Вы находитесь на странице: 1из 98

. .

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. .
:
, -,
, ,
.
: 2007
ISBN: 5-225-03892-1

1.
1.1.
1.2.
1.3.
1.4.
1.5.
1.6.
2.
3.
3.1. Assist Control
3.2. IMV SIMV
4.
4.1.
4.2. , - Volume Control
4.3. ,
4.3.1. Pressure Limited Ventilation (PLV)
4.3.2. Pressure Control
4.4.
4.4.1. Pressure Support
4.4.2. Continuous Positive Airway Pressure (CPAP)
5.
5.1. Biphasic Positive Airway Pressure (BIPAP) Airway Pressure Release Ventilation
(APRV)
5.2. Bilevel Positive Airway Pressure (BiPAP)
5.3.
5.3.1. Pressure Regulated Volume Control (PRVC)
5.3.2. Volume Assured Pressure Support (VAPS)
5.4.
5.4.1. Mandatory Minute Ventilation (MMV)
5.4.2. Volume Support
5.4.3. Adaptive Support Ventilation (ASV)
5.5. Trachea Gas Insufflations (TGI)
5.6.
5.7. - Automated Tube Compensation (ATS)
5.8. Proportional Assist Ventilation (PAV)
5.9. Neurally Adjusted Ventilation Assisted (NAVA)
6.
6.1.
6.2.
6.3.
6.4.
7.
7.1. PLV
7.2. Volume Control
7.3. BiPAP
7.4.
8.
8.1. Volume Control
8.2. Pressure Control, Pressure Support

8.3.
9.
9.1. Volume Control
9.2. Pressure Control
9.3. Pressure Support, , BiPAP APRV,

9.4.
9.5.
10.
10.1.
10.1.1.
10.1.2.
10.1.3.
10.1.4. -
10.2. ()
10.3. Pressure Support
10.4. BIPAP
10.5.
11.
11.1.
11.1.1. -
11.1.2. - -
11.1.3. -
11.2.
11.2.1. -
11.2.2.
11.2.3.
11.3.
11.4.
11.5.
11.6. ,



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(Paw). , (Ppeak).
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(positive end expiratory pressure, PEEP),
. , , PEEP.
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(Pes),
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() .
() PEEP. , PEEP
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(R)
PEEP .
R = (peak - PEEP)/V'
V' - .
()
. Pplat PEEP,
(Cstat).
Cstat = V/(Pplat - PEEP).
, plat,
( 0,5 ).
.
, Paw,
Pplat. (Cdyn).
Cdyn = V/(Paw - PEEP).
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= 1/.

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- (Paw):
aw = (Ret V') + (Raw V') + (CL/V) + (Ccw/V).
Paw
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(. 2.2).

. 2.2.
[Maclntyre N. Branson R., 2001]. (
): Paw - ; Ptr - ; Palv
- ; Pes - ; Ret ; Raw - ;
CL - ; Ccw- .
: 1 - ; 2 - ( ); 3 ; 4 - , (5).
CL Ccw , :
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Ers = EL + Ecw
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CL Ccw. - , ,
:

1/Crs = 1/CL + 1/Ccw


1/Ccw = 1/Crs - 1/CL


Ccw= 1/(1/rs - 1/CL)
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30 . . ,
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8 - 9 /.
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- 6 / [Amato . . et al., 1998;
Acute Respiratory Distress Syndrome Network, 2000].
-
[Lachmann ., 1992]. ,
PEEP 5 - 8 . .
[Brower R. et al., 2004].

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(O2) 80 - 100 . . [Hickling . et al., 1990; J. G. Laffey
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3.
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(Assist Control), - (Intermittent Mandatory
Ventilation - IMV). IMV
(Synchronized Intermittent Mandatory Ventilation - SIMV).
, .
Assist Control SIMV ,
- , .
Volume Assist Control Assist Control, a Volume SIMV - SIMV.
Assist Control SIMV ,
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. , Pressure
Limited Ventilation, " "
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, (Volume Control),
(Volume Support) (Volume Assist).
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3.1. Assist Control
Assist Control
(. 3.1).
, 10 1 . , 60 ,
10 6 (60: 10 = 6). 6
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. 3.1. Assist Control ( Volume Control).


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6 ), ,
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( 10 ). , Assist
Control (mandatory).
Assist Control, ,
,
, - Control
Mandatory Ventilation (CMV) - .
3.2. IMV SIMV
IMV .
, 10
1 . Assist Control, 10 6
(60: 10 = 6).
.
, (. 3.2).
6 .

. 3.2. IMV ( Volume Control).


IMV,
SIMV (. 3.3).
.
10 1 . 6 .
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. 3.3. SIMV ( Volume Control).


IMV SIMV,
, ( 10 ).

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IMV SIMV
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4.

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4.2. , - Volume Control
Volume Control Assist
Control SIMV (. . 3.1 3.2). , SIMV
Pressure Support .
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Pressure Control.
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. 4.5. Volume Control,


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Volume Control: 8-9 /
( 600 -700 ), 12- 14 1 , PEEP - 5-8 . ., - 3-4
. ., 1,5-2 /, -, - 0,1 - 0,3 ,
- 35-40 /. - 1:2.
70 -90 /, 1:3 1:4, .
: max 30 . . ,
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PEEP 15-20%.
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(Control Mandatory Ventilation, CMV),
(Intermittent Positive Pressure
Ventilation, IPPV). CMV Assist CMV-SIMV (IPPV
Assist IPPV-SIMV ).
4.3. ,
, , : Pressure
Limited Ventilation Pressure Control.
4.3.1. Pressure Limited Ventilation (PLV)
, (Pressure Limited
Ventilation - PLV), .

. -
, . .
, .
, PLV
. 4.8.

. 4.8. Pressure Limited Ventilation.


PLV Assist Control SIMV.
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. PLV
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. PLV
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PLV .
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. PLV
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PLV
.
PLV: 20 -25 . .,
12- 14 1 , PEEP - 5-8 . . (
- 0,5 - 0,8 ).
PLV Volume Control
(. 9.1). ,
.

4.3.2. Pressure Control


Pressure Control Pressure Limited Ventilation.
,
.
, - (. .
4.3, ; 4.9, ). Volume Control.
,
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Assist Control SIMV.

. 4.9. Pressure Control. :


; - :
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. Pressure Control
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. Pressure
Control ,
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-
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- pressure Support.
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Pressure Control
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Pressure Control -

.
.
Pressure Control: (Pinsp) - 15- 18
. ., - 0,7 - 0,8 , 12- 14 1 , PEEP - 5-8 . .,
- 3-4 . ., 1,5-2 / .
0,5 - 0,6 .

Pressure Control. -
,
(. 4.9, ). , ,
(. 4.9, ).
, , ,
(. 4.9, ). ,
, .
, Pinsp.
, Pinsp
-. , PEEP.
: - 12 /, - 6 /,
- 25 1 , - 4-5 / ( 400 -450 ),
- 10 . ., PEEP
- 3 . ., m - 30 . .
. , ,
(Pressure Control Ventilation, PCV).
PCV Assist PCV - SIMV.
4.4.
SIMV ( )
Pressure Support . ,
,
.
4.4.1. Pressure Support
Pressure Support ( ) ,
. Pressure Control PLV
, . . .
,
SIMV.
SIMV Volume Control, Pressure Control, ,
, BIPAP PRVC. Pressure Support
:
, PEEP . Pressure Support
-
(. . 4.3, ).
Pressure Support
.
. ,
. .
,
. ,
SIMV. ,
, ,


( ).
SIMV, ,
.
. .
() .
. Pressure Support
( ) (
, ).
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. Pressure Support
.
.
. -
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, 25% .
(. . 4.10, ),

.
,
Pressure Support ,
3 . ,
"" .

. 4.10. Pressure Support. -


; - - ( 25%
); - , 25%
. Pressure Support.
Pressure Support
. , -
, , 25% (. 4.10, ).
.

- .
. Pressure Support,
(, ) .
Pinsp
.
(Ptr),
Pressure Support . Ptr
.

Pressure Support
(Paw). ,
Paw. - tr Paw
. Ptr , Paw,
- (. 4.11).

. 4.11. ,
Pressure Support, .
, - .
, "" Paw Ptr ,
,
.
, - .

. .
. Pressure Support
Pressure Control.
. ,
.
Pressure Support: (Pinsp) - 1518 . ., PEEP - 5- 8 . ., - 3-4 . ., 1,5-2 /.
Pinsp, Pressure
Support 8- 12 1 . ,

. , .
: - 12 /, - 6 /,
- 25 1 , - 5-6 / ( 450 -500 ),
- 10 . ., PEEP 3 . ., m - 30 . . - 20 ,
- 15 1 .
, 650 -700 .
: (Pressure Support
Ventilation, PSV), (Assisted Spontaneous Breathing, ASB).
4.4.2. Continuous Positive Airway Pressure (CPAP)
Continuous Positive Airway Pressure (CPAP) -
. - SIMV.
Pressure Support . PEEP (. 4.12).
,
, - ,
.

. 4.12. .
.
:

;

.
.
.
- ,
, .
: (PEEP) 58 . .
: - 12 /, - 6 /,
- 25 1 , PEEP - 3 . .
- 20 , - 15 1 .
,
650 -700 .

5.
.

.
, .
5.1. Biphasic Positive Airway Pressure (BIPAP) Airway Pressure Release Ventilation (APRV)

.
(Biphasic Positive Airway Pressure - BIPAP)
SIMV (. 5.1).

. 5.1. BIPAP.

( ). :
.
. .
:
, - .
. .
PEEP ( ).

, . , ,
Pressure Control SIMV.
BIPAP.

, ,
Pressure Control. , Pressure Control,
BIPAP Assist Control, SIMV.

BIPAP 1:2- 1:1. ,
: 1:2- 1:1. ,

.
,
.
,
,
(Airway Pressure Release Ventilation,
APRV). ,
"" (. 5.2). APRV
.

. 5.2. APRV.

- . Pressure Control
BIPAP.
APRV.
.
,
APRV .
, , ,
-PEEP ,
.
. , .
. () .
. BIPAP APRV
( ) (
, ).
. BIPAP APRV
,
. ,

, ,
.
.
.
- SIMV,
.
:
.
, , Pressure
Support. , Assist Control.

BIPAP.
BIPAP -
.
BIPAP-SIMV: (Pinsp) - 15- 18
. ., - 0,7 - 0,8 , 12- 14 1 , PEEP - 5-8 . .,
- 3-4 . ., 1,5-2 /.
0,5 - 0,6 .
: - 12 /, - 6 /,
- 30 1 , PEEP - 3 . ., m - 30 . .
: (BiVent),
(BiLevel), (DuoPAP),
(Spontaneous Positive Airway Pressure, SPAP).
BiPAP .
5.2. Bilevel Positive Airway Pressure (BiPAP)

- Bilevel Positive Airway Pressure, , .
Biphasic Positive Airway Pressure (BIPAP -
"I"). BIPAP
- , .
BIPAP Pressure Control:

.
BiPAP
"i" .
,
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, BIPAP.
. BiPAP
, :

;

.
.
.
BiPAP -
,
.

. (PEEP) 5-8 . .,
12- 15 . .
5.3.

: ,
: ,
, -
.
.
, - .
5.3.1. Pressure Regulated Volume Control (PRVC)
, (Pressure Regulated Volume
Control - PRVC), Assist Control, SIMV.
- Volume Control (. 5.3).

. 5.3. PRVC.

. PRVC, Pressure Control.
(Pinsp)
. Pinsp
. ,
, ,
.
Pinsp,
. "" Pinsp 2-3 . . ,
5 . . Pressure Control,
.

.
:
;
;

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;
, 1,5 ;
,
Pinsp PEEP, ,
.
. , .
. ,
- .
. PRVC .

.
Pressure Control.
.

.
.

.
. ,
.
PRVC -
: ,
.
.
PRVC: - 8-9 /,
- 1,0 - 1,2 , - 12- 14 1 , PEEP - 5-8 . ., - 3-4 .
., 1,5-2 /. 0,50,6 .
: - 12 /, - 6 /,
- 30 1 , PEEP - 3 . ., max - 30 . .
: (Autoflow),
(Adaptive Pressure Ventilation), VV+ - .
5.3.2. Volume Assured Pressure Support (VAPS)
(Volume
Assured Pressure Support - VAPS) 0
. - , , , .
VAPS , Pressure Support. ()
, .
,
, - . 25%
. ,
VAPS Pressure Support (. . 4.4, ).
,
25% . ,
.

. VAPS "" Pressure Support
Volume Control (. . 4.4, ).
. , .
. () .

. ( )
( ).
. Pressure Support,
.
. , VAPS "",
,
(max). , ,
25%, , Pressure Support.
VAPS:
.
,
.
. ,
.
.
VAPS: (PinSp) - 15- 18 .
., PEEP - 5-8 . ., - 3-4 . ., 1,5-2 /,
- 8-9 /.
: - 12 /, - 6 /,
- 25 1 , - 5-6 / ( 450 -500 ),
- 10 . ., PEEP 3 . ., - 30 . . - 20 ,
- 15 1 .
, 650 -700 .
:
(Volume Assured Pressure Support - VAPS), (Pressure
Augmentation).
5.4.
"" - .
- .
" "
. ""
, .

.
5.4.1. Mandatory Minute Ventilation (MMV)
- Mandatory Minute Ventilation (MMV) Volume Control, SIMV.
.
.
, .
, ,
Pressure Support. ,
: - ,
, , .
, MMV -
. ,
MMV Volume Control SIMV Pressure Support.
,
, .

Volume Control SIMV


. MMV .

(. 5.4).

. 5.4. MMV.

SIMV.

.
.
CPAP Pressure Support ,
, .
, ,
Volume SIMV. -
(. 5.5).

. 5.5. MMV. -
Pressure Support
SIMV
.
MMV ,
,
- .
.
, .
.
.

, ,
PEEP.
.
MMV:
.
.
MMV. :
- 8-9 / ( 600 -700 ), - 12- 14 1 , PEEP - 5-8 . .,
- 3-4 . ., 1,5-2 / , - .
- 35-40 /. - 1:2.
70 -90 /, - 1:3- 1:4.
- 0,1- 0,3 . 10 /.
: (Pinsp) - 15- 18 . ., PEEP -5-8 . .,
- 3-4 . ., 1,5-2 /.
: max - 30 . .
, , PEEP 1520%.
5.4.2. Volume Support
Pressure Support.

.
Pressure Support ,
(. 5.6).
. (Mandatory Rate Ventilation, MRV).

. 5.6. Volume Support.


, .
Volume Support MMV.
Volume Support: - 8-9
/, (Pinsp) - 15- 18 . ., PEEP - 5-8 . ., - 34 . ., 1,5-2 /. - 12 .

: m - 30 . .
: PSVG (Tressure Support Volume Garantee) -
, VPS
(Variable Pressure Support) - , APV (Adaptive
Pressure Ventilation) - .
5.4.3. Adaptive Support Ventilation (ASV)
(Adaptive Support Ventilation - ASV)
, MMV.
MMV - ,
.
,
. ,
:
.

(. 5.7).

. 5.7. .
1 -
; 2
- ; 3
.
- 14- 16 1 .
, ,

. . ,
- .

.
ASV. :
, (
, )
. Pressure Control,
(f) .

(VT).
f VT :
VT
. VT 22 /, - 30
. .;

VT - 4,4 / - , 2
;
- 5 1 ;
.
. -
(VE)
(4,4 /):
fmax = VE: VT min
, :
.
, , "
", ().
:
= R.
, , .
: , .
90% , , 2.
99% 3.
, 2. 60
.

SIMV. ,
. ,
Pressure Control.
, Pressure Support.
ASV PEEP, FiO2
.

.
ASV
.
. VE
, - .
ASV
,
- , -.
Pressure Control Pressure Support. ,

. , .
ASV
.
5.5. Trachea Gas Insufflations(TGI)

.
.
, (.
. 1.1, ). ,
.
. .
,
.

,
. , ,
, ,
- Trachea Gas Insufflations (TGI).
, .
""
, .
.
-.
, TGI .
5.6.
" " :

.
.
.
,
. ,
.
" " .

Pressure Control Pressure Support, ASV. ,
- PRVC Volume Support,
Volume Control Volume Support.

.
5.7. - Automated Tube Compensation (ATS)


(Automated Tube Compensation - ). , Pressure
Support: .
Pressure Support ,
(Paw), (Ptr),
. Ptr, Paw
. ,
, ,
.
1 100%.
.
, , (
). PEEP .
, , , PEEP,
0 . .
, .
. ,
,
" ". ,
,
. ,

. , ,
() : Pressure Control, BIPAP, PAV.
.
.

.
,
Ptr.
5.8. Proportional Assist Ventilation (PAV)
(Proportional Assist Ventilation - PAV)
.
Pressure Limited Ventilation Assist Control
. - .
. , (Volume Assist), ,
, .
. , (Flow Assist),
, - .
.
PAV -
,
.
.
, , .
, 75%
. 25% . ,
, 3 . .
- .
, - .
,
.
.
.
.
,
. 100%
0 ,
.
.
. ,
, .
, , , Pressure Support:
, - .
, PAV
.
, ,
, .
,
.

. .
, ,
.

.
,
. "run
away phenomenon" ( ).
.

, -
.
PAV.

, . ,
80% .
PAV ,
-.
- (Proportional
Pressure Support, PPS).
5.9. Neurally Adjusted Ventilation Assisted (NAVA)
NAVA ,
- .
, ,
(Paw).
, ,

( ) .
.
.

, .
,
Ptr , .

.
.
.
NAVA ,
"" , , .
, ,
, .

6.
- .
:
1.
( ), ;
2.

( );
3.

( );
4.

, ,
( );
5. -
, , - ,
.
.
6.1.
:
- .
-
( );
- .

;
;
- PEEP.
,
-.
PEEP.

.
.
-
.
- -;
. .
,

. ,
.
: .

. ,
,

6.2.

80% ,
. -
,
,
. :
- .
-
;
.

;
,
. ,
.
PEEP.
, , ,
;
.

;
- Assist Control SIMV.

(Volume Control), (Pressure Control).
SIMV
Pressure Support . , . .

;
.
PEEP (-);

.
300 -400 .
6.3.


, , . ,
,
:

.
100 - 150 .
.
: - .
;
, ;

.
;

.
.
( BIPAP);
- PRVC , , VAPS;
,
,
( 0,1).

.
6.4.

. -
20 -30%.
, ,
- .
, ,
, :

( Pressure Support);
Pressure Support;

;

-, ,
.
-
, , , -
-
.
.
,
,
,
.
.

7.
. , -

.
.
,
-
. .
.
.

. : 50 100%
.
.
.
, .
7.1. PLV

- , (Pressure Limited Ventilation PLV).
.
. ,
. Assist Control
. ,
.

,
( Assist Control ).
.

. -

PLV .
.


.
. ,
, -
PLV. .
7.2. Volume Control
(Volume
Control). .

.
.
. ,
.

Assist Control SIMV.


SIMV ( )
.
-
(m).
,
.
,
, :
,
;

;

() .
7.3. BiPAP

,
.
7.4.

.
:
;
;
( )
;
;
,
.

. -
- .
- . , ,
.

8.

,
, .
:
, Pressure
Support .
. (Pplat),
, - PEEP
PEEP.

-, .
8.1. Volume Control
Volume Control
Assist Control SIMV.
SIMV
Pressure Support.
,
. ,
.
Volume Control.
Volume Control.
(max), :
();
;
;
;
PEEP.
.
- .
, - .
. , ,
,
.
8.2. Pressure Control, Pressure Support
Pressure Control
Assist Control SIMV.
.
, - . ,
.
Pressure Support
SIMV.
, .
8.3.
-
.

.
.
(FiO2). SIMV
.

Pressure Support.
5 . .
- .
Assist Control
.
, . , Assist
Control, , .
, ,
. ,
.

,
. , ,
2-3 .

9.

. ,
.
, -,
.

.
()
: .

, .
, .
,
.
,
.
(. 9.1).
,
Pressure Support.

, 01.
.

. 9.1. .
()

,
.
()
.
9.1. Volume Control

. .
- m 30 . . -

Pinsp m 10 - 15 . . , , , ,
- .
.
Pinsp
, m
, . ,
Pinsp,
Volume Control.
, Pinsp.
,
.
Pressure Limited Ventilation,
.
9.2. Pressure Control

Pressure Control
.
. ,
- 90 (. 9.2).
45.
,
.

. 9.2.
" ".
.
, .
90 ,
, .
,
,
. ,
, .
0,1.
,
100 (0,1 ).
. -, . -,
" " (
- 150 ). , 0,1 (
, ). -
3,5 . .

9.3. Pressure Support, CPAP, BIPAP APRV,



Pressure Support CPAP
. ,
,
.
-
- .
4.
9.4.

: - ,
SIMV,
.
.
9.5.

, . ,
, , :
;
;
;
;

.
,
,
.

10.
.
"" - .

Pressure Support. , Volume Control.
Volume Control
: "
" . Volume Control ""
. .
,
(set Vpeak)
. , ,
: . 1-2
. ,
. .
,
2 . .; , .
PSV. Pressure Support
: - 2 . . PEEP, -
PEEP ( 2 . .).
, .
2 .
,
, , .
.
, .
-
, set Vpeak.
set Vpeak, , .
, Pressure Support, ,
25% .
set Vpeak,
, Volume Control.
"" .
Pressure Support ,
. ,
.
10.1.
, ,

. ,
.
,
(Pes), (Ptr) Y-
(Paw),
. .

10.1.1.
.
- (. 10.1).
Paw ( ) - (
). ,
,
PEEP.
.

. 10.1. . , -
; , -
; , -
.
Pes, Paw ,
, "
" (. 10.2). "" .
- .
. , Pressure Support
, ,
.
25 40 -50%, (. 10.3).
PEEP. ,
.

. 10.2. ,
[Georgopoulos D. et al., 2006]. ,
""
. -
.

.
- ()
, .

. 10.3. Pressure Support



[Georgopoulos D. et al., 2006]. -

( ).
(
); - Pressure
Support.

Pes, Paw ,
(.
10.4).

. 10.4. Pressure Support [Georgopoulos D. et al.,


2006]. ,
,
.
.
. -
.
.
: .
, . ,
, . -.
-
(. 10.5).

. 10.5. - - :
( ).

, ,
. ,
.
(. 10.6).

. 10.6.
[Maclntyre N., Branson R., 2001]. - (
); -
( ).
.
-
,
(. 10.7).

. 10.7. [Georgopoulos D. et al., 2006].

Volume Control .

( ).
( ).
, .

.
.
.
Volume Control ,
(. 10.8).

. 10.8.
Volume Control. - ,
es; -

"" .
, "",
; -
: Paw ,
- .

. . ,
, .
Pressure Control
.
(. 10.9).

. 10.9.
Pressure Control. - ,
aw
Pes; -
, aw
; ,
Paw.


.

,
.
.
Pressure Support
. ,
,
(. 10.10, ).

. 10.10. Pressure
Support [Georgopoulos D. et al., 2006]. a -
,
( )
; -
. :
, ,
.

(. . 10.10, ). .
- .
. - .
- ,
, .

.
- . ,
: ,
.
, -

. ,

.
.
Pressure Support
, (. 10.11, ).
:
(. . 10.11, ).

. 10.11. Pressure Support. -



, ; -
.
.
(. 10.12).
, ,
( , )
-.
TGI,
"" , -
.

. 10.12. [Maclntyre N., Branson R., 2001]. ; - .



(. . 10.2).

. ""
.

- .

.
10.1.2.

(. 10.13, ).
(. . 10.13, , ). ,
( )
.

. 10.13.
[Maclntyre N., Branson R., 2001). ( PEEP ),
( peak Pplat ); - -
peak
plat ( PEEP - ); , --
PEEP
( ). "" ,
"" - ,
, .
,
, .

( ).
. ,
. , Paw Pes , (. .
10.13, ).
,
.
, . ,
. , Paw, .

, ,
Pes, Paw Pes (. . 10.13, ).
:
, ,
.
,
, . Paw Pes ,
(. . 10.13, ).

.
10.1.3.
Pressure Support
, .
.
Pressure Support ,
:
(. 10.14).

. 10.14. Pressure Support [Maclntyre N., Branson


., 2001]. a - ( Paw); (
tr).
, .
, -
.

, ,
.
,
(. . 10.8).

.

- [Ranieri V. . et al., 2000].


:
P = a tb c,
P - ; t - , ; , b,
- .
- b. -, 1,01,
. - 1,01,
, 1,01 - .
, .
,
.
(. 10.15).

. 10.15. -. -
, - .
[Ranieri V. . et al., 2000].

PEEP
-.
10.1.4. -
Paw Pes -
,

.
10.2. ()
,
() . ,
- .
, , .
, -
: .
.
-
. ,

.
.
, .
"-", (. 10.16).

. 10.16. -
[Maclntyre N., Branson R., 2001]. -
(low Pflex); - (upper Pflex).
.
, (10 /).
.
. -
, . .
, (. 10.17).

. 10.17. -
[Maclntyre N., Branson R., 2001. -
60 /; 10 /;
- 10 /;
- -V , .
- - .
.

,
.
, , .
. ,
, . ,

. , -
PEEP , Pplat -
. , .

[Pelosi P., Gattinoni L., 2000]. - ,
, ,
, , .
.
.
, , ,
, .
,
.
. , PEEP -
. ,
-,
. -
.
10.3. Pressure Support
:
.

90% .
. 5%.
Pressure Support

(. 10.18).

. 10.18.
( ).

10.4. BIPAP
BIPAP
Pressure Support.
.
BIPAP.
Pressure Support BIPAP (. 10.19).

. 10.19.
BIPAP.
, Pressure Support
, . .
. .

BIPAP . ,
, .
(. 10.20, ).

. 10.20.
BIPAP. -

; -

.
,
25% (. . 10.20,
). , " " ,
.
.

10.5.
ASV, PAV, ,
4.
, . ,
.
, , .
. - .
,

. -
,
- .
,
.

: - .

.
(150 / ) .
.
,
.
( 25 . .)
, .
,
: ,
,
. Pressure Control, Pressure Support,
BIPAP. - Assist Control STMV.
NAVA .

11.


. ,
.
11.1.
() - () -
.
: () ().
, ,
. , ,
. ()
. -
, -
.
.
, , - , ,
.
. , .
-
pO2/FiO2,
P/F. 300 . . , 200 . . .
- .
. , P/F
, , ,
.
[Ware L. ., Mat-thay M. ., 2000],
. (I) -
.
. II
. , -
. -
.
, (sponge lung)
[Bone R., 1993]. -
, : " " - baby lung
[Gattinoni L., PesentiA., 1987].
,
.
.
.
- II .
III ,
- .
: ,
, .
.

11.1.1. -
I .
.
.
() .
Pressure Control BIPAP.
PRVC. - Assist Control.
Pressure Control: (Pinsp) - 25-30
. ., - 0,8- 1,1 , Assist Control- 12- 14 1 ,
PEEP - 10 - 15 . ., - 3-4 . ., 1,5-2 /. :
- 10 /, - 4 /, - 35 1 ,
- 3-4 /, - 20
. ., PEEP - 7 . . FiO2 - 0,4- 0,6.
FiO2,
, O2 60 . .
90%.
- ,
.
.
, ""
.
-.
, :
.
" " " ".
- .
. ,
.
P/F
300 . . 50 . . .

95% 97%
(FiO2 0,4 ).
-.
P/F 50 . . ,
99- 100%.
20 - 30%. ,

: .
,
.
- :
;
;
;
;
.
- Pinsp
.


- .


.
.
Pressure Control BIPAP :
(Pinsp) 30 . ., PEEP 10 . .
.
.
1:1.
10
.
1 - (. 11.1, )

. 11.1. . - ; -
. : I - ; II -
; III - ; IV - .

1. PEEP, Pinsp 3 . . .
10 , .
, .
2. PEEP, Pinsp 3 . .,
,
( )
PEEP 40 . . Pinsp 60 . . ( -
)
"" 10 .
3. PEEP Pinsp,
,
. "", PEEP
25 . . Pinsp 45 . . ( , ).
10 . ,

.

PEEP Pinsp "" 2 . . ( 10 ""),
. PEEP,
, , . PEEP
.

10 PEEP Pinsp ,

.

PEEP , 2-3 . . .
Pinsp 6- 8 / .
FiO2 0,4- 0,6.

, ,
O2 60 . . 90%.
2 - (. . 11.1, )

. 11.2. . 1 - SpO2
; 2 - SpO2 3 -
.

1. "" PEEP 3 . . Pinsp - 5 . .
"" 10 ,
. -
.
2. PEEP Pinsp , Pinsp 60 .
. (PEEP 28 . .).
3. PEEP 25 . . Pinsp 45 . .,
,
.

PEEP Pinsp "" 2 . . ( 10 ),
. PEEP,
, , . PEEP
.

10 Pinsp 60 . . PEEP 28 .
.,

PEEP , 2-3 . . .
Pinsp 6 - 8 / .
FiO2 0,4 - 0,6.
, ,
O2 60 . . 90%.
,
.

- -.
. ,
, ,
, .
.

"" ,
.
, -
.
, (SpO2)
94-95%. SpO2
(. 11.2).
, O2 / F
SpO2. SpO2 - 99100% - , 90 -92% -
.
-
- -. " ", -
. , ,
P/F.
,
.
-
. ,
-,
-.
-
.
.
.
11.1.2. -
II -
.
( - 30 . .). 6 /
( 7- 8 /).
260 . .,
90%.
- 80 - 100 . .
, O2
.
PEEP.
,
Volume Control Assist Control.
(),
30 . . . ,
- (0,1- 0,3 ). ,
(1:1-2:1).
PEEP ( 8- 10 . .).
11.1.3. -
,
.
.
. - ,
, , .

PEEP 3-4
. . .
11.2.

. , .
. -
.
. . -
, , .
:
1. ,
.
2. () -,
(. 11.3).
3. ,
, , .

. 11.3. "-"
"-". 1 - ; 2 -
.
-
. , .
.

.
(). (. 11.4). PEEP ().

. 11.4. (Palv),
(Paw) (pl)
[ . ., 1997]. -
:
,
, ; -
: -
, -
,

; - :
.
.
; -
:
,
.

, .
, PEEP.
-, PEEP , . .
. -, , PEEP
. , PEEP -
PEEP.
11.2.1. -
- .
1. .
2. .
3. .
4. .
1. - .
PEEP . ,
.
PEEP, . -

Volume Control (. 11.5).

. 11.5.
PEEP Volume Control
[Macln-tyre N., Branson R., 2001].
, - . - ; - - ( )
PEEP.
,
.
Pressure Control .
, PEEP,
. - -
,
(. 11.6).

. 11.6.
PEEP Pressure Control [-Intyre N., Branson R.,
2001].
, - . - - ; - -
( ) PEEP.

. -
PEEP
.

-.

2. PEEP
.
. ,

PEEP. , PEEP,
, PEEP (. 11.7).

. 11.7.
PEEP.
, - (
).
3. PEEP ,
(. 11.8). ,
PEEP. PEEP,
PEEP.

. 11.8. PEEP .
, ,
PEEP.
4. - ,
.

. Y-
-. Paw Pes
-
(. 11.9).

. 11.9. -
. - - -
.

; - - .

aw es
PEEP .
,
PEEP. -,
, .

.
PEEP, ,
. - -
.
: , . , PEEP
PEEP . ,
: - .
, , ( 1:1).
PEEP ,
PEEP. - ,
.
,
. - .
-
. .

.

. . -
,
. "" 02 - 50 70 .. ,
.
-
.

-
. , , , ,
-
.

.
11.2.2.

.
,
.
, , ,
.
, . [Plant P. et al.,
2000],
. ,
.
,
, .

[Gladwin M., Pierson D., 1998]
, ,
.
.
, ,
.
PEEP.
- , .
PEEP, , PEEP.
PEEP ""
.
PEEP .
Volume Control PEEP,
(. 11.10).

. 11.10. PEEP
Pressure Control [Maclntyre N., Branson JR., 2001.
, -
. - - ; - PEEP,

( ): aw ; VT
; - PEEP, , -
( ): Paw ; VT .
, , PEEP
PEEP. ,
.
PEEP
, ,
.
. PEEP
PEEP . ,
- . PEEP
2-3 . . .
Pressure Control
PEEP (. 11.11).

. 11.11. PEEP
Volume Control [Maclntyre N., Branson R., 2001].
, -
. - - ; - PEEP,
( ): Paw
; VT ; - PEEP, ,
- ( ): aw ; VT
.
,
PEEP. PEEP
. -, ,
, -. ,
, PEEP.
- PEEP
. PEEP .
. , PEEP
PEEP PEEP,
. PEEP 2-3 . . ,
.
,
PEEP, , .
PEEP ,
, .

- PEEP
Paw Pes. PEEP
.
,
PEEP. PEEP.
PEEP , , PEEP.
PEEP 80% .
.
- 02.
. 02
, . ,
.
, - .
. ,
- .
-
(), .
02
,
. - . ,
,
.
. ,
.
.
,
. ,
,
.
O2.
11.2.3.
,
Volume Control, Pressure Control BIPAP.
SIMV.
,
Pressure Support. -
, 25 50 -60%.
, ,
.
Pressure Control SIMV.
: (Pinsp) - 22-25 . ., - 0,5- 0,7 ,
- 8 1 , PEEP - 7-8 . ., - 3-4 . ., 1,5-2 /,
- . FiO2 ,
O2 60 . . 90% (
FiO2 0,5- 0,6).
(Pressure Support): (Pinsp) - 20 -22 . ., PEEP-7-8
. ., - 3-4 . ., 1,5-2 /. 50%.
: - 10 /, - 4 / ,
- 15 1 , - 3-4 /,
- 20 . ., PEEP - 5 . .
- 20 , - 10 1 .

11.3.

,
, . ,
, ,
[ . ., 2005].
,
(). ,

99- 100%.
80 -90 . . ,
, .

, :

O2.
. ,
150 .
.

- () :
" ,
".
:
" , ,
".
, ,
.
.
.
,
.
.
.

. .
: .
() - 0 - 15 . . (. 11.12).
- (),
; .
()
() .
,
.

. 11.12. PEEP . - PEEP


( = ); - PEEP :
- ( = - ).
30 . . .
, .
.
. ,
,
. ,
, -,
. ,
PEEP
.
.
.
, , .
-
.
.

(. 11.13).

. 11.13. . 1-
; 2 - .

Volume Control
Assist Control.
Volume Control: 8-9 /
( 600 -700 ), 12- 14 1 , PEEP - 5-8 . ., - 3-4
. ., 1,5-2 /, - , - 0,1- 0,3 ,
- 35-40 /. - 1: 2.
70 -90 /, 1:3 - 1:4,
.
FiO2 :
, . , 0,40,6.
FiO2
.
.
.
65-75%.
: Pmax - 20 -25 . . ,
15-20% , ,
PEEP.
11.4.

,
.
-.
,
. : .
, - , .
, ,
. ,
. - , :
, .

- ,
.
, , .
, ,
. "" , ,
. ,

.
. , ,
" ", " ".

. PEEP.
, ,
.
, -
. ,
- ,
. (Pes)
(Paw), . ,
. Pes , Paw, , ,
.
Pressure Control SIMV.
: (Pinsp) - 35-40 . ., - 0,8- 1,1 ,
- 10 - 12 1 , PEEP- 10 - 15 . ., - 3-4 . ., 1,5-2 /,
FiO2 - 0,4- 0,5. FiO2 , O2 60
. . 90%.
(Pressure Support): (Pinsp) - 25 . ., PEEP - 10 - 15
. ., - 3-4 . ., 1,5-2 /.
: m - 45 . ., - 10 /, - 4
/, - 35 1 , - 3-4
/, -20 . .,
PEEP - 7 . . - 20 , - 15 1 .

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- 1 50 - 100 .
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: (PEEP) - 810 . ., FiO2 - 0,4- 0,5.
: - 12 /, - 6 / ,
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- 15 1 ,
, 650 -700 .
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. - Volume Control Assist Control.
Volume Control: - 8-9 /
( 600 -700 ), - 12- 14 1 , PEEP - 5-8 . ., - 3-4
. ., 1,5-2 /, - , - 0,1 - 0,3 ,
- 35-40 /. - 1:2.
70 -90 /, 1:3 - 1:4,
- . FiO2 , O2
70 . . 95% ( FiO2 0,50,7).
,
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: (PEEP) 810 . ., FiO2 - 0,5- 0,7.
: - 12 /, - 6 / ,
- 25 1 , PEEP - 5 . ., - 20 ,
- 15 1 ,
, 650 - 700 .
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BIPAP.
BIPAP: (Pinsp) - 12- 15 . .,
- 0,7- 0,8 , - 12- 14 1 , PEEP - 2-3 . ., - 3-4
. ., 1,5-2 /, FiO2 - 0,4- 0,5. FiO2 ,
O2 60 . . 90%
( FiO2 0,5- 0,6).
: - 12 /, - 6 /,
- 30 1 , PEEP - 1 . ., max 30 . .

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3. . ., . . : .- : -, 2004.-64 .
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