, 380059 Tbilisi, saqarTvelo, E-
mail - mamukachkhaidze@hotmail.com

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 sarCevi

Tavi 1
Ffiltvebis xelovnuri ventilacia intensiur TerapiaSi -------------------- 4 gv.
terminologia --------------------------------------------------------------------------------- 7 gv.

Tavi 2
Tanamedrove respiratoruli daxmarebis ZiriTadi principebi
eqimis logika ----------------------------------------------------------------------------------- 8 gv.
pacientis sunTqvis parametrebi, maTi mniSvneloba f.x.v.-is
optimaluri reJimebis SerCevisas, respiratoruli sistemis
mdgomareobis diagnostika --------------------------------------------------------------- 8 gv.

Tavi 3
sunTqvis ciklis formireba
sunTqvis cikli ----------------------------------------------------------------------------------- 12 gv.
iZulebiTi ventilaciis meTodebi ------------------------------------------------------- 13 gv.
ventilacia moculobis kontroliT –Volume control ventilation
(V.C.V.) ------------------------------------------------------------------------------------------------ 13 gv.
ventilacia wnevis kontroliT – Pessure control ventilation
(P.C.V.) ------------------------------------------------------------------------------------------------- 18 gv.
parametrebis SerCeva wnevis kontroliT ventilaciis dros,
respiratoruli meqanikis mrudebis gamoyenebiT ------------------------------- 21 gv.
spontanuri sunTqvis cikli ----------------------------------------------------------------- 23 gv.
damxmare ventilaciis meTodebi ---------------------------------------------------------- 24 gv.
Pressure support ventilation- wneviT damxmare ventilacia ----------------------- 25 gv.
PEEP/CPAP ( positive end expiratory pressure / Continius Positive
Airway Pressure ) dadebiTi wneva amosunTqvis bolos /
mudmivi dadebiTi wneva ------------------------------------------------------------------------ 28 gv.
daskvna ------------------------------------------------------------------------------------------------- 30 gv.

Tavi 4
ventilaciis riTmis Camoyalibeba ------------------------------------------------------ 30 gv.
trigeri ----------------------------------------------------------------------------------------------- 31 gv.
ventilaciis riTmis Camoyalibebis reJimebi --------------------------------------- 33 gv.

Tavi 5
ventilaciis damatebiTi meTodebi da reJimebi ------------------------------------- 37 gv.

Tavi 6
mrudi – wneva / moculoba (zogierTi situaciis interpretacia) ---------- 41 gv.

daskvna ----------------------------------------------------------------------------------------- 44 gv,

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 Tavi 1

filtvebis xelovnuri ventilacia Tanamedrove intensiur TerapiaSi

filtvebis xelovnuri ventilacia Tanamedrove intensiuri Terapiis

ganuyofel nawils warmoadgens. misi mniSvneloba imdenad didia, rom mravali
Cveni kolega mas mkurnalobis meTodsac ki uwodebs. amasTan dakavSirebiT
saintereso iqneba moviSvelioT, 1993 wels '"saerTaSoriso konsensus komitetis"
mier SemuSavebuli ganmarteba ( Consensus Conference on Mechanical Ventilation - January
28-30 , 1993 , at Northbrook , Illinois , USA . Chairman - A . S . Slutsky - Canada . masala
gamoqveynebulia Jurnal " Intensive Care Medicine " - specialur damatebaSi - Reports ,
Guidelines and Recomendations 1998 ) : " meqanikuri ventilacia aris mZime pacientis
mkurnalobis damxmare da ara Terapiuli meTodi. mwvave , kritikul avadmyofebSi
f.x.v.-is winaSe mdgomi fundamenturi amocanebi SeiZleba daiyos or jgufad : A -
fiziologiuri amocanebi da B - klinikuri amocanebi, razec qvemoT gveqneba
saubari. es koncefciebi unda gvaxsovdes ara marto f.x.v.-is dawyebisas, aramed misi
gamoyenebis mTel periodSi. xelovnuri ventilacia unda davasruloT maSinve,
rogorc ki PpaTofiziologiuri safuZveli misi gagrZelebisa aRar iarsebebs.
A- f.x.v.-is fiziologiuri amocanebi (miznebi) :
1. SevinarCunoT da vmarToT filtvebSi gazTa normaluri cvla :
i) alveoluri ventilacia ( PaCO2, pH ) : ventilaciuri daxmarebis mTavari
amocana, umetes SemTxvevaSi, alveoluri ventilaciis normalizebaa. zog
gansakuTrebul SemTxvevaSi amocana SeiZleba iyos ventilaciis gazrda normaze
metad (mag .: hiperventilacia intrakranialuri wnevis Sesamcireblad ), an piriqiT -
normaze dabali ventilacia, raTa misi parametrebis gazrdiT ufro meti ziani ar
mivayenoT pacients vidre sikeTes velodebiT misgan (e.w. permisiuli hiperkapnia,
an mw./qr. ventilaciuri ukmarisoba ) ;
ii)arteriuli oqsigenacia (PaO2, SaO2). mTavari amocanaa mivaRwioT da
SevinarCunoT arteriuli sisxlis oqsigenaciis done mocemuli klinikuri
SemTxvevisTvis misaReb cifrebze, Jangbadis dasaSvebi koncentraciis gamoyenebiT,
klinikuri SemTxvevebis umetesobisaTvis - es niSnavs SaO2 > 90% an PaO2 > 60mmHg , -
normaluri oqsihemoglobinis disociaciis mrudis SemTxvevaSi. ar arsebobs
klinikuri dadastureba imisa rom normaze maRali PaO2 raime upiratesobas
iZleodes, radganac arteriul sisxlSi Jangbadis Semcveloba ganisazRvreba
hemoglobiniTac, iseve rogorc PO2-iT. amave dros organizmisTvis Jangbadis
miwodeba pirdapir kavSirSia gulis wuTmoculobasTan, iseve rogorc sisxlSi
Jangbadis SemcvelobasTan. yvela es faqtori, ra Tqma unda, gasaTvaliswinebelia
qsovilTa oqsigenaciis gaumjobesebisaken mimarTuli mkurnalobis dros.

2.gavzardoT filtvebis moculoba:

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 i) CasunTqvis bolos filtvebis adeqvaturi gaSla - mivaRwioT filtvebis
sakmaris gaSlas yovel CasunTqvaze, raTa Tavidan aviciloT SesaZlo, an
vumkurnaloT arsebul ateleqtazebs da maT gavlenas oqsigenaciaze, komplainsze da
filtvis dacviT meqanizmebze.
ii) funqciuri rezidualuri (narCeni) tevadoba : raTa mivaRwioT f . r . t. - is
momatebas ( normalur maCveneblebamde ) an SevinarCunoT gazrdili f . r . t . PEEP
- is saSualebiT, im SemTxvevebSi roca f . r . t - is Semcirebas avadmyofisTvis
dramatuli Sedegi eqneba (dabali PaO2, filtvis Zlieri dazianeba ) mag. : ARDS - is
an postoperaciuli tkivilis dros.
3. SevamciroT an / da vakontroloT sunTqvaze daxarjuli muSaoba :
i)SevamciroT sasunTqi kunTebis datvirTva: rodesac pacients sunTqva
gaZnelebuli aqvs, sunTqvis procesi Zlier datvirTvas moiTxovs - gazrdili
rezistentobis Tu daqveiTebuli komplainsis gamo, Tanac es datvirTva naklebad
efeqturia an saerTo mdgomareobis simZimis gamo sasurvelia minimaluri energo
danaxarjebi. aseT situaciebSi meqanikuri ventilacia grZeldeba manam, sanam
specialuri Terapia an sxva RonisZiebebi ar Caaqroben am paTologiur procesebs.
B - f.x.v.-is klinikuri amocanebi ( miznebi ) :
imdenad ramdenadac f.x.v. umetes SemTxvevaSi emsaxureba mxolod
respiratoruli sistemis ukmarisobis kompensirebas, pirveladi klinikuri
amocanaa - Tavidan aviciloT filtvis iatrogenuri dazianeba da sxva garTulebebi
sanam misi gaumjobeseba moxdeba (spontanurad Tu sxvadasxva saSualebebiT). sxva
amocanebia:
1. SevamciroT an movxsnaT hipoqsemia: gavzardoT PaO2 anu SaO2, alveoluri
ventilaciis gazrdiT, filtvebis moculobis momatebiT, Jangbadis miwodebis
gazrdiT an Jangbadis moxmarebis SemcirebiT, am Tu sxva meTodebiT SevamciroT
sicocxlisaTvis saSiSi hipoqsiis xarisxi.
2. SevamciroT an movxsnaT mw . respiratoruli acidozi : SevamciroT
”sicocxlisaTvis saSiSi “' acidemia da swrafad daviyvanoT PaCO2 normis
farglebSi .
3. SevamciroT respiratoruli distresi : raTa SevamciroT avadmyofisaTvis
autaneli diskomforti , sanam pirveladi avadmyofoba an disfunqcia
likvidirebuli iqneba.
4. ateleqtazebis reversireba an maTi prevencia : Tavidan aviciloT an
gamovasworoT filtvebis arasruli gaSlis Sedegad ganviTarebuli klinikuri
gverdiTi movlenebi .
5. sasunTqi kunTebis gadaRlis Tavidan acileba : umetesoba SemTxvevebisa es
niSnavs sasunTqi kunTebis gadatvirTvis Semcirebas maSin , roca datvirTva Zalian
didia an roca sasurvelia am datvrTvis minimumade dayvana.
6. mogveces saSualeba sedacia an / da neirokunTovani blokada gamoviyenoT:
roca saWiroa zogadi anesTezia, Rrma sedacia ( manipulaciebis dros ), aseve im
daavadebebis dros roca saWiroa Rrma sedacia, relaqsacia, spontanuri sunTqvis
daTrgunva.
7. mTeli organizmis an miokardiumis mier Jangbadis moxmarebis Semcireba :
SevamciroT Jangbadis moxmareba maSin roca spontanuri sunTqva an sxva kunTovani
aqtivoba amcirebs sistemur Jangbadis miwodebas an gadatvirTavs isedac

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gadatvirTul guls, mag. : kardiogenuri Soki an mZime mozrdilTa respiratoruli
distres sindromi ( ARDS ) .
8. SevamciroT intrakranialuri wneva : gansakuTrebul situaciebSi ( mw .
daxuruli Tavis travma ), SevamciroT momatebuli qalas Sida wneva
kontrolirebadi hiperventilaciiT.
9. davareguliroT gulmkerdis kedlis moZraoba : iSviaT SemTxvevebSi
(gulmkerdis rezeqcia , masiuri umoZrao gulmkerdi ) roca gulmkerds dakarguli
aqvs Tavisi ventilaciuri funqcia - raTa uzrunvelvyoT adeqvaturi ventilacia da
filtvebis gaSla.
axali teqnologiebi da meqanikuri ventilaciis konceftualuri ganviTareba
gvaZlevs saSualebas : erTis mxriv , f . x . v . - is dros pacientis sasunTq sistemas
minimaluri ziani mivayenoT ( sasunTq gzebSi wnevis kontroli, komplainsis da
rezistentobis gazomva, sxvadasxva tipis respiratoruli mrudebis interpretacia,
baro da volu travmis kontroli / prevencia, haeris ganotiveba / SeTboba ), meores
mxriv , moxerxdes pacientis TandaTanobiTi , komfortuli gadayvana damoukidebel
sunTqvaze .
SeiZleba gamoiyos zogierTi klinikuri situacia , romlebic moiTxoven f . x .
v.-s:
1. uSualod sasunTqi sistemis dazianeba - ventilaciuri sunTqviTi ukmarisoba
(mZime pnevmonia, gulmkerdis travma neknebis dazianebiT, mozrdilTa
respiratoruli distresis sindromi) aseT SemTxvevaSi f . x . v . - is dawyebis
Cveneba aris : qoSini , sasunTqi moculobis Semcireba , PaO2 - is Semcireba . sunTqvis
wuTmoculoba ( orientiria PaCO2 ) SeiZleba iyos Semcirebuli ( hipoventilacia ) -
dekompensaciis stadiaSi, an momatebuli ( hiperventilacia ) subkompensaciis
stadiaSi . f .x. v. umjobesia daviwyoT subkompensaciis stadiaSi.
2. sunTqvis nervuli regulaciis moSla , centraluri ( qala tvinis travma ,
tvinis Reros SeSupeba , opoidebiT mowamvla) da periferiuli. aseT situaciebSi
saWiroa sunTqvis centris regulatoruli funqciis sruli Canacvleba ventilaciis
iZulebiTi reJimebis gamoyenebiT da arteriuli sisxlis gazebis adeqvaturi
monitoringiT. klinikur Cveneba f . x . v . - is dawyebisa aris sunTqvis sixSiris
Semcireba ( apnoemde ) , hipoventilacia.
3. f.x.v. qalasSida hipertenziis dros : am dros sasunTqi sistemis funqcia
SeiZleba arc ki iyos darRveuli, magram pacients dasWirdes f.x.v. raTa vmarToT
hiperventilaciis xarisxi qalasSida wnevis dasaregulireblad.
4. f.x.v. kritikul mdgomareobaSi myofi avadmyofebisaTvis :Ltravmuli ,
toqsiuri , kardiogenuri da sxva nebismieri tipis Soki, multiorganuli
ukmarisoba, mZime sefsisi . aseT SemTxvevebSi uSualod respiratoruli sistema
SeiZleba arc iyos dazianebuli , sunTqvis regulacia normaSia , magram avadmyofs
sWirdeba f.x.v. Jangbadis miwodebis gazrdisa da sunTqvaze energodanaxarjebis
Semcirebis mizniT .
amdenad , f.x.v. - is aucilebloba yovelTvis ar aris dakavSirebuli uSualod
sunTqviTi funqciis moSlasTan. ventilaciis dawyebisa da Sewyvetis kriteriumebi
jerjerobiT isev rCeba Ziebisa kamaTis sagnad.
Tanamedrove sasunTqi apartura , aRWurvili mikroprocesoruli marTviT,
saSualebas iZleva gamoviyenoT sxvadasxva reJimebi da ventilaciis tipebi,
sxvadasxva klinikur situaciebSi sxvadsxva amocanebis gadasawyvetad . udavoa, rom

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eqimi detalurad unda erkvevodes , Tu rogor muSaobs aparati ama Tu im reJimSi -
es aris warmatebuli mkurnalobis safuZveli da pacientis usafrTxoobis garantia.

terminologia

Tanamedrove sasunTqi aparatebis umetesoba dasavleT evropuli an

amerikuli warmoebisaa, am Temaze arsebuli literaturuli wyaroebic inglisur
enazea gamocemuli, amis gamo Cndeba aucilebloba inglisurenovani terminologiis
adaptaciisa qarTulenovan momxmarebelTan. inglisuri mcnebebis qarTulad
gadmoTargmnisas xSirad azri maxinjdeba da arsis gageba Wirs , gansakuTrebiT
Znelia gasagebad da CvenTvis miuCvevelic qarTuli Targmanis abreviaturebi
(umetesoba Cveni kolegebisa profesiuli saubrebis dros mainc inglisur
abreviaturas iyenebs) . amdenad winamdebare saxelmZRvaneloSi mocemuli iqneba
mxolod inglisuri abreviaturebi, maTi axsna mocemuli iqneba inglisurad da
qarTulad. inglisuri terminebi iTvleba ZiriTadad xolo qarTuli CaiTvleba
damatebiTad - raTa gavaioloT arsis gageba. amitom inglisuri terminebis xSiri
gamoyenebis mizani iqneba Tavidan aviciloT terminologiuri areuloba da
gavuioloT sasunTq aparatebTan muSaoba Cvens kolegebs .
qarTuli Targamanebis sizustis Taobaze diskusia ar aris mizanSewonili,
radganac avtors ar aqvs miznad dasaxuli axali qarTuli samedicino
terminologiis Seqmna.
literaturaSi ar arsebobs terminologiuri erTianoba mcnebasTan -"f.x.v.-is
reJimebi" - dakavSirebiT . saqme is aris , rom zogierTi mcneba (volume control ,
pressure control , pressure support) exeba sunTqvis ciklis formirebis xerxs , xolo sxva –
CMV , (s)CMV , SIMV - gamoxataven ventilaciis riTmis Camoyalibebis principebs .
iseTi mcnebebi rogoricaa "ventilacia wneviT" an "ventilacia moculobiT" , ki aris
ventilaciis saxeobis (mode) gamomxatveli. Aamdenad , gTavazobT , yvela saxeoba
sunTqviTi ciklebisa , iZulebiTi Tu damxmare , aRvniSnoT terminiT "ventilaciis
saxeoba ", xolo terminiT "ventilaciis reJimi"-ventilaciis riTmis Camoyalibebis
principebi .
amrigad , konkretuli avadmyofis " respiratoruli daxmarebis reJimis "
sruli aRwera daaxloebiT ase unda gamoiyurebides :
'reJimi SIMV , trigeri '' wneviTi'', mgrZnobeloba - 1 cmH2O , ventilaciis
saxeoba Volume control + Pressure Support (P. S .+ 20 cm H2O) , PEEP/CPAP +7 cm H2O,
FiO2-0,4. monitoringis monacemebi – wuTventilacia 11,5 - 12 l/wT , sunTqvis sixSire
18 wT-Si, Pressure Support ciklis sasunTqi moculoba 400-460 ml. ''
mcneba ventilaciis saxeoba, Seesabameba agreTve Tanamedrove'
''inteleqtualuri '' venitilaciis tipebs – Pressure limited ventilation , BiPAP , VAPS.

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 Tavi 2

Tanamedrove respiratoruli daxmarebis ZiriTadi principebi

eqimis logika
Tanamedrove respiratoruli Terapiis ZiriTad mizania aRmofxvras kargad
cnobili problema , romelsac reanimatologiur Jargonze ewodeba pacienti
ebrZvis aparats ! '' . am problemis pirdapiri Sedegi aris sedaciuri preparatebis
masiuri gamoyeneba anu pacientis sakuTari maregulirebeli sistemis daTrgunva .
aucilebelia gaviazroT , rom pacientis winaaRmdegoba ventilatoris muSaobisadmi
( sistemis -''pacienti - respiratori ' – desinqronizacia ) miuTiTebs
respiratoris parametrebis Seusabamobas pacientis moTxovnilebasTan .

maSasadame , aucilebelia ventilatoris adaptireba pacientis

moTxovnilebebTan da ara piriqiT . amdenad , eqimis amocanaa kargad gaerkves
pacientis moTxovnilebebSi da maT Seusabamos respiratoris muSaoba . Tu
mivsdevT am logikas , SeiZleba iTqvas , rom dayofa - ''iZulebiTi da damxmare
reJimebi '' pirobiTia , f.x.v.-is yvela reJimi eqimis mier unda aRiqmebodes rogorc
damxmare reJimi , mxolod respiratoruli daxmarebis sxvadasxva xarisxiT .
sizustisTvis SeiZleba iTqvas , rom erTaderTi , savsebiT iZulebiTi ,
pacientTan araadaptirebuli reJimia – CMV gamorTuli trigeriT . es aris is
erTaderTi reJimi rac gaaCniaT CvenTvis cnobil aparatebs ''ro'', ''Sechrist''.
es reJimi , misaRebia mxolod sruliad pasiuri pacientisTvis , magaliTad
anesTeziis dros .
meore principuli momenti aris is rom, Tanamedrove f.x.v. aRar aris
gargani sunTqvis funqciis meqanikuri Canacvleba , aramed mas Terapiul
prevenciuli funqciac akisria.

pacientis sunTqvis parametrebi, maTi mniSvneloba f.x.v . is

optimaluri reJimebis SerCevisas, respiratoruli sistemis
mdgomareobis diagnostika

@
warsulSi iseTi mcnebebi , rogoricaa sunTqvis sixSire , wuTmoculoba ,
sasunTqi tevadoba , ganixileboda rogorc parametrebi romlebic unda SegvekveTa
aparatisTvis da Tavs mogvexvia pacientisTvis , dRevandel dRes , roca sasunTq
aparatebs gacilebiT meti da mzardi SesaZleblobebi aqvT , damxmare da
spontanuri reJimebiT ventilaciis dros sunTqvis parametrebi iZenen
sadiagnostiko mniSvnelobebs .
sunTqvis wuTmoculoba ( Minute Volume) – haeris narevi , romelic CaisunTqeba
da amoisunTqeba erTi wuTis ganmavlobaSi .

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 s.w.m. warmoadgens sunTqvis yvelaze mniSvnelovan parametrs . rogorc
cnobilia , organizmi aregulirebs s.w.m. -s naxSirorJangis produqciis mixedviT ,
maSasadame , es parametri , gazomili spontanuri sunTqvis dros , iribad
migviTiTebs organizmis metabolizmis intensivobas . s.w.m.- is normaluri
maCveneblebia 5-10 l/wT , magram unda gvaxsovdes rom , paTologiuri
mdgomareobebis dros ( Soki , cxeleba ) Jangbadis moxmareba da naxSirorJangis
produqcia gazrdilia , Sesabamisad , s.w.m. SeiZleba gaizardos 13-16 l/wT. s.w.m. -is
adeqvaturoba , rogorc spontanuri ise xelovnuri ventilaciis dros , SeiZleba
Sefasdes PaCO2-is mixedviT ( 35-45 mmHg). aqve saintereso iqneba moviSvelioT e.w.
ventilaciis efeqturobis indeqsi ( Ventilatory Efficacy Index VEI) , romelic
warmodgenas gvaZlevs , Tu ramdenad agresiuli ventilaciuri reJimebia saWiro
konkretuli pacientisTvis adeqvaturi sunTqvis wuTmoculobis misaRwevad ,
VEI = 3800 / (PIP – PEEP ) R.R. PaCO2
sadac , PIP - CasunTqvis pikuri wnevaa ( cmH2O), PEEP ( cmH2O ) – amosunTqvis
bolos dadebiTi wneva , R.R. – sunTqvis sixSire , PaCO2 - ki arteriul sisxlSi
naxSirorJangis parcialuri wneva . VEI naklebi 0,46 ventilaciur problemebze
metyvelebs . es indeqsi advili dasaTvlelia da kargi saSualebaa aparatuli
reJimebis efeqturobis dinamikaSi dakvirvebisTvis .
sunTqviTi moculoba ( Tidal Volume-T.V. ) _ haeris narevi , romelic
CaisunTqeba erTjeradi mSvidi CasunTqvis dros da amoisunTqeba filtvebis mier .
unda aRiniSnos , rom CasunTquli moculoba yovelTvis ar aris amosunTqulis
toli , SeiZleba amosunTquli naklebi iyos , es metyvelebs alveolebSi haeris
nawilis darCenaze anu “ funqciuri narCeni tevadobis “ zrdaze rac SeiZleba
pacientis sasunTqi sistemis mdgomareobis dadebiT dinamikazec miuTiTebdes ( mag. :
mozrdilTa respiratoruli distres sindromis dros ) da uaryofiTzec ( rodesac
“f.n.t. “ normaze metia , anu filtvebi gadawelilia , mag . : filtvebis obstruqciuli
daavadebis dros e. w. avto-PEEP ) . nebismieri asakobrivi jgufisTvis sunTqviTi
moculobis zRvrebia 5-15 ml/kg. sunTqviTi moculobis Semcireba spontanuri
sunTqvis dros miuTiTebs pacientis sunTqvis unarianobis aradeqvaturobze da
moiTxovs ventilatoruli daxmarebis gazrdas , xolo sunTqviTi moculobis
normaze meti maCvenebeli meqanikuri ventilaciis dros – filtvis gadawelvaze .
filtvis sunTqviTi moculobis SerCevisas aucileblad unda vadevnoT Tvalyuri
CasunTqvis pikur wnevas , raTa Tavidan aviciloT e.w. “ baro travma” azrTa
sxdadasxvaoba arsebobs am cifrebis normebTan dakavSirebiT, avtorTa umetesoba
Tvlis rom alveoluri wneva > 35 cmH2O barotravmis ganviTarebis risksa da
albaTobas zrdis . aseve , zedmetma sunTqviT moculobam SeiZleba gamoiwvios “
volu travma”. es SedarebiT axali terminia , is niSnavs filtvebis gadawelvis
Sedegad maTi epiTeliumis dazianebas da lokaluri an generalizebuli
inflamaciuri kaskadis CarTvas , rac mozrdilTa respiratoruli distres
sindromis msgavsi paTfiziologiiT da klinikuri mimdinareobiT xasiaTdeba , mas “
ventilatoriT gamowveuli filtvis dazianeba “ ewodeba – VILI - “ Ventilatory
Induced Lung Injury” da meqanikuri ventilaciis Zalzed seriozul garTulebas
warmoadgens .
sunTqvis sixSire ( frecuency – f – R.R. ) ---- wuTis ganmavlobaSi CasunTqva -
amosunTqvis raodenoba . cxadia , rom s.w.m. = s.m. X s.s. anu M.V.= T.V. X f
maSasadame, filtvebis wuT ventilacia mniSvnelovnad aris damokidebuli sunTqvis

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sixSireze . mozrdilebSi iZulebiTi ventilaciis sunTqvis sixSire rogorc wesi
varirebs 4-20 s/wT , metad stabilur pacientebSi 8-12 s/wT. mwvave an qr.
restriqciuli an obstruqciuli filtvis daavadebian pacientebSi SeiZleba 20 - ze
meti sunTqvis sixSire dagvWirdes , es damokidebulia saWiro wuTventilaciaze da
mizandasaxul PaCO2-is mniSvnelobaze . bavSvebSi sunTqvis sixSiris sazRvrebi , ra
Tqma unda , ufro farToa da sxadasxva asakobrivi jgufis SigniT varirebs .
sunTqvis sixSiris SerCevisas , PaCO2 –Tan , pH- Tan , pacientis komfortulobasTan
erTad unda gaviTvaliswinoT haeris sahaero gzebSi Sekavebis ( gansakuTrebiT
maRali sixSiriT ventilaciis dros ) da avto PEEP – is ganviTarebis saSiSroeba .
wneva sasunTq gzebSi (Airway pressure-P ) – izomeba wylis svetis santimetrebSi
anu milibarebSi , 1 cm H2O = 1 mBar . nulad miCneulia atmosferuli wneva .
janmrTeli adamianis damoukidebeli sunTqvis dros wneva meryeobs nulis
farglebSi - is uaryofiTia ( - 1 –2 cm H2O ) CasunTqvisas da dadebiTia ( + 1 - + 2
cm H2O ) amosunTqvisas. f.x.v –is dros ki Sebrunebuli situaciaa – CasunTqva
xorcieldeba sasunTq gzebSi respiratoris mier Seqmnili dadebiTi wnevis xarjze
( + 5 dan + 30 is farglebSi) , xolo amosunTqva pasiuria , is xorcieldeba
filtvisa da gulmkerdis elastiurobis xarjze , am dros wneva Camodis
atmosferulamde ( Tu ar aris dayenebuli amosunTqvis bolos dadebiTi wneva -
PEEP / CPAP ). f.x.v. is dros wneva sasunTq gzebSi Zalian mniSvnelovani
parametria , ramdenadac is yvelaze seriozuli faqtoria , romelsac SeuZlia
daazianos bronquli xe da alveolebi . f.x.v. – is sxvadasxva reJimebis ganxilvisas
detalurad analizdeba wneva sasunTq gzebSi sunTqvis ciklis sxdasxva fazaSi .
f.x.v.-is dros aucilebelia wneva sasunTq gzebSi ganxiluli iqnas ufro
detalurad , anu misi komponentebis mixedviT ( pikuri CasunTqvis wneva , platos
wneva , saSualo wneva sasunTq gzebSi , amosunTqvis bolos dadebiTi wneva ) .
CasunTqvis pikuri wneva ( Peak inspiratory pressure - PIP ) – aris maqsimaluri
wneva , romelic filtvebSi haeris miwodebisas . moculobis kontroliT
ventilaciis dros , pikuri wneva damokidebulia sasunTqi sistemis komplainsze ,
sasunTqi gzebis rezistentobaze , CasunTqvis moculobaze , pikur nakadze sahaero
gzebSi ( ix. Semdeg ) . mudmivi komplains / rezistentobis dros maRali pikuri nakadi
iZleva maRal pikur wnevas . zogadad , yvela sxva parametris erTnairobis
pirobebSi nakadis aRmavali profili sxva profilebTan SedarebiT maRal pikur
wnevas anviTarebs , radganac pikuri nakadis siCqare maqsimums aRwevs CasunTqvis
bolos . wnevis kontroliT ventilaciis dros ki pikuri wneva TiTqmis Tanabaria
SekveTili wnevisa . miuxedavad amisa , maRali sawyisi da Semdgom daRamavali
nakadis arsebobis gamo wnevis kontroliT ventilaciis dros sawyisma wnevam
SeiZleba 1-3 cm H2O – iT gadaaWarbos SekveTil wnevas .
Pplatos wneva ( Plateau pressure ) –ganisazRvreba rogorc CasunTqvis bolos
dadebiTi wneva , romelic minimum 0,5 wamis ganmavlobaSi grZeldeba sasunTq gzebSi
nulovani nakadis pirobebSi . misi gazomvisTvis aucilebelia pasiuri ventilaciis
arseboba . is daaxloebiT gviCvenebs saSualo alveolur wnevas . rodesac wnevis
kontroliT ventilacias aqvs adgili , SekveTili wneva im SemTxvevaSi uaxlovdeba
platos ( alveolis ) wnevas , rodesac Tundac 0,5 wamis ganmavlobaSi sasunTq
gzebSi nakadi ar fiqsirdeba .
saSualo wneva ( Mean airway pressure MAP ) – gasaSualoebuli wneva sistemaSi
ventilaciis Tanabar periodSi ganisazRvreba , rogorc sahaero gzebis saSualo

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wneva . radganac CasunTqvis rezistentoba yovelTvis naklebia amosunTqvis
rezistentobaze , saSualo wneva romelsac gviCvenebs aparatis monitori yovelTvis
naklebia vidre alveolis saSualo wneva (MalvP) . es ukanaskneli SeiZleba
daviTvaloT sasunTqQ gzebSi saSualo wnevis gamoyenebiT : MalvP = (VE / 60 ) ( RE – RI )
+ MAP, sadac RI da RE- aris eqspiraciuli da inspiraciuli rezistentobebi , xolo
VE – amosunTquli moculoba .
amosunTqvis bolos dadebiTi wneva (Positive end expiratory pressure PEEP ) – aris
wneva romelic viTardeba sasunTq gzebSi amosunTqvis fazis damTavrebis bolos .
iTvleba rom janmrTeli adamianis sasunTqi sistema damoukidebeli sunTqvis dros
aviTarebs daaxloebiT 3 - 5 cm H2O PEEP –s. amdenad f.x.v. –is dros ( garda iSviaTi
gamonaklisebisa ) saWiroa davayenoT PEEP – is minimum es cifrebi , filtvis
sxdasxva paTologiebis dros misi mniSvnelobebi SeiZleba varirebdes , udavoa
PEEP - is maRali mniSvnelobebis roli dabali funqciuri narCeni tevadobis mqone
filtvebis ventilaciis dros . es wneva erT-erTi mTavari « iaraRia » mozrdilTa
respiratoruli distres sindromis dros oqsigenacia / ventilaciis
gasaumjobeseblad.
sasunTq gzebSi haeris nakadi ( Airway flow / Peak flow)- sasunTq gzebSi haeris
gatarebis siCqare . izomeba litri/wT-Si . realurad izomeba haeris nakadi aparatis
konturis distalur nawilSi , rac Seesabameba nakads pacientis traqeaSi . Tu
gaviTvaliswinebT , rom haeris nakads CasunTqvisas da amosunTqvisas aqvs
sxvadasxva mimarTuleba , miRebulia , rom CasunTqvis nakadi CaiTvalos dadebiTad
, xolo amosunTqvis nakadi – uaryofiTad . sasunTq gzebSi nakadi warmoadgens
uaRresad mniSvnelovan maCvenebels sunTqvis meqanikisa . ramdenadac nakadi - es
aris haeris gatarebis siCqare traqeobronquli xis milebSi , logikuria , rom igi
damokidebulia am milebis mdgomareobaze . sinqronuli , moculobis kontroliT
ventilaciis dros pacientis datvirTvis xarisxi , sunTqvaze daxarjuli muSaoba da
misi aparatTan sinqronizacia damokidebulia pikuri nakadis siCqareze . es cifrebi
idealurad unda Tanxvdebodes pacientis moTxovnilebebs . es ki moiTxovs pikuri
nakadis siCqares 40-100 l/wT. didebisTvis da daaxloebiT 8-25 l/wT mde bavSvebSi (
bavSvebSi iseve rogorc didebSi universaluri recepti ar arsebobs da yovel
konkretul SemTxvevaSi nakadis siCqare irCeva individualurad , dasaxuli
amocanebis Sesabamisad ) . moculobis kontroliT ventilaciis dros nakadis
siCqare SeiZleba mocemul zRvrebze dabalic ki SevukveToT , imisaTvis rom SeirCes
am konkretuli SemTxvevisaTvis saWiro CasunTqvis dro ( CasunTqva amosunTvis
drois Sefardeba) . wneviTi kontroliT ventilaciis dros ki pikuri nakadis
siCqare warmoebuli sididea da ara SekveTili , is ganisazRvreba SekveTili
wneviT , sahaero gzebis rezistentobiT , pacientis ZalisxmeviT da CasunTqvis
droiT anu CasunTqva / amosunTqvis drois SefardebiT .
CasunTqvis dro ( Inspiratory Time / I:E ratio ) – CasunTqvis drois SerCeva
zogadad , eyrdnoba xelovnur ventilaciaze hemodinamkur pasuxs , oqsigenaciis
statuss da spontanuri sunTqvis ( roca aris) xarisxs. spontanuri sunTqvis
arsebobis dros haeris miwodeba koordinirebuli unda iyos pacientis
inspiraciul ZalisxmevasTan , raTa moRweuli iqnas sinqronizacia . es rogorc wesi
, moiTxovs CasunTqvis dros daaxloebiT 0,8 dan 1,2 wamamde , I : E = 1 : 2 –1 : 1,5 .
kontrolirebadi ventilaciis dros CasunTqvis dro SeiZleba gavaxangrZlivoT
raTa avwioT saSualo wneva sasunTq gzebSi da gavzardoT oqsigenaciis xarisxi .

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rodesac vzrdiT CasunTqvis dros , mkacri kontroli sWirdeba mis zegavlenas
pacientis gul-sisxlZarRvTa sistemaze . faqtorebi , romlebic zRudaven am
parametris gazrdas aris : pacientis diskomforti , sedaciis saWiroeba , avto PEEP
is ganviTareba , hemodinamikuri Seuguebloba .
Jangbadis procentoba CasunTqul haerSi ( FiO2 ) – misi SerCeva damokidebulia
mozandasaxul Jangbadis parcialur wnevaze sisxlSi da imaze Tu am cifrebis
misaRwevad ramdenad maRali PEEP da sasunTq gzebSi saSualo wneva aris saWiro ,
agreTve rogoria hemodinamikuri pasuxi aseT respiratorul reJimze . zogadad ,
Jangbadis maRali procentobis SesaZlebeli uaryofiTi gavlenis Tavidan
asacileblad , unda gamoviyenoT minimaluri , dasaSvebi Jangbadis procentoba (
iTvleba rom FiO2<0,6 anu <60% SedarebiT usafrTxoa ) . miuxedavad amisa , rodesac
vfiqrobT Jangbadis uaryofiT gavlenaze ar unda dagvaviwydes agresiuli
sunTqviTi reJimebis ( maRali wneviT ventilacia ) damazianebeli moqmedeba filtvis
qsovilze . iseT pacientebSi , romelTa oqsigenacia gaZnelebulia , Jangbadis
procentoba unda daviyvanoT SesaZlebel minimumamde , PEEP –isa da sasunTq gzebSi
saSualo wnevis optimizaciiT , Rrma sedacia / relaqsaciiT ( an mis gareSe ) ,
agreTve sisxlis JangbadiT saturaciis dasaSvebi zRvris qvemoT daweviTac ki ,
SatO2< 90 %..

Tavi 3
sunTqvis ciklis formireba

sunTqvis cikli ( s. c. ) - sunTqvis cikli es aris drois monakveTi or

Tanmimdevrul CasunTqvas Soris . sunTqvis mrudebis detaluri ganxilvisaTvis
gamovyoT sunTqis ciklis Semdegi fazebi :
CasunTqva - s. c. – is pirveli fazaa , xasiaTdeba dadebiTi nakadiT sasunTq
gzebSi , haeri Cadis filtvebSi , sasunTqi tevadoba izrdeba . CasunTqva MmTavrdeba
dadebiTi nakadis Semcirebisas nulamde .
CasunTqvis pauza ( plato ) – meore faza s.c.-isa , arsebobs mxolod
ventilaciis iZulebiTi reJimebis dros , warmoadgens CasunTqvis bolodan
amosunTqvis dawyebamde nulovani nakadis periods , haeris tevadoba filtvebSi am
dros ar icvleba.
amosunTqva – s.c. –is mesame fazaa , xasiaTdeba uaryofiTi nakadiT sasunTq
gzebSi , am dros haeri gamodis filtvebidan , sasunTqi tevadoba mcirdeba ,
amosunTqvis bolos nakadi nulis toli xdeba . sasunTqi tevadoba am dros ,
normaSi , nulis toli unda gaxdes .
mosvenebis periodi – s.c.-is meoTxe fazaa , amosunTqvis damTavrebidan Semdegi
CasunTqvis dawyebamde drois periodia da am dros sasunTq gzebSi nakadi ar aris ,
am periodis xangrZlivoba Zalian mniSvnelovania sunTqvis sixSiris an CasunTqvis
drois gazrdis rezervebis gansazRvrisaTvis .
f.x.v.-is da spontanuri sunTqvis dros mimdinare procesebis detaluri
analizisTvis gamoiyeneba e.w. grafikuli mrudebi ., romlebic gamoxataven
ZiriTadi parametrebis cvlilebebs s.c. –is ganmavlobaSi. Tanamedrove

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ventilatorebi aRWurvilia grafikuli monitorebiT , romlebic gviCveneben
sasunTq mrudebs realur droSi da Zalian iols xdian mimdinare procesebSi
garkvevas . amitomac ventilaciis meTodebisa da reJimebis ganxilvisas
warmodgenili iqneba maTi grafikuli gamosaxulebebi standartuli sunTqvis
mrudebis saxiT . umetesoba monitorebisa gviCveneben Semdeg mrudebs: sasunTq
gzebSi nakadi / dro , CasunTqvis moculoba / dro , wneva sasunTq gzebSi / dro ,
wneva sasunTq gzebSi / CasunTqvis moculoba ( es ukanaskneli gansakuTrebiT
mniSvnelovania sasunTqi sistemis komplainsis , rezistentobis , funqciuri narCeni
tevadobis Sesafaseblad , PEEP-is sworad SesarCevad , da a. S. amaze qvemoT
visaubrebT ) .

iZulebiTi ventilaciis meTodebi

rogorc ukve aRvniSneT , f.x.v. –is yvela reJimi da saxeoba SeiZleba

CaiTvalos damxmared , aq igulisxmeba is rom , yvela maTTagani met - naklebi
xarisxiT ergebian pacientis moTxovnilebebs ( gamonaklisia CMV reJimi
gamorTuli trigeriT ) . zogierTi f.x.v – is meTodi SeiZleba gamoviyenoT pasiur
pacientTan , romelsac ar aqvs damoukidebeli sunTqvis mcdelobebi ( mag .:
relaqsirebuli pacienti ) da am gagebiT maT tradiciulad ewodebaT “ iZulebiTi” (
mandatory ) . maSin roca sxva meTodebi aucileblad moiTxovs pacientisagan
damoukidebeli sunTvis mcdelobas –e. w. “ damxmare “ reJimebi ( support ) .
miuxedavad zemo aRniSnulisa , yvela isini SeiZleba gavaerTianoT mcnebaSi “
respiratoruli daxmarebis xarisxi “. amis gamo , ama Tu im meTodis ganxilvisas ,
gansakuTrebul yuradRebas mivaqcevT Tu sunTqvis romeli parametrebi
kontroldeba aparatis mier da romeli yalibdeba pacientis mier .
sunTqvis ciklis Camoyalibebis ori saxeoba miekuTvneba iZulebiT ventilacias
, esenia “ ventilacia moculobis kontroliT “ - volume control ventilation " da “
ventilacia wnevis kontroliT” – " pressure control ventilation ".
amdenad garkveulia , Tu sunTqvis ciklis romeli parametri iTvleba
gansakuTrebiT principulad da regulirdeba aparatis mier CasunTqvis fazaSi .

ventilacia moculobis kontroliT - volume control ventilation

( VCV ) -

sunTqvis ciklis Camoyalibeba - am ciklis Camoyalibebisas , CasunTqvis fazaSi

- CasunTqvis drois ganmavlobaSi ( inspiratory time ) viTardeba mudmivi CasunTqvis
nakadi ( inspiratory flow ) ris Sedegadac yalibdeba CasunTqvis moculoba ( tidal volume).
am saxeobis ventilaciis ZiriTadi mizania – pacientma miiRos garantirebuli
CasunTqvis moculoba , rac mocemul sunTqvis sixSiresTan erTad uzrunvelyofs
sasurvel sunTqvis wuTmoculobas . magram Zalian mniSvnelovania gvaxsovdes , rom

13
am dros sasunTq gzebSi wneva ara regulirebadia , e . i . mTlianad damokidebulia
pacientis sasunTqi sistemis mdgomareobaze ( rezistentoba da komplainsi ) .

wneva sasunTq gzebSi CasunTqvis fazaSi ( VCV is dros ) – cvalebadia , is

TandaTan izrdeba CasunTqvis dasawyisidan bolomde , amdenad yvelaze mTavari
parametri , barotravmis ganviTarebis TvalsazrisiT , aris sasunTq gzebSi
pikuri wneva .
pikuri wneva damokidebulia or maxasiaTebelze : sasunTq moculobasa da
filtvebis welvadobaze ( Compliance ) .
gaviTaliswinoT, rom CasunTqvis wnevis Semcirebis xarisxi limitirebulia
sasurveli wuTventilaciis moTxovnebiT. ganvixiloT pikuri wnevis cvlilebebi
erTnairi CasunTqvis moculobebis dros magram sxvadasxva welvadobis mqone
filtvebisaTvis ( mag .: pacients ganuviTarda ARDS ). .

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 yovelive zemo aRniSnulidan gamomdinare , SeiZleba CamovayaliboT VCV – s (
moculobis kontroliT ventilacia ) ZiriTadi Taviseburebebi :
. SekveTilia operatoris mier da zustad inarCunebs CasunTqvis moculobas .
sunTqvis sixSiris SerCevis Semdeg garantirebulad iZleva sasurvel
wuTventilacias .
. sasunTq gzebSi wneva cvalebadia , is damokidebulia filtvebis
welvadobaze , Sesabamisad zogierTi paTologiuri mdgomareobebis dros (ARDS an
pnevmosklerozi ) roca filtvis welvadoba daqveiTebulia , pikurma wnevam
SeiZleba aiwios usafrTxo zRvarze zeviT ( 35 cm H2O ) da ganviTardes filtvis
barotravma .

V.C.V. inspiraciuli pauziT ( plato CasunTqvaze)

rogorc adre aRvniSneT , sasunTq gzebSi wneva Volume control ventilation – s

dros TandaTanobiT imatebs , CasunTqvis dasawyisidan bolomde . logikuria
vifiqroT , rom wneva alveolebSic imatebs , amave dros gaiSlebian manamde

15
CaCutuli alveolebi , magram sasunTqi gzebis winaaRmdegobis gamo haeri
alveolaSi erTgvari dagvianebiT Cadis , maSasadame , imisaTvis rom mTeli
CasunTquli haeri mivides alveolebamde , garkveuli droa saWiro . garda amisa ,
agreTve mniSvnelovania gvaxsovdes rom zogierTi alveola mezobel alveolaze
nela ixsneba wvrili bronqiolebis nawilobrivi obstruqciisa da surfaqtantis
simciris gamo . haeris alveolebSi Tanabrad gadanawilebis mizniT , SeiZleba
gamoyenebuli iqnas inspiraciuli pauza _ periodi roca CasunTqva ukve damTavrda
– CasunTqvis dadebiTi nakadi nulis tolia , CasunTqvis sarqvelic daiketa , magram
amosunTqvis sarqveli garkveuli drois ganmavlobaSi isev daketili rCeba . am
drois ganmavlobaSi haeri Tanabrad gadanawildeba traqeobronqul xesa da
alveolebs Soris , sasunTq gzebsa da alveolebSi wneva gaTanabrdeba . bunebrivia ,
rom wneva sasunTq sistemaSi , am gadanawilebis gamo , ramdenadme mcirdeba , e.i.
inspiraciuli pauzis dros wneva naklebia pikuri CasunTqvis wnevaze ( CasunTqvis
bolos). swored inspiraciuli pauzis wneva ( anu plato wneva ) gamoxatavs yvelaze
zustad alveolur wnevas .

V.C.V. cvalebadi inspiraciuli nakadiT

aqamde Cven ganvixilavdiT moculobis kontroliT ventilacias , romelic

yalibdeba mudmivi CasunTqvis nakadiT . amave dros , Tanamedrove teqnologiebi
gvaZlevs saSualebas uzrunvelyoT SekveTili CasunTqvis moculoba araTanabari

16
nakadiT . amdenad , aris mcdeloba CasunTqvis nakadis mrudi davamsgavsoT
fiziologiurs . operatori ukveTs mxolod CasunTqvis pikur nakads , xolo
aparati avtomaturad iTvlis da qmnis saWiro nakadis formas.

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 rogorc suraTidan Cans , klebadi nakadis gamoyenebisas sasunTq gzebSi
pikuri wneva iklebs 1 cmH2O –Ti , magram plato wneva rCeba ucvleli (wneva
alveolebSi) 17 cm H2O . amave dros igive sasunTqi tevadobis misaRwevad
CasunTqvis dro 1,5 – dan 2 wamamde gaizarda., ramac gamoiwvia amosunTqvis drois
Semcireba , Sedegdad - arasruli amosunTqva – momdevno CasunTqvis dawyebis
momentSi amosunTqvis nakadi nulis toli ar gaxda . Tumca am problemis gadaWra
martivad SeiZleba : CasunTqvis nakadis gazrdiT Cven gavzrdiT CasunTqvis
siCqares, e.i. SevamcirebT CasunTqvis dros rac Tavis mxriv gazrdis amosunTqvis
dros , maSasadame , CasunTqvis nakadis pikuri siCqaris da sunTqvis sixSiris
manipulirebiT SesaZlebelia sasurveli sasunTqi parametrebis miRweva,
rasakvirvelia unda gvaxsovdes, rom CasunTqvis nakadis siCqaris gazrda gamoiwvevs
CasunTqvis pikuri wnevis garkveul donemde gazrdas , amave dros amosunTqvis
drois gazrda saSualo wnevas sahaero gzebSi amcirebs , amdenad yvela am
parametrs sWirdeba monitoringi da yovel konkretul pacientze maT zegavlenas
–mkacri Sefaseba .

ventilacia wnevis kontroliT - Pressure control ventilation

(P.C.V. )

sasunTqi ciklis formireba – wnevis kontroliT ventilaciis dros sasunTqi

ciklis formirebisas , CasunTqvis fazaSi xdeba dakveTili wnevis SenarCuneba , es
wneva narCundeba mudmiv doneze DdakveTili drois ganmavlobaSi ( CasunTqvis
dro-Inspiratory time ) . operatori irCevs aparatis panelze CasunTqvis wnevas da
CasunTqvis dros . CasunTqvis moculoba da nakadis siCqare ki am ori parametrisa
da pacientis sasunTqi sistemis komplains / rezistentobis warmoebulia . pacientis
sasunTqi sistemis mdgomareobisa da mis mier damoukidebeli CasunTqvis
intensivobis ( Tu aseTi saxezea ) gavleniT nakadi swrafad izrdeba maqsimalur
pikur ciframde da Semdeg , TandaTanobiT , CasunTqvis bolosTvis Camodis nulamde
. iseve rogorc moculobis kontroliT , wnevis kontroliT ventilacia
warmoadgens iZulebiTi ventilciis saxeobas , e.i. misi gamoyeneba SeiZleba “pasiur
pacientTanac “ , romelsac ar aqvs damoukidebeli sunTqva.

18
 amrigad , nakadis sidide , misi gazrdis an Semcirebis siCqare da Sesabamisad
sasunTqi moculoba damokidebulia pacientis respiratoruli sistemis
mdgomareobaze . upirveles yovlisa – sasunTqi gzebis gamtarianobis unarze , aseve ,
damoukidebeli sunTqviTi aqtivobis intensivobaze . sxvagvarad rom vTqvaT ,
sasunTqi moculoba , da Sesabamisad , sunTqvis wuTmoculoba , Pressure control
ventilation – is dros , operatoris mier SekveTili parametrebiT , garantirebuli
ar aris . am tipis ventilaciis yvelaze saSiSi garTulebaa sasunTqi gzebis
gamtareblobis darRveva , magaliTad , dagrovili naxvelis gamo . am dros aparati
agrZelebs SekveTili wnevis ganviTarebas , SekveTili drois ganmavlobaSi , magram
es wneva ukve ver uzrunvelyofs sasurvel CasunTqvis tevadobas ( gazrdili
rezistentobis gamo) , e. i. pacienti , romelic formalurad imyofeba iZulebiT
ventilaciaze , SeiZleba saerTod ver iRebdes sasunTq moculobas !

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 mTavari upiratesoba rac gaaCnia Pressure control ventilation - s aris sasunTq gzebsa
da alveolebSi maqsimaluri wnevis SezRudva , is risi gulisTvisac Seiqmna
ventilaciis es tipi , rogorc alternativa Volume control ventilaciisa .
gansakuTrebiT xSirad es problema warmoiSveba maSin , rodesac filtvis
komplainsi daqveiTebulia , magaliTad ARDS –is dros . Tumca e.w. “Ria filtvis “ (
Open lung conception) da filtvis zeda da qveda gaSlis wertilebis koncefciebi ( upper
and lower inflection points) aseve PEEP-is swori SerCeva da sxva ventilaciis
ultraTanamedrove koncefciebi , iZleva saSualebas aseTi kritikuli pacientebi
Volume control ventilaciazec ki usafrTxod vamyofoT ( dabali CasunTqvis
moculobebiT –3-5 ml/kg da maRali PEEP –iT ->12 cmH2O ) .
amdenad , ZiriTadi Taviseburebebi P. C. V.-isa aris:

- zustad viTardeba SekveTili wneva sasunTq gzebSi ,

- sasunTq gzebSi nakadi da sasunTqi moculoba SeiZleba icvlebodes

erTidaigive wnevis dros , es damokidebulia sasunTqi gzebis gamtarobaze ,
CasunTqvis mcdelobis intensivobasa da filtvis qsovilis welvadobaze ,

- ventilacia wnevis kontroliT aris iZulebiTic , anu is SeiZleba

gamoyenebuli iqnas pacientTan , romelsac ar aqvs damoukidebeli sunTqvebi ,

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 - am tipis ventilaciis dros pacienti metad aris daculi barotravmis
ganviTarebisgan.

parametrebis SerCeva'wnevis kontroliT ventilaciis dros ,

respiratoruli meqanikis mrudebis gamoyenebiT

wnevis kontroliT ventilaciis dros , eqimi panelze ayenebs CasunTqvis wnevas

da CasunTqvis dros . rogor SevarCioT optimaluri Tanafardoba pikur wnevasa da
CasunTqvis dros Soris ? erTi ram cxadia : yoveli sasunTqi ciklis dros pacientma
unda miiRos saWiro sasunTqi moculoba , amave dros mis misaRwevad unda
gamoviyenoT minimaluri wneva sasunTq gzebSi . zogierT SemTxvevaSi SezRudulia
agreTve CasunTqvis droc ( rodesac saWiroa maRali sunTqvis sixSire ) . wnevis da
nakadis mrudebis gamoyenebiT SeiZleba zustad SevarCioT optimaluri parametrebi.

am suraTze mocemulia wnevisa da CasunTqvis drois optimaluri SerCevis

magaliTi .

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 am suraTze warmodgenilia CasunTqvis drois gaxangrZlivebis Sedegi .
CasunTqvaze nakadi aRwevs nuls magram respiratori agrZelebs dadebiTi wnevis
SenarCunebas sasunTq gzebSi . rac warmoadgens inspiraciuli pauzis anu plato
wnevis erTgvar analogias . saRi , homogenuri , normaluri komplainsisa da
rezistentobis mqone filtvebisTvis aseTi midgoma , ra Tqma unda ar warmoadgens
aucileblobas , magram arahomogenuri filtvis mqone pacientebisTvis ( mozrdilTa
respiratoruli distres sindromi , ateleqtazebi an infiltratebi ) amas
Terapiuli efeqti eniWeba , radganac inspiraciuli pauza iZleva saSualebas
CasunTquli haeri Tanabrad gadanawildes arahomogenur ubnebs Soris , gaSalos es
ubnebi , da PEEP-is garkveuli mniSvnelobebis saSualebiT SevinarCunoT gaSlili
ubnebi , riTac ra Tqma unda gaizrdeba CasunTqvis moculoba . aseT dros aris
saSiSroeba aradeqvaturad Semcirdes amosunTqvis dro , rasac sWirdeba
kontroli .

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 suraTze naCvenebia zedmeti CasunTqvis wneva sasunTq gzebSi , arasakmarisi
CasunTqvis drosTan kombinaciaSi . CasunTqva mTavrdeba ufro adre vidre nakadi
Camova nulamde . am SemTxvevaSi pacienti iRebs igive sasunTq moculobas ( 900 ml. )
magram amave dros pikuri wneva gacilebiT maRalia ( 23 nacvlad 17-sa). aqve Cans
rom adgili aqvs mniSvnelovan drois monakveTs CasunTqvis bolosa da Semdegi
CasunTqvis dasawyiss Soris . e.i. Cven SegviZlia gavzardoT CasunTqvis dro .

spontanuri sunTqvis cikli

sanam ventilaciis damxmare meTodebs ganvixilavT , Tvali gadavavloT

spontanuri sunTqvis ciklis formirebas . ventilaciis damxmare tipi
spontanurisagan imiT gansxvavdeba , rom am dros romeliRac erTi parametri
formirdeba aparatisagan , xolo danarCeni Seesabameba damoukidebel sunTqvas .
spontanuri sunTqvis dros yvela parametri formirdeba pacientis mier e.i.
CasunTqva xorcieldeba gulmkerdis RruSi uaryofiTi wnevis gaCenisas (
daaxloebiT –2 cmH2O ) , ris gamoc viTardeba dadebiTi nakadi sasunTq konturSi
. CasunTqvis xangrZlivoba kontroldeba pacientis sunTqvis centris mier ,
amosunTqva viTardeba gulmkerdis da filtvebis elastiurobis xarjze , Tanac am
dros sasunTq gzebSi viTardeba mcire dadebiTi wneva , amosunTqvis bolos ( CPAP
reJimis dros ) sasunTq gzebSi rCeba is wneva rac operatorma airCia ( CPAP/PEEP )
.

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 rodesac spontanuri sunTqva xorcieldeba aparatis konturSi , aparati qmnis
aucilebel airTa narevs da axorcielebs sasunTqi ciklis parametrebis
monitorings , pirvel rigSi CasunTqvis moculobas , sunTqvis sixSires da sunTqvis
wuTmoculobas . im SemTxvevaSi Tu romelime parametri usafrTxoebis zRvars
gascdeba , respirators SeuZlia gvamcnos amis Sesaxeb , amave dros avtomaturad
CarTavs iZulebiTi ventilaciis apnoe reJims .
spontanuri sunTqva konturSi ( CPAP = 0 ) iSviaTad gamoiyeneba , magram mas ,
sunTqvis meqanikis grafikuli monitoringis pirobebSi , didi diagnostikuri
mniSvneloba eniWeba rodesac saWiroa pacientis sasunTqi gzebis da filtvis
mdgomareobis Sefaseba .

damxare ventilaciis meTodebi

damxmare ventilacia SeiZleba gamoyenebuli iqnas rogorc asistirebadi

ventilaciis dros ( mag .: SIMV (PB , Siemens ) IMV ( Drager), rodesac aparati
axorcielebs garkveuli raodenobis iZulebiT CasunTqvebs , magram amave dros
pacientsac aqvs damoukidebeli CasunTqvis mcdelobebi ) aseve - CPAP reJimis
drosac , roca yvela CasunTqva inicirebulia pacintis mier . Puritan Bennett –is
tipis aparatebs ori saxis damxmare ventilacia SeuZliaT , es aris : daxmareba
wneviT – Pressure support ventilation da daxmareba nakadiT – Flow By 2. damxmare
ventilacias axasiaTebs ori Tavisebureba : 1) respiratori axorcielebs mxolod
erTi parametris formirebas , romelic exmareba pacients CasunTqvisas , 2)
respiratori iwyebs daxmarebas mxolod im SemTxvevaSi rodesac pacienti
gamoavlens damoukidebeli CasunTqvis mcdelobas , rasac mohyveba aparatis mier
daxmarebis CarTva . pacientis inspiraciul mcdelobas “ grZnobs “ e.w. trigeri

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(Trigger) , es aris aparatis unari daafiqsiros pacientis CasunTqvis mcdeloba da
misces signali damxmare reJimebis CarTvas , es sakiTxi mogvianebiT iqneba
ganxiluli . daxmare reJimebidan yvelaze metad gavrcelebulia Pressure support
ventilation ( sxvadasxva tipis trigerebiT ) –wneviT damxmare ventilacia .

Pressure support ventilation –wneviT damxmare ventilacia

es meTodi mimarTulia damoukidebeli CasunTqvis dros pacientis

fizikuri datvirTvis Semcirebisken . Drager –is aparatebSi misi sinonimia Assist
spontaneus breathing (ASB)- spontanuri sunTqva daxmarebiT . es termini kargad
gamoxatavs rom es meTodi arsiT – damoukidebeli sunTqvaa . pacienti TviTon
aregulirebs sunTqvis parametrebs , aparati mxolod exmareba mas CasunTqvis aqtis
SesrulebaSi _ amcirebs sasunTqi kunTebis datvirTvas . pacientis mier CasunTqvis
mcdelobisas , romelsac aregistrirebs trigeri , mis sasunTq gzebSi viTardeba
daxmarebis wneva , SekveTili eqimis mier . Pressure control ventilation - isagan
gansxvavebiT CasunTqvis dro ganisazRvreba pacientis mier . rodesac CasunTqvis
nakadi Semcirdeba garkveul zRvramde e.i. CasunTqvis bolos , respiratori wyvets
wneviT daxmarebas. (nakadis es zRvruli siCqare , romelzec aparati wyvets
daxmarebas , warmoadgens konkretuli aparatis teqnikur daxasiaTebas , rogorc
wesi es aris 5l/wT ) .

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 wneviT daxmarebis spontanuri sunTqvis cikls aqvs igive maxasiaTeblebi rac
Cveulebriv spontanur sunTqvis cikls – sasunTqi tevadoba , CasunTqvis dro .
respiratori mxolod umsubuqebs pacients CasunTqvis aqts , rogorc CvenTvis
cnobilia spontanuri CasunTqvis dros gulmkerdis RruSi viTardeba uaryofiTi
wneva , pressure support ventilation iZleva saSualebas uaryofiTi wneva ar ganviTardes
gulmkerdSi , ramac SesaZloa ganapirobos ufro meti CasunTqvis moculobis
ganviTareba , spontanur sunTqvasTan SedarebiT . realuri CasunTqvis moculoba
damokidebulia pacientis unarze gaakeTos adeqvaturi CasunTqva , filtvis
komplainsze da sasunTqi gzebis rezistentobaze . rogorc ukve aRvniSneT es meTodi
moiTxovs pacientisagan damoukidebeli sunTqvis arsebobas , mas unda hqondes
unari adeqvaturad areguliros sunTqvis wuTmoculoba , meores mxriv es meTodi
idealuria cnobierebis mqone pacientisTvis , romelsac SeuZlia adeqvaturad
areguliros sunTqva magram darRveuli aqvs sunTqvis meqanika (neknebis
mravlobiTi motexilobebi , fizikuri gamofitva , filtvis qsovilis sxvadasxva
tipis dazianeba) . Pressure support ventilation – aZlevs pacients TiTqmis srul
Tavisuflebas areguliros CasunTqvis moculoba , CasunTqvis dro da sunTqvis
sixSire.
PSV - is Taviseburebebi , misi msgavseba da gansxvaveba PCV – Tan

PSV (ASB) – warmoadgens damxmare meTods , sunTqvis cikli formirdeba

mxolod pacientis inspiraciuli mcdelobis SemTxvevaSi . amiT gansxvavdeba igi PCV
–isagan.
PSV –dros CasunTqvis xangrZlivoba , PCV –isgan gansxvavebiT , regulirdeba
pacientis mier , Sesabamisad respiratoruli daxmarebis xarisxi am dros naklebia .
PSV da PCV –is dros wneva sasunTq sistemaSi limitirebulia operatoris
mier , es iZleva saSualebas barotravmis riskis gareSe gamoviyenoT mocemuli
reJimebi im pacientebSi , romelTac Semcirebuli aqvT filtvis komplainsi .( ra
Tqma unda wneva unda SeirCes usafrTxo sazRvrebSi - <30 cm H2O ) .

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 PSV da PCV – is dros SesaZlebelia adgili hqondes sasunTqi moculobisa da
wuTventilaciis Semcirebas , rodesac pacients sasunTqi gzebis obstruqcia aqvs ,
amitom aucilebelia adeqvaturi kontroli da monitoringi.

meore tipis daxmareba cnobilia e.w. “Flow By 2” is saxeliT , es reJimi “ Puritan

Bennett 7200 “ Taobis ventilatorebs aqvT da igi SemdegSi mdgomareobs : daxmareba
xdeba haeris dadebiTi nakadiT , mgrZnobelobac anu trigeric orientirebulia
pacientis mier sasunTq gzebSi garkveuli siCqaris haeris nakadis ganviTarebaze .
e.i. rodesac pacienti akeTebs CasunTqvis mcdelobas , mis sasunTq gzebSi
warmoiqmneba garkveuli siCqaris haeris nakadi (Flow ) , operatori TviTon irCevs
nakadis im grkveul sidides , romelzec unda CairTos trigeri da ganxorcieldes
aparatis mier pacientis asistireba . yvelaze dabali nakadis trigeri rogorc
wesi aris 3 l/wT –Si ( garda pediatriul /neonatologiuri adaptirebuli
ventilatorebisa sadac trigeri iwyeba 0,3 –0,5 l/wT –dan da gamoiyeneba mxolod
dabali elastiurobis anu metad xisti konturebi ) , iTvleba , rom ufro dabal
sidideze aparatma SeiZleba sasunTqi konturis vibracia an sxva gareSe moZraoba
aRiqvas rogorc pacientis mier ganviTarebuli CasunTqvis mcdeloba da
ganaxorcielos asistirebuli CasunTqva . praqtikaSi aris SemTxvevebi , rodesac
pacientTan gamoiyeneba orive tipis daxmareba erTdroulad , Tumca aqve unda
aRiniSnos rom zogierTi pacientisTvis FnakadiT daxmareba garkveul sunTqviT
diskomforts qmnis . imdenad , rom SeiZleba nawilobriv daTrgunos spontanuri

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sunTqvis mcdelobebi , gansakuTrebiT mcire asakis pediatriul pacientebSi . ufro
axali Taobis ventilatorebs es ori tipi daxmarebisa Serwymuli aqvT , mag .:
daxmareba xdeba wneviT magram trigeri mgrZnobiarea nakadisadmi . (760 da 840
seriis Puritan Bennett) , amas aqvs ori upiratesoba : 1) wneviT daxmareba ufro
efeqturi da komfortulia 2) nakadiT trigeri (Flow trigger) ufro damzogveli da
fiziologiuria.

PEEP / CPAP ( Positive End – Expiratory Pressure / Continius Positive Airway Pressure )–
dadebiTi wneva amosunTqvis bolos / mudmivi dadebiTi wneva

araintubirebuli , janmrTeli adamianis mbgeravi iogebi qmnian dadebiT

wnevas amosunTqvis bolos , romelic daaxloebiT 3 - 5 cmH20 –s tolia . es aris
erT-erTi damcveli meqanizmi (surfaqtantis da filtvebis elastiurobis Semdeg ) ,
romelic icavs maT amosunTqvisas kolafsisagan da ateleqtazebis
ganviTarebisagan . daintubirebuli pacientis mbgeravi iogebi analogiur funqcias
ver Seasruleben , zogierTi paTologiuri mdgomareobebis dros ki ( magaliTad
mozrdilTa respiratoruli distress sindromi , masiuri ateleqtazi an sxva tipis
konsolidacia ) adgili aqvs alveolebis CaCutvas , amosunTqvis dros maTSi
wnevis dacemis gamo , Semdegi CasunTqvis fazaSi CaCutuli alveolebis nawili isev
iSleba (adgili aqvs e.w. CaCutva –gadawelvis fenomens ) , rac iwvevs am
alveolebSi inflamaciis mediatorebis gamonTavisuflebas da lokaluri
inflamaciuri kaskadis CarTvas , es ukanaskneli , Tu saqme masiur ubnebTan gvaqvs ,
generalizebuli sistemuri inflamaciuri pasuxis sindromiT- SIRS - SeiZleba
garTuldes. an e.w. V .I .L .I . ganviTardes (razec zemoT gvqonda saubari ) .
yovelive amisgan Tavis dasacavad , Tanamedrove respiratorebs gaaCniaT
saSualeba SevinarCunoT garkveuli sididis dadebiTi wneva amosunTqvis bolos .
profilaqtikis mizniT , rogorc wesi , viyenebT (garda zogierTi
kardioqirurgiuli pacientebisa ) 3,5 dan 5 cmH2Omde PEEP-s , xolo ukve
dazianebuli arahomogenuri filtvebis samkurnalod – maRal PEEP –s 10 –15 cmH2O
.an ufro maRalic. amdenad , amosunTqvis bolos wneva sasunTq gzebSi ar Camodis
dakveTil doneze qvemoT , sunTqvis iZulebiTi reJimebis dros am opcias ewodeba
PEEP xolo , spontanuri reJimis dros – CPAP . am bolo SemTxvevaSi termini xazs
usvams imas , rom dadebiTi wneva SenarCunebulia rogorc amosunTqvaze ise
CasunTqvaze. CPAP reJimi SeiZleba gamoviyenoT damoukideblad da aseve
Pressure support ventilation - Tan erTad .
Tanamdrove sasunTq aparatebSi es parametrebi gaerTianebulia erT (
regulirdeba erTi saxeluriT ) maCveneblad – PEEP / CPAP. iZulebiTi
ventilaciis dros regulirdeba PEEP –dadebiTi wneva amosunTqvis bolos , xolo
spontanuri sunTqvis dros ki - CPAP -mudmivi dadebiTi wneva . Tuki iZulebiTi
ventilaciis dros PEEP- is dasayeneblad sakmarisia vareguliroT amosunTqvis
sarqvelis winaaRmdegoba , CPAP – iT spontanuri sunTqvis dros , aucilebelia
mivawodoT pacients damatebiTi nakadi raTa SenarCunebuli iqnas SekveTili wneva
. e.i. CPAP reJimi SeiZleba ganxiluli iqnas , rogorc erTgvari Pressure support
ventilation , sadac daxmarebis wneva tolia sabazo (CPAP) wnevisa . maSasadame ,
CPAP-iT spontanuri sunTqva warmoadgens damxmare sunTqvis erT-erT tips ,
ramdenadac , cdilobs ra SeinarCunos SekveTili wneva sasunTq gzebSi , aparati

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 awvdis pacients damatebiT haeris nakads da amiT umsubuqebs mas CasunTqvas .
amdenad , opcia CPAP –s SeiZleba davarqvaT ventilaciis damxmare meTodi.
zogierT ventilatorSi ( Drager babylog 8000SC ) regulirdeba CasunTqvis da
amosunTqvis sarqvelis mgrZnobeloba , zogierTSi (romelTac aqvT Pressure support
ventilation, mag.: PB 760) damatebiT regulirdeba amosunTqvis sarqvelis
mgrZnobeloba , es ukanasknelni kidev ufro efeqturs da komfortuls xdian CPAP
– iT daxmarebis dones .

rogorc ukve aRvniSneT , PEEP / CPAP xels uSlis alveolebis CaCutvas da

ateleqtazebis gaCenas an , sworad SerCeuli sidide , exmareba arsebuli
ateleqtazebis mkurnalobas . mozrdilTa respiratoruli distres sindromis
adreul etapze PEEP 10 cmH2O –s toli an meti zrdis e.w. funqciur rezidualur
tevadobas ( FRC ) , rac aumjobesebs ventilacia perfuziis Tanafardobas , rac Tavis
mxriv aumjobesebs oqsigenaciasa da ventilacias .
meores mxriv , PEEP / CPAP –is gamoyenebas Tan axlavs met-naklebad
gamoxatuli gverdiTi movlenebi . PEEP aucileblad gamoiwvevs sasunTq gzebSi
pikuri da Sesabamisad saSualo wnevebis momatebas , rac zrdis barotravmis
ganviTarebis risks da uaryofiT gavlenas axdens hemodinamikaze . saSualo wnevis
gazrda sasunTq gzebSi niSnavs gulmkerdis RruSi wnevis gazrdas rac Tavis mxriv
amcirebs venur dabrunebas gulisaken da Sesabamisad , hipovolemiuri
mdgomareobis dros , sagrZnoblad amcirebs gulis wuTmoculobas . amis garda ,
zrdis ra filtvis kapilarebis rezistentobas , PEEP zrdis marjvena parkuWis
SemdegdatvirTvas (afterload) , ramac arsebuli marjvena gulis ukmarisobis
SemTxvevaSi SeiZleba seriozuli hemodinamikuri problemebi Seqmnas . Tumca
aRsaniSnavia , rom marcxena parkuWis ukmarisobis dros dadebiTma wnevam

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gulmkerdis RruSi SeiZleba dadebiTi gavlena iqonios hemodinamikaze : e.w.
transmuruli wnevis , marcxena parkuWis SemdegdatvirTvis Semcirebis gamo . ama Tu
im tipis gulis ukmarisobis dros , dadebiTi wneviT ventilaciiT miyenebuli ziani
Tu sargebloba warmoadgens orive parkuWis wina da SemdegdatvirTvebis
delikaturi balansis Sedegs , es Tema gacilebiT ufro farTo da detalur
ganxilvas moiTxovs da winamdebare wignis formatSi ar aris gaTvaliswinebuli .
sabolood SeiZleba davaskvnaT , rom PEEP/CPAP–s gamoyenebisas , gansakuTrebiT
maRali cifrebis dros , didi sifrTxile da hemodinamikis ZiriTadi parametrebis
mkacri kontrolia saWiro , miTumetes kritikul mdgomareobaSi myof da /an gulis
ukmarisobis mqone pacientebTan .

daskvna

Cven ganvixileT meqanikuri ventilaciis ZiriTadi tipebi:

I-iZulebiTi meTodebi –V.C.V. da P.C.V . isini SeiZleba inicirebuli iqnes
aparatis an / da pacientis mier.
II-damxmare meTodebi –P.S. (ASB) , CPAP. es meTodebi ar inicirdeba aparatis
mier , isini irTvebian mxolod pacientis mier CasunTqvis mcdelobaze pasuxad.
III- spontanuri sunTqva – aparati ar monawileobs sunTqvis ciklis
formirebaSi.

Tavi 4
ventilaciis riTmis Camoyalibeba

ventilaciis riTmi – sasunTqi ciklebis Tanamonacvleobaa erTi wuTis

ganmavlobaSi . ventilaciis riTmis Camoyalibebisas aparatis mikroprocesoris
winaSe ori amocanaa : rodis daiwyos CasunTqva da rodis daamTavros igi , raTa
daiwyos AamosunTqva .
CasunTqvis dawyeba SeiZleba inicirebuli iqnas aparatis mier , wina
CasunTqvidan garkveuli drois gasvlis Semdeg . drois es monakveTi SerCeulia
eqimis mier , sunTqvis sixSiris SekveTis saxiT . pacientis sunTqviTi mcdelobebi am
SemTxvevaSi saWiro ar aris , aparati TviTon iwyebs iZulebiT CasunTqvebs .
garda amisa , aparats SeuZlia daiwyos CasunTqva pacientis sunTqviT
mcdelobaze pasuxad , anu roca CairTveba trigeri . trigeris tipebze da muSaobis
principebze adrec gvqonda saubari da kidev davubrundebiT mogvianebiT . trigeris
CarTvis Sedegad CasunTqva SeiZleba iyos mTlianad iZulebiTi an damxmare.

Semdegi sakiTxi romelic aparatma unda gadawyvitos aris , rodis

daamTavros CasunTqva da daiwyos amosunTqva . CasunTqvidan amosunTqvaze
gadasvlis 4 varianti arsebobs :

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 - Volume cycled – cikluroba moculobis mixedviT . CasunTqvidan amosunTqvaze
gadarTva xdeba maSin roca miiRweva sasurveli CasunTqvis moculoba . es principi
Tanamedrove aparatebSi aRar gamoiyeneba.
- Pressure cycled - gadarTva wnevis mixedviT . CasunTqvidan amosunTqvaze
gadarTva xdeba sasurveli wnevis miRwevis Semdeg . SeiZleba gamoyenebul iqnas
Pressure support ventilation –is dros .
- gadarTva nakadis mixedviT – CasunTqvidan amosunTqvaze gadarTva xdeba
maSin , roca CasunTqvis nakadi Semcirdeba garkveul sididemde . yvelaze
gavrcelebuli principia Pressure support ventilation –is dros .
- Time cycled – CasunTqvidan amosunTqvaze gadarTva xdeba garkveuli drois
gasvlis Semdeg - rasac CasunTqvis dro ewodeba . es aris yvelaze gavrcelebuli
meTodi iZulebiTi ventilaciis sxvadasxva tipebis gamoyenebisas ( CMV , SIMV ) . es
meTodi gansakuTrebiT usafrTxoa pacientisaTvis , radganac miuxedavad imisa
rogor realizdeba SekveTili parametrebi , aparati aZlevs pacients amosunTqvis
dros . garda amisa , mxolod es meTodi iZleva saSualebas ganviTardes
inspiraciuli pauza CasunTqvis bolos , roca nakadi nulis tolia , xolo wneva da
moculoba rCeba mudmivi garkveuli drois ganmavlobaSi .
Tanamderove aparatebSi yvelaze xSirad gamoiyeneba Time cycled meTodi
iZulebiTi ventilaciis dros da nakadis mixedviT gadarTva - damxmare reJimebis
dros.

trigeri

ventilaciis riTmis Camoyalibebisas mniSvnelovani roli eniWeba , aparatis

mier pacientis damoukidebeli CasunTqvis mcdelobis registrirebas , Sesabamisad
am mcdelobasTan sinqronizacias . swored am mizans emsaxureba trigeri .
dReisTvis gamoiyeneba ori tipis trigeri :
- wneviTi trigeri (pressure trigger) - afiqsirebs sasunTq gzebSi uaryofiTi
wnevis gaCenas , rac pacientis mcdelobis Sedegia . roca es wneva miaRwevs eqimis
mier SekveTil trigeris mniSvnelobas (-1 - 6 cmH2O), aparati pasuxobs CasunTqvis
inicirebiT (iZulebiTi an damxmare ) . mniSvnelovani uaryofiTi mxare am trigerisa
aris is , rom pacients sWirdeba sakmaod didi datvirTvis Sesruleba imisaTvis rom
ganaviTaros Tundac – 1 an –2 cm H2O. amave dros es Tviseba SeiZleba gamoyenebuli
iqnas pacientis sunTqviTi varjiSis mizniT (aparatidan gaxangrZlivebuli moxsnis
dros ) . aucilebelia mivaqcioT yuradReba imas , rom trigeris mgrZnobeloba
igulisxmeba sabazo wnevasTan mimarTebaSi . magalTad : Tu SekveTilia mudmivi
dadebiTi wneva (CPAP) + 5 , xolo trigeri – 2 , maSin CasunTqvis mcdeloba
registrirebuli iqneba , rodesac sasunTq gzebSi ganviTardeba wneva +3.
- nakaduri trigeri (Flow By) - warmoadgens yvelaze srulyofil trigers .
konturSi mudmivad miedineba haeris garkveuli nakadi . CasunTqvis dawyebisas
pacienti iRebs am nakads , e.i. trigeri dauyovnebliv amuSavdeba . aparati afiqsirebs
haeris "gaJonvas" , anu aregistrirebs pacientis mcdelobas . rasac mohyveba
aparatis mier CasunTqvis dawyeba.

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 didi mniSvneloba aqvs trigeris swor SerCevas , magaliTad : araadeqvaturad
dabali trigeris SemTxvevaSi (Zalian mgrZnobiare trigeri) , nebismieri , ara
pacientis mier gamowveuli vibracia , konturis Serxeva an pacientis
araadeqvaturad susti mcdeloba CasunTqvisa , aparatis mier aRiqmeba rogorc
damoukidebeli CasunTqvis mcdeloba , rasac mohyveba aparatuli CasunTqvis
inicireba . meores mxriv , aradaeqvaturad MmaRali trigeri moiTxovs
pacientisagan ganxakuTrebiT Zlier datvirTvas . nebismier am SemTxvevebSi
pacientis unari damoukidebeli CasunTqvis Sesrulebisa Sefasdeba araadeqvaturad ,
rac gamoiwvevs mTel rig Secdomebs pacientis respiratoruli daxmarebis
taqtikaSi .
xelovnuri sunTqvis aparatis erTerTi umniSvnelovanesi maxasiaTebeli ,
romelic mis xarisxs gansazRvravs , aris dro romlis ganmavlobaSic aparati
aRiqvams da upasuxebs trigeris CarTvas .

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 ventilaciis riTmis Camoyalibebis reJimebi

unda aRiniSnos , rom dReisTvis ar arsebobs erTiani nomenklatura ,

romelic gamoxatavda riTmis Camoyalibebis reJimebs . xSirad sxvadasxva firmebi
sxvadsxva saxelwodebiT aRniSnaven erTnair an TiTqmis erTnair reJimebs . Cvens
mier aRwerili reJimebi Seesabameba "Puritan Bennett" da "Servo Venilator-Siemens"
ventilatorebs.
reJimi CMV ( Continous Mandatory ventilation) – mudmivi iZulebiTi ventilacia

es riTmi warmoadgens iZulebiTi ventilaciis ciklebis Tanmimdevrobas .

SeiZleba gamoyenebuli iqnas Volume control an Pressure control meTodebis dros .
CasunTqvebi inicirdeba aparatis mier im sixSiriT rac SekveTilia parametriT –
"sunTqvis sixSire" .
reJimi (S) CMV (Synchronized Continous Mandatory Ventilation)-sinqronizebuli
mudmivi iZulebiTi ventilacia

(S)CMV isa da CMV –s Soris gansxavaveba SemdegSi mdgomareobs -

pirveli reJimis SemTxvevaSi iZulebiTi sunTqvis ciklis inicireba SeiZleba moxdes
rogorc respiratoris mier , ise pacientis mier . e.i. iZulebiTi CasunTqvis
dawyeba sinqronizdeba pacientis mcdelobasTan . Tu CasunTqvis mcdelobebi ar aris
maSin respiratori axorcielebs sunTqvis ciklebs SekveTili sixSiriT , Tumca ,
Tuki iZulebiT CasunTqvebs Soris dafiqsirdeba pacientis mcdeloba CaisunTqos ,
aparati ganaxorcielebs CasunTqvas . e.i. realuri sunTqvis sixSire da
wuTventilacia SeiZleba aWarbebdes SekveTils . swored amitom es reJimi
warmoadgens saSiSroebas e.w. "avtociklirebisa" , Zalian mgrZnobiare trigeris
dayenebis SemTxvevaSi aparati gazrdis iZulebiTi sunTqvis sixSires pacientis
SemTxveviTi moZraobis , kunTebis kankalis an konturis rxevebze pasuxad .

f.x.v. –is Taviseburebebi CMV sa da (S)CMV –s dros-

- ventilaciis riTmi Sesdgeba mxolod iZulebiTi sunTqvis ciklebisagan .

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 - SeiZleba gamoyenebuli iqnas iZulebiTi ventilaciis rogorc moculobis ise
wnevis kontrolis reJimebi .
- (S)CMV –s dros sunTqvis realuri sixSire SeiZleba aWarbebdes SekveTils ,
pacientis mier inicirebuli CasunTqvebis an zedmetad mgrZnobiare trigeris gamo .
ramac SeiZleba gamiwvios hiperventilacia da arasrulfasovani amosunTqvis gamo
barotravmac ki .
- trigeris gamorTvis an misi mgrZnobelobis Semcirebis SemTxvevaSi (nakleb
mgrZnobiare ) aparati veRar aRiqvams pacientis mcdelobebs da Sesabamisad aRar
ganaxorcielebs CasunTqvas mis mcdelobasTan sinqronulad e.i. (S) CMV reJimi
daemsgavseba CMV –s .
SeniSvna: reJimi (S)CMV Seesabameba A/C (Assist /Control) reJims –Bear –is tipis
aparatebze , IPPV (Intermittent Positive Pressure Ventilation)–s Drager-is aparatebze .
trigeris gamorTvis SemTxvevaSi A/C da IPPV reJimebi xdeba CMV – s analogiuri.

reJimi Spont. - spontanuri ventilacia

spontanuri ventilaciis reJimSi pacients eZleva saSualeba: a) isunTqos

absoluturad damoukideblad Tuki CPAP , Pressure support an Flow By meTodebi
gamorTulia , an b) asistirebulad zemoT CamoTvlili meTodebis gamoyenebisas . am
dros sunTqvis sixSire , sasunTqi moculoba da wuTventilacia kontrolirdeba
pacientis mier , aparati akontrolebs mxolod airTa narevis procentul
Semadgenlobas , monitorings ukeTebs ZiriTad parametrebs , maTi mniSvnelovani
cvlilebis SemTxvevaSi rTavs "gangaSs" , zogierTi aparati apnoes SemTxvevaSi
avtomaturad iwyebs iZulebiT ventilacias SekveTil reJimebSi . unda aRiniSnos ,
rom spontanuri ventilacia asistirebis romelime meTodis gareSe seriozuli
datvirTvaa pacientisaTvis , radganac endotraqealuri mili , sasunTqi konturi ,
aparatis filtrebi da sasunTqi sarqvelebi mniSvnelovnad zrdis sasunTqi gzebis
rezistentobas , rac did Zalisxmevas moiTxovs pacientisagan. Sesabamisad aman
SeiZleba uaryofiTi gavlena iqonios mis hemodinamikaze , swrafad gamofitos
resursebi .

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 spontanuri sunTqvis reJimis Taviseburebebi :
- ventilaciis riTmi Sesdgeba mxolod spontanuri an damxmare ciklebisagan .
- sasunTq moculobas , CasunTqvis dros , sunTqvis sixSires , wuTventilacias
ayalibebs pacienti .
- respirators SeuZlia daexmaros pacients CasunTqvaze , Tuki CarTuli iqneba
CPAP , Prssure support an Flow By meTodebi .

reJimi SIMV (Synchronized Intermittent Mandatory Ventilation ) –sinqronuli

monacvleobiTi iZulebiTi ventilacia
am reJimSi xorcieldeba iZulebiTi sunTqvis ciklebi Volume control an Pressure
control meTodiT , romelTa Soris SualedSi pacients eZleva saSualeba awarmoos
spontanuri an damxmare sunTqva . parametriT "sunTqvis sixSire" operatori ukveTs
aparats iZulebiTi CasunTqvebis aucilebel raodenobas wuTSi . Tu pacients ar aqvs
damoukidebeli CasunTqvis mcdelobebi an trigeris mgrZnobeloba arasakmarisia
CasunTqvis mcdelobis dasafiqsireblad , sunTqvis cikli warmodgenili iqneba
mxolod iZulebiTi CasunTqvebiT . pacientis CasunTqvis mcdelobis
registrirebisas , (S)CMV-isagan gansxvavebiT , aparati ar awarmoebs iZulebiT
CasunTqvas , aramed axorcielebs spontanur an asistirebul sunTqvis cikls .
amrigad , SIMV cikli Sesdgeba iZulebiTi da spontanuri sunTqvis fazebisagan .

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 SIMV reJimSi sunTqvis riTmis Camoyalibebis Taviseburebebi :
- SIMV Sesdgeba iZulebiTi da spontanuri ventilaciis monacvleobiTi
fazebisagan .
- spontanuri sunTqvis ar arsebobis SemTxvevaSi sunTqva xorcieldeba
SekveTili sasunTqi moculobiT , sunTqvis sixSiriT da wuTventilaciiT aparatis
mier , amdenad garantirebulia minimaluri sunTqvis wuTmoculoba . aseT
SemTxvevaSi SIMV analogiuria CMV –isa .
- sunTqvis wuTmoculoba SeiZleba gaizardos pacientis spontanuri an
asistirebuli sunTqvebis xarjze , romlebic iZulebiT sunTqvebs Soris intervalSi
xorcieldeba .
- rodesac SekveTili sunTqvis sixSire nulis tolia , SIMV analogiuria
spontanuri sunTqvis reJimisa .

(S)CMV –isa da SIMV –is Sedareba

- pacientis damoukidebeli inspiraciuli mcdelobebis gareSe CMV ,

(S)CMV , (A/C , IPPV) da SIMV absoluturad identuria . da SeiZleba gamoviyenoT
pasiur pacientTan .
- damoukidebeli sunTqvebis arsebobis pirobebSi (S)CMV reJimi zrdis
iZulebiTi sunTqvebis sixSires , rac SedarebiT maRali sunTqvis sixSiris dros
gamoiwvevs amosunTqvis drois Semcirebas da arasrulfasovani amosunTqvis
Camoyalibebas , maSin rodesac SIMV aZlevs pacients saSualebas , damoukidebeli
sunTqvis fazaSi , TviTon areguliros sasunTqi moculoba da CasunTqva /
amosunTqvis xangrZlivoba . amdenad SIMV gacilebiT ufro usafrTxoa vidre
(S)CMV .
- Tu gaviTvaliswinebT , rom SIMV reJimi sunTqvis sixSiriT toli nulisa ,
analogiuria reJimisa "spontanuri sunTqva" , SeiZleba davaskvnaT , rom SIMV

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warmoadgens yvelaze universalur reJims ventilaciis riTmis Camoyalibebisa ,
romelic SeiZleba gamoviyenoT , rogorc sruliad pasiur aseve spontanur an
damxmare sunTqvis reJimebze myof pacientTan . SIMV is dros , iZulebiTi sunTqvis
sixSiris nel-nela Semcireba da pacientisaTvis ufro meti "Tavisuflebis" miniWeba
warmoadgens avadmyofis aparatidan moxsnis yvelaze misaReb meTods .

Tavi 5

ventilaciis damatebiTi meTodebi da reJimebi

Tanamedrove sasunTq aparatebs , garda ZiriTadi respiratoruli

koncefciebisa , romlebic met-naklebad msgavsia , gaaCniaT e.w. damatebiTi meTodebi
da reJimebi . aqve unda aRiniSnos , rom es meTodebi sxvadasxva aparatebs
sxvadasxvanairi aqvT . qvemoT ganvixilavT zogierT am meTods.
Sigh – Rrma CasunTqva - aris damatebiTi parametri , romelic gamoiyeneba
iZulebiTi ventilaciis reJimebSi . misi arsi mdgomareobs SemdegSi : periodulad
izrdeba CasunTqvis moculoba 1,5 - 2 jer , es Rrma CasunTqva Sedgeba ramodenime
Tanmimdevruli ciklisagan , romelTa sixSire SerCeulia operatoris mier . mizani
aris filtvebis perioduli gadaberva , raTa Tavidan aviciloT ateleqtazebis
ganviTareba an gavSaloT ateleqtazirebuli ubnebi . TavisTavad cxadia , rom am
reJimis gamoyenebas Tan axlavs seriozuli riski barotravmis ganviTarebisa .
Sesabamisad , misi gamoyeneba unda moxdes didi sifrTxiliT da mxolod
dauzianebeli filtvis qsovilis mqone pacientebSi .
IRV ( Inversive ratio ventilation) – ventilacia CasunTqva / amosunTqvis Sebrunebuli
TanafardobiT - I / E Sefardeba Cveulebrivad meryeobs 1 : 3 dan 1 : 1, 3 mde . Tumca
cnobilia , rom rac ufro xangrZlivia CasunTqva , miT ufro Tanabrad nawildeba
haeri filtvebSi da miT ufro meti daxuruli alveola iSleba , rac Tavis mxriv
amcirebs intrapulmonur Suntebs da aumjobesebs oqsigenacias . gansakuTrebiT
mZime pacientebs , romelTac aqvT ARDS da ventilaciis Tanamedrove koncefciebis
gamoyenebam ar mogvca sasurveli Sedegi , rekomendebulia Sebrunebuli I : E –s
gamoyeneba – 3 : 1 , 4 : 1 . am meTodis gamoyenebas Tan axlavs sakmaod seriozuli
problemebi , sasurvelia sunTqvis meqanikis grafikuli monitoringi , aseve
aucilebelia pacientis adeqvaturi sedacia .
BiPAP-BiFASIC positive airway pressure –mudmivi dadebiTi wnevis or doniani
ventilacia - es reJimi (an misi sinonimi PSV + ) – gamoyenebulia Tanamedrove tipis
ventilatorebSi "Drager Evita " da "Nellcor Puritan Bennett 840" . es tipi SeiZleba
ganvixiloT rogorc gaumjobesebuli Pressure control ventilacia . aparati
SekveTili sixSiriT (f) zrdis sasunTq gzebSi wnevas sasurvel cifrebamde da
inarCunebs mas garkveuli drois ganamavlobaSi . klasikuri PCV – isagan
gansxvavebiT , BiPAP reJimSi pacients SeuZlia damoukideblad isunTqos wnevis
zeda fazaSi . maRali wnevis fazebs Sua pacients aseve SeuZlia Seasrulos

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damoukidebeli an asistirebuli sunTqvebi . Tu vimsjelebT relaqsirebul
pacientze , BiPAP (PCV + ) reJimi SeiZleba CaiTvalos iZulebiTi ventilaciis
reJimad , radganac , sunTqvis sixSiris fiziologiur , normalur sidideebze
dayenebisas es reJimi "klasikuri " PCV –is msgavsad muSaobs . ZiriTadi
daniSnuleba am reJimisa aris maRali sunTqviTi aqtivobis mqone pacientis
ventilireba , maSin roca mas maRali CPAP sWirdeba da mudmivi maRali dadebiTi
wnevis SenarCuneba ki dakavSirebulia hemodinamkur garTulebebTan an sxva
problemebTan . aseT SemTxvevaSi BiPAP reJimi SeiZleba ganvixiloT , rogorc
gaumjobesebuli APRV ( airway pressure release ventilation) . am ukanasknelisagan
gansxvavebiT , BiPAP gvaZlevs saSualebas gamoviyenoT Pressure support ventilation
maRali wnevis fazebs Soris.

raRa Tqma unda , BiPAP reJimi aris gacilebiT ufro komfortuli da

usafrTxo pacientebisaTvis vidre iZulebiTi ventilaciis sxva meTodebi .
Pressure limited ventilation (PLV) – ( moculobiT ventilacia SezRuduli wneviT) –
PLV meTodi SemuSavebulia Drager-is mier , is gamoyenebulia Evita –s seriis
aparatebSi . es erT-erTi yvelaze rTuli meTodia rogorc gasagebad aseve
praqtikuli gamoyenebis TvalsazrisiT . is SeiZleba ganvixiloT , rogorc Volume
control ventilation wnevis SezRudviT , an rogorc Pressure control ventilation nakadis
SezRudviT . operatori irCevs CasunTqvis moculobas , pikur nakads da
maqsimalur wnevas . sunTqvis ciklis dawyebisas ( IPPV (CMV) an SIMV reJimSi )
respiratori awvdis pacients SekveTil pikur nakads , rogorc VCV is dros ,
mudmivi siCqariT , magram Tu wnevam sasunTq gzebSi miaRwia dasaSveb normas ,

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aparati amcirebs nakadis siCqares ise rom aRar moxdes wnevis Semdegi mateba , da
nakadis miwodeba grZeldeba sanam ar miiRweva sasurveli (SekveTili) CasunTqvis
moculoba . Tu pacientis sasunTqi sistema , dabali komplainsisa da maRali
rezistentobis gamo , ar iZleva sasurveli CasunTqvis moculobis (VT) ganviTarebas
sasurveli wnevis farglebSi , maSin aparati wyvets CasunTqvas da gangaSis
signaliT atyobinebs operators amis Sesaxeb.

advili warmosadgenia , rom Tu davayenebT wnevis SedarebiT maRal zRvars ,

es reJimi daemsgavseba VCV –s , xolo maRali pikuri nakadis da wnevis dabali
zRvaris SemTxvevaSi – PCV - s . gardamavali sididis maCveneblebis arCevis
SemTxvevaSi , PLV iZleva saSualebas wnevis pikebis Tavidan acilebisa ( sasunTqi
gzebis maRali rezistentobis dros ) da misi grafikebi emsgavseba VCV –s
daRmavali nakadiT (deceleration flow) . damatebiT aRasaniSnavia , rom PLV ver
Seamcirebs zedmet wnevas , romelic gamowveulia filtvis dabali komplainsiT .
es reJimi aris erTaderTi iZulebiTi ventilaciis reJimi Drager Evita –s seriis
aparatebisTvis , misi gamoyeneba dakavSirebulia garkveul sirTuleebTan ,
operatorisagan moiTxoveba maqsimalurad erkveodes am reJimis koncefciaSi da
kargad hqondes warmodgenili ( grafikebis saSualebiT ) CasunTqvis drois
regulireba aparatis mier . am reJimis mniSvnelovani Tavisebureba aris is , rom
is Slis zRvars wnevis kontroliT da moculobis kontroliT ventilaciebs Soris .

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 dasasruls , aRvwerT sam reJims , romlebic Seiqmna pacientis
usafrTxoebisTvis . isini ar warmoadgenen damoukidebel reJimebs , radganac
Seicaven ukve aRwerili reJimebis elementebs .

Apnea Ventilation – apnoe ventilacia – Zalian sasargeblo opciaa , romelic

bevr Tanamedrove aparats gaaCnia . is gaaqtivebulia damxmare an spontanuri
reJimebis dros . operatori irCevs drois monakveTs (20-60 wami) romlis
ganmavlobaSi aparati elodeba asistirebul an spontanur CasunTqvas , Tu am drois
periodSi ar daregistrirda pacientis CasunTqva , aparati afiqsirebs apnoes da
avtomaturad irTveba iZulebiTi ventilacia , romlis parametrebic operatoris
mier winaswar aris SerCeuli . amavdroulad irTveba gangaSis xmovani signali . es
opcia udavod zrdis pacientis usafrTxoebas misi "aparatidan moxsnis" procesSi .

Minimum minute volume (MMV) –SekveTili minimaluri wuTmoculobiT

ventilacia - pacientis usafrTxoebis gazrdis kidev erTi mcdelobaa . aparati
aregistrirebs pacientis wuTventilacias , misi asistirebad an spontanur sunTqvaze
yofnis dros , rodesac sunTqvis wuTmoculoba Camova winaswar SerCeul
maCveneblebze qveviT , aparati avtomaturad rTavs iZulebiT ventilaciis reJims ,
romelic dayenebulia operatoris mier , sasurveli wuTmoculobis miRwevis Semdeg
aparati wyvets daxmarebas da aZlevs pacients SesaZleblobas damoukideblad
isunTqos . iZulebiTi sunTqvis Sewyvetis kriteriumad iTvleba miRweuli ,
sasurveli wuTventilaciis fonze pacientis damoukidebeli sunTqvebis arseboba .
aRniSvnis Rirsia is , rom Tu pacientis mdgomareoba sworad aris Sefasebuli da is
mxolod amis Semdegaa gadayvanili iZulebiTi sunTqvidan damxmare / spontanurze ,
naklebad mosalodnelia rom misi wuTventilacia Semcirdes dasaSeveb normebze
qvemoT . amdenad , es opcia , albaT , gansakuTrebul mdgomareobebis dros iqneba
saWiro .

VAPS volume assured pressure support – wneviT daxmarebis , garantirebuli

wuTmoculobiT ventilacia – es reJimi firma Bird –s mieraa SemuSavebuli Bird 8400
sti –aparatebisTvis . am reJimis Tavisebureba SemdegSi mdgomareobs : CvenTvis
cnobilia , rom PSV –is dros CasunTqvis moculoba SeiZleba Semcirdes kritikul
cifrebamde , es reJimi ki gulisxmobs , aseT SemTxvevaSi damatebiTi nakadis
miwodebas . operatori irCevs sasunTq moculobas , CasunTqvis nakads , sunTqvis
sixSires . trigeris CarTvis pasuxad aparati iwyebs daxmarebas wneviT (PSV ) ,
nakadis SekveTil donemde Semcirebis Semdeg aparati zomavs CasunTqul moculobas,
Tu is sasurvel (SekveTil ) moculobaze naklebia – respiratori agrZelebs haeris
nakadis miwodebas sanam ar CaasunTqebs saWiro moculobas .

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 es meTodi SeiZleba gamoyenebuli iqnas rogorc aqtiuri sunTqvebis mqone
aseve pasiur pacientebTan. aqve unda aRiniSnos , rom CasunTqvis nakadis sididis
SerCeva moiTxovs Zalian did yuradRebas da grafikul monitorings . aseve
sayuradReboa , rom VAPS –is dros sasunTq gzebSi pikuri wneva SezRuduli ar
aris, ase rom CasunTqvis " iZulebiTi komponentis " periodSi wnevam SeiZleba
gadaaWarbos SekveTil normas .

Tavi 6
mrudi - wneva/moculoba ( zogierTi situaciis interpretacia)

respiratoruli meqanikis gamomxatveli sxvdasxva grafikebidan ( moculoba

/dro , wneva / dro , nakadi / dro , moculoba / nakadi) erT – erTi mniSvnelovania
CasunTqvis wnevis CasunTqvis moculobasTan damokidebulebis mrudi .
am grafikze marjvena mrudi CasunTqvas Seesabameba , marcxena – amosunTqvas ,
patara “ niskarti” amosunTqvis dasawyisSi – saintubacio milze wnevis gradients .
wnevis ( horizontalur ) RerZze mrudis dasayrdeni wertili PEEP-s gviCvenebs ,
idealuri komplainsis da rezistentobis SemTxvevaSi mrudis wverebze gavlebuli
xazi daxloebiT 45 graduss unda hqmnides RerZebTan , rac ufro maxvilia am xazis
horizontalur RerZTan kuTxe ( anu rac ufro “dawolilia” mrudi ) miT ufro

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dabalia filtvis komplainsi da maRalia sasunTqi gzebis rezistentoba . mrudSi
sami zonaa : qveda zona Seesabameba amosunTqvis dros filtvis “ CafuSvas “.

Tu sunTqva am zonaSi xorcieldeba ( dabali sasunTqi moculoba , dabali

CasunTqvis wneva) es aucileblad gamoiwvevs filtvebis CafuSvas , funqciuri
narCeni tevadobis ( f.n.t. ) Semcirebas da ateleqtazebis ganviTarebas ; Semdegi
zonaa _ normaluri ( fiziologiuri ) sasunTqi tevadobis zona , mas aseve ‘’
usafrTxo zonas “ uwodeben , am zonaSi xorcieldeba e.w. Tidal Volume _iT sunTqva ;
amis Semdeg zonas filtvebis gadawelvis zona ewodeba , Tu Cvens mier SerCeuli
parametrebi pacients am zonaSi asunTqebs ( maRali sasunTqi moculoba , maRali
CasunTqvis wneva ) es gamoiwvevs filtvebis gadawelvas ( overdistention ).

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 aq naTlad Cans , rom wnevis Semdgomi mateba aRar iwvevs moculobis zrdas ,
e.i. filtvebi maqsimalurad aris gaSlili da Semdgomi wnevis mateba saxifaToa
baro / volu travmis an V.I.L.I. –is ganviTarebis TvalsazrisiT .
normaluri sasunTqi gzebis da filtvis parenqimis mqone pacienti , CasunTqvis
fazaSi wnevis matebas pasuxobs moculobis zrdiT , xolo dabali komplainsis
mqone filtvis ( mag.: ARDS –is dros) P / V mrudi sul sxvagvarad gamoiyureba .

26- e suraTze Cans rom wnevis matebas Tavidan ar mohyveba CasunTqvis

moculobis zrda , mxolod garkveul wnevaze gamoCndeba moculoba , maSasadame “
filtvis CafuSvis zona “ gazrdilia da gadaweulia marjvniv . swored aseT
situaciaSia aucilebeli PEEP –is maRali cifrebis ( >10cm H2O ) gamoyeneba , raTa
gavzardoT Ff.n.t. , SevamciroT CafuSvis zona , movaxdinoT sasunTqi moculobis
optimizacia , PEEP –is swori SerCevis magaliTia sur. 27 . PEEP aRemateba sur. 26-ze
naCveneb filtvis gaSlis wertils ( recruitment point ) . es ki iZleva saSualebas
filtvi aRar CaifuSos amosunTqvis bolos , e.i. Tavidan aviciloT e.w. CafuSva /
gaSlis fenomeniT gamowveuli alveolebis dazianeba ( recruitment / decruitment) . am

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magaliTiT kargad Cans P/V mrudis roli da mniSvneloba PEEP –is sworad
SerCevaSi.
sworad SerCeuli PEEP zrdis funqciur narCen tevadobas , gvaZlevs
saSualebas pacienti vasunTqoT fiziologiuri Tidal Volume – is zonaSi ( an masTan
maqsimalurad miaxlovebul zonaSi) , gavaumjobesoT misi oqsigenacia da
ventilacia.

daskvna

Cven detalurad ganvixileT xelovnuri ventilaciis Tanamedrove reJimebis da

meTodebis praqtikulad yvela saxeoba. respiratoruli Terapiis mTavari
principia : ventilatori yovelTvis unda iyos adaptirebuli pacientis
moTxovnilebasTan da ara piriqiT . xelovnuri ventilaciis dros aucilebelia
Ppacientis mdgomareobis srulfasovani monitoringi : gulis SekumSvaTa sixSire ,
arteriuli wneva , pulsoqsimetria , Sereuli venuri saturacia, arteriuli sisxlis
gazebi es is ZiriTadi parametrebia romelTa gareSe warmoudgenelia adeqvaturi
da warmatebuli respiratoruli daxmarebis warmoeba.

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 Ggamoyenebuli literatura:
1. Journal of Intensive Care Medicine-Reports,Guidelines and Recommendations, 1998.
2. Manual of Clinical Problems in Pulmonary Medicine . R.A.Bordow , K.M.Moser,1991.
3. Respiratory Physiology in Anesthetic Practice, T.J.Gal, 1991.
4.

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