transmedТрансляционная медицинаTranslational Medicine2311-44952410-5155Almazov National Medical Research Centre, Saint Petersburg, Russia10.18705/2311-4495-2020-7-1-39-52transmed-538Research ArticleАНЕСТЕЗИОЛОГИЯ И РЕАНИМАТОЛОГИЯPAIN, CRITICAL CARE, AND ANESTHESIAПропорциональная вспомогательная вентиляцияProportional assist ventilationМазурокВ. А.MazurokV. A.

Мазурок Вадим Альбертович, д.м.н., профессор, заведующий кафедрой анестезиологии и реаниматологии Института медицинского образования

ул. Аккуратова, д. 2, Санкт-Петербург, Россия, 197341

Mazurok Vadim A., MD, PhD, Dr. Sc., Professor and Chairman Department of Anaesthesiology/Reanimatology, Institute of Medical Education

Akkuratova str. 2, Saint Petersburg, Russia, 197341

vmazurok@mail.ruФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Medical Research CentreRussian Federation202010032020713952Copyright © Мазурок В.А., 20202020Мазурок В.А.Mazurok V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://transmed.almazovcentre.ru/jour/article/view/538

Идея пропорциональной вспомогательной вентиляции легких, при которой респираторный паттерн — частоту и глубину дыхания — задает сам пациент, была высказана в 1992 году, однако до сих не нашла широкого практического применения. Одной из возможных причин тому является сложный алгоритм настройки режима на респираторах первых поколений. Со временем накопленный массив информации о раннем поражении диафрагмы в результате ее атрофии у пациентов, находящихся на респираторной поддержке, лег в основу осознания важности поддержания физиологического состояния диафрагмы во время искусственной вентиляции легких и обусловил появление термина «миотравма». На рубеже XXI века идея максимально возможного сохранения самостоятельного дыхания у пациента во время проведения механической вентиляции легких реализовалась в формировании концепции «диафрагма-протективной вентиляции». Стала очевидной необходимость дальнейшего развития технологий вспомогательной вентиляции легких, призванных уменьшить риск повреждения диафрагмы, снизить частоту асинхронии в паре «пациент–респиратор», облегчить процесс отлучения пациента от аппарата искусственной вентиляции легких. Настоящая статья, основанная на данных литературы и собственном клиническом опыте использования пропорциональной вентиляции, описывает особенности настройки режима на разных респираторах, расставляет акценты, необходимые для успешного клинического использования пропорциональной вентиляции легких. Описывает условия ее проведения, преимущества и ограничения.

The idea of proportional assist ventilation, in which the patient himself sets the respiratory pattern — the frequency and depth of breathing — was suggested in 1992, but has not yet found widespread practical application. One of the possible reasons for this is the complex algorithm of regime adjustment on first-generation respiratory devices. Over time, the accumulated body of information on the early damage of the diaphragm because of its atrophy in patients on respiratory support formed the basis of the awareness of the importance of maintaining the physiological state of the diaphragm during artificial lung ventilation and led to the emergence of the term “myotrauma”.

At the turn the 21st century, the idea of the maximum possible preservation of spontaneous breathing of the patient during mechanical lung ventilation realized in the formation of the concept of “diaphragm-protective ventilation”. The need for further development of assisted lung ventilation technologies designed to reduce the risk of diaphragm damage, the frequency of asynchrony in the pair “respirator-patient”, and to facilitate the process of weaning of the patient from the artificial lung ventilation became apparent. This article, based on scientific literature and own clinical experience of using proportional ventilation, describes the peculiarities of regime adjustment on different respirators, places the accents necessary for successful practical use of proportional lung ventilation. Describes key conditions for its use, advantages and limitations.

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