T: G S S S F O SO SO

1
??T??? ??????????G?? ? S???????? ??? ??S??????
S?? F??????? ?O? ???????S???O? ??S????O?

• ?. ?IEKKAS

2

• ????????? (?2 st? a?µa)
• F?s???????? ???? PaO2 ??a ?t?µa 15-85 et?? se
  ?a??st? ??s? 104,2 - (?????a x 0,27)mmHg.
• lt50mmHg ep????d??? ?p??a?µ?a (ta ??tta????
  µ?t????d??a de? p??s?aµß????? O2 - ????t?p???s?
  a?ae??ß??? µetaß???sµ??).
• 50-60mmHg s?ßa?? ?p??a?µ?a - apa?te?ta?
  ??????s? O2.
• ???????? e?d???se?? ?p??a?µ?a? ta???a?d?a ?a?
  a???s? p?es?? (µetap?pt??? se ß?ad??a?d?a ?a?
  ?p?tas?), ta??p???a (?p???a), a?a?ata??µ?
  a?µ?t?s?? (a???s? a?µ?t?s?? stefa??a???-e??ef????)
  , ?????s?, ?a?a?t??? ????s?, a??s???a, s????s?,
  ??µa.

3

• ????? ??????S (?2 st??? ?st???)
• ?p??a?µ??? ad??aµ?a ???????s?? a?µat?? ?aµ???
  p????t?ta e?sp?e?µe??? O2, shunt.
• A?a?µ??? ad??aµ?a µetaf???? O2 a?a?µ?a,
  d???t???as? µe CO, µetat?p?s? t?? ?aµp???? Hb.
• K????f????? µe??s? pa????? a?µat??
  ?a?d?a??e?a?? shock, t?p??? a??e??s?spas?.
• ??tta??t????? ad??aµ?a ?st?? ?a ???s?µ?p?????
  O2 d???t???as? µe CN.

4

• ????????S ???G???T???????S
• ??ap?e?st??? a?ep???e?a.
• ??? ?µf?a?µa µ???a?d???.
• ?a?d?a?? a?ep???e?a.
• ?atap????a ?p??asd?p?te a?t??????a?.
• ?pe??ataß???sµ?? (s?pt????, e??a?µat?e?,
  p???t?a?µat?e?).
• ?ete??e???t???? ep?p?????.
• ????t???as? µe CO.
• ?p?t????s? ap????f?s?? p?e?µ????a?a ? ?p?d?????
  eµf?s?µat??.

5
?????? ?2 S?? ??S???????

• ?pa?t???ta?
• ?p?t????a pa???? ?2 ?e?t???? de?aµe?? ef?d???e?
  µe µe??t??e? p?es?? t? ?2 st??? ?a??µ???.
  ??a??a?t???, ?ß?da ?2.
• ???µet?? ?2 µ?t??s? pa????? (lt/min).
• ???a?t??a? ef???a?s?, ???esµ?? ?2 µe ?d?atµ???.
  
• S?st?µata-s?s?e??? ????????e?ape?a?.

6

• S?S?????? ???G???T???????S (1)
• ??????? ?a?et??e? (??a??? ?2) ??? 1-4lt/min,
• - e????a a?e?t??, ep?t??p??? st?? as?e?? ?a µ???
  ?a? ?a t??e? ta?t?????a,
• - ? p????t?ta ?2 µp??e? ?a ?p?????s?e? µ??? ad??,
• - ?at??????? ??a ?????a ?at ?????
  ????????e?ape?a ?a? ??a as?e?e?? p?? ??e?????ta?
  ?2 ?? 40.
• ?p??? µ?s?e? ??? 6-10lt/min,
• - s???? de ?????ta? e????a a?e?t??,
• - d?a??t??? t??pe? sta p????a (ap?ß???
  e?p?e?µe??? C?2, a??µe??? ?2 µe a??a),
• - pa?????? p????t?ta ?2 35-60.

7

• S?S?????? ???G???T???????S (2)
• ??s?e? Venturi d?a??t??? d?? µe???e? t??pe? sta
  t????µata ?a? spe???e?d? s????a 15cm st? ????
  t???,
• - d???ete?eta? ?2 se ??a ?e?t???? a???f?s?? µe
  p??? ste?? st?µ??,
• - µe t? ???µ?s? t?? ep?t????a? ???? ?a? t??
  e?a??a?? a???f?s??? d?af???? d?aµ?t???
  e?asfa?????ta? s???e???µ??e? ?a? sta?e???
  p????t?te? ?2 24-60 (de ???eta? epa?e?sp??? t??
  e?p?e?µe??? C?2),
• - ap?te???? t? ?ata?????te?? s?st?µa e?e???µe???
  ????????e?ape?a?, ????? ?a ??e???eta? sf??t?
  efa?µ??? st? p??s?p?.

8

• S?S?????? ???G???T???????S (3)
• ?????µa ? p??sa?µ??eta? st?? ??? s????a ? st?
  t?a?e??st?µa,
• - e??e?a efa?µ??? st? weaning.
• ??s?a s??e???? ?et???? p?es?? ae?a????? (CPAP)
• - d?a??te? t????µata-ae???a??µ??? ??a ae??ste??
  p??sf?s? st? p??s?p?,
• - ?et??? p?es? se ??e? t?? f?se?? t??
  a?ap?e?st???? ??????,
• - ????? ??? ?2 µe p???a????sµ??? p????t?ta,
• - e??e?a efa?µ??? se ??e?a a?ap?e?st???
  a?ep???e?a, ?p???a ?p???, weaning.

9

• S?????G???S ???G???T???????S
• S?ßa?? ?p??a?µ?a ????? ?ata???t?s? C?2
• - p????t?ta ?2 gt40 µe ??? 5-515lt ?a? ???a?t??a,
• - e?sa???? st? ?.?.T., e?t?? a? p???e?ta? ??a
  ?????a ??s?, ?a? a?a?????s? t?? a?t???.
• ?p????d??? ?p??a?µ?a
• - p????t?ta ?2 100, ??a??? µ??a????? ae??sµ??.
• ?p??a?µ?a µe ?ata???t?s? C?2
• - ?fe??eta? ?????? se ?p?ae??sµ? (f?s????????
  ???e??d?a?t???a?? d?af??? ?2),
• - µ?s?a Venturi, ?s? t? d??at? ?aµ???? p????t?te?
  ?2 (24-28), stad?a?? a???s? a?t??.

10

• ?????????? ???G???? (1)
• ?a????????? a?t?d??se?? st?? e?sp??? se
  as?e?e?? µe ?????a ?pe??ap??a ? ??e?a ?atast???
  ??S,
• - ? ta?e?a d?????s? t?? ?p??a?µ?a? ?d??e? st??
  ?at????s? t?? ?p??a?µ???? e?e??sµat?? ?a? t??
  ep?de???s? t?? ?p?ae??sµ?? a????? e?e???µe???
  ??????s??.
• ?te?e?tas?a e? ap????f?s??
• - a? t? ???t? a?t??atasta?e? ap? ?2, ? ????? t??
  ???e??d?? µ???a??e? ?a?, se pe?????? µe µ????
  ae??sµ? (st???s? ? ap?f?a??) ?a? ????? a?µ?t?s?,
  d?µ????????ta? pe?????? ate?e?tas?a?.

11

• ?????????? ???G???? (2)
• ?e????
• - ?p?s??fa??e?d?? ???p?as?a p????t?ta ?2 gt40
  p???a?e? s?spas? a??e??? t?? aµf?ß??st??e?d???
  ?a? a??pt??? ???d??? ?st?? µp??e? ?a ?d???se? se
  t?f??s?,
• - ß?????p?e?µ????? d?sp?as?a ?et??? p?es?
  ae?a?????.
• ??????e? t?????t?ta a?????? t?? s?????t??s??
  ?a? t?? d????e?a? ??????s??,
• - pa?a???? e?e??e??? ????? ?2,
• - p?e?µ????? ??d?µa µe a?µ???a???? e??d??µa,
  ?atast??f? t???????e??d?e?d???? ?????.

12

• ?????? ???G???T??????? (1)
• ????e? e?de??e??
• - ?????a ap?f?a?t??? p?e?µ???p??e?a (?.?.?. - 90
  pe??pt?se?? - ???s?µ?t?ta 30 t?? 1? ????? ?a?
  70 t?? 1? 5et?a),
• - p??t?pa??? p?e?µ????? ?p??tas?,
• - epa?a?aµßa??µe?e? p?e?µ?????? eµß????,
• - ?a?d?a?? a?ep???e?a,
• - µet? ap? p?e?µ??e?t?µ?,
• - ?p??????a?µ?a ?at? t?? ??p?s? ? st? d????e?a
  t?? ?p???.
• ???t???a
• - PaO2lt55mmHg ?,
• - PaO2 55-60 mmHg se s??d?asµ? µe p???e????a?µ?a,
  ?a?d?a?? a?ep???e?a de???? ?????a? ? p?e?µ?????
  ?p??tas?.

13

• ?????? ???G???T??????? (2)
• ??????s? ?p??????a?µ?a? st??? as?e?e?? µe
  ?.?.?.
• - a???s? ep?ß??s?? st? p?s?st? a?t?? ?????
  ?p??????a?µ?a,
• - ? s??e??? ??????s? ?2 (t??????st?? 16-18 ??e?)
  ?pe?te?e? t?? ???te????? ? t?? ?????????
  ??????s??.
• St???? ????????e?ape?a?
• - d?????s? ?p??????a?µ?a?, ????? ep????d???
  a???s? t?? PaCO2,
• - ße?t??s? f?s????-??????? ?at?stas?? ?a?
  p???t?ta? ???? t?? as?e??,
• - a???s? ep?ß??s??,
• - µe??s? p???e????a?µ?a?,
• - µe??s? ??st??? ?p??es??? ??e?a? (µ?s? t??
  µe??s?? t?? s????t?ta?-d????e?a? ??s??e?a?).

14

• ?F?G???S? ????
• ??sp?e?µe??? a??a? s?et??? ???as?a 40-60,
  ?e?µ???as?a µ????te?? a?t?? t?? s?µat??
  a?ta??a?? ???as?a?-?e?µ?t?ta? µ?s? a??te???
  ae?a?????.
• ??t? ap? t?? t??p?da, ? a??a? ap??t? ?e?µ???as?a
  370C ?a? ???as?a 100 (?s??e?µ??? s?µe??)
  apa?a?t?t? ??a t? d?at???s? t?? ?e?t???????t?ta?
  t?? ae?a?????.
• ??sp??? ????? a??a
• - ap??e?a ?e??? ??a?? ?a p???a??se? af?d?t?s?.
• - a??te?? a?ap?e?st??? d?ata?a?? ???? ß????a?,
  ????s?? ???ss?t?? ep???????, a???µ??? ?ata???t?s?
  e????se??, p?????s? ß?????spasµ??.
• - ?at?te?? a?ap?e?st??? d?ata?a?? µ??a?????
  ?d??t?t?? p?e?µ??a µe??s? FRC, e?d?t???t?ta?,
  ???? ate?e?tas???.

15
?G???????S (1)

• ???a?t??e? ?e?µ?? ?e??? (1?? t?p??) ? a??a?
  pe??? p??? ap? t?? ep?f??e?a ?e???
  (ap?ste???µ????) ? µ?sa ap? t? ?e?? ?e?µa???µe???
  d??e??? t?p???t?s? ?e?µa???µe??? µeta??????
  ?a??d??? ?at? µ???? t?? s????a apa?????
  apa?te?ta? 0,5ml ?e??? ??a 10lt ?2.

16

• ?G???????S (2)
• ??ta??a?t??e? ?e?µ?t?ta?-???as?a? (2?? t?p??)
  ????s??p????, ?d??f?ß??, s??d?asµ?? a?t??.
• ?a?a?t???st??? ??a??p???t???? ???a?t??a
• - ?e?µ???as?a a??a st?? t?a?e?a 32-360C,
  p?s?t?ta ?e??? 30-43 g/m3,
• - ?e?µ???as?a, ef???a?s? sta?e??? ??a µe????
  e???? ????,
• - ap??t?ta ???s??, s??t???s??,
• - µ??a??sµ?? asf??e?a? p??e?d?p???s? ??a
  ?pe????a?s?, ?pe????µa?s?, ???d???
  ??e?t??p????a?,
• - d?at???s? ste???t?ta? e?sp?e?µe??? µ??µat??,
  ap?f??? ???µ??e??.

17

• ?G???????S (3)
• ?p????? ???a?t??a st?? pe??pt?s? p?????,
  pa????e?st?? e????se?? ?a? ?????? ????? ae??sµ??
  p??t?µ??ta? ?? ?e?µ?? ?e??? ?a? a?t??eta.
• ?p?p????? s?s?e??? ef???a?s??
• - a?epa???? ef???a?s? s?µßa??e? ?????? st??
  ?????? t?µ?? ???? a??a ? st??? a?ta??a?t??e?
  ?e?µ?t?ta?-???as?a?,
• - ?pe????a?s? µp??e? ?a ?d???se? se d???t???as?
  e? ?dat??, ???a?µa ae?a?????, d?ata?a??
  ???ss??-ß??????,
• - ep?ß????s? ????? a?ap???? ???? a???s??
  a?t?stas?? ?a? ?e???? ????? s?????se??,
• - ???µ??e?? t? pe??ß????? t?? ???a?t???? e???e?
  t?? a??pt??? µ????ß??? apa?a?t?t? ? ???s?
  f??t??? st? e?sp?e?st??? ?????µa.

18

• ???G????????F?S? (1)
• ?a?a???? ß???????? e????se?? ?a? a?ta?a??ast????
  ß??a? a?a??a?a ??a t?? e???det???s? ?a?
  ap?µ?????s? pa??????? µ????ß??? ap? t???
  ae?a??????.
• ?a???? p?s???te? as?e?e?? (?????? d?as?????µ????
  ? µe t?a?e??st?µ?a) a???µ??? pa?a???? e????se??
  ?a? ad??aµ?a ap???eµ???.
• ?pa?te?ta? ? µe µ??a???? µ?sa ap?µ?????s? t??
  e????se?? ap? t?? t?a?e?a ?a? t??? ß??????? t??
  as?e??.
• ?e???d??? ß?????a?a???f?s? a?a??a?a ??a t??
  p?????? ate?e?tas?a?, ???e??d???? ?at???e?s?? ?a?
  ???µ??e??.

19

• ???G????????F?S? (2)

S?s?e?? (µa??µet??), ????st?? ?a? ??????
a?a???f?s??.
20

• ???? ??? ??????F?S?
• ??t?µ?s? t?? a?ap?e?st???? ?at?stas?? as?e??
  a???as? ???a?a.
• ???et??µas?a as?e?? p????f???s?, ??????????
  e??s??s?, ??????s? ?atast???? ? a?a???s?a?
  (?d?a?te?a d?s??est? eµpe???a).
• ?pe????????s? as?e?? ??a t?? ap?f??? ?p??a?µ?a?
  ?a? t?? epa???????? a?t?? (a????µ?e?, ?p?tas?)
  ??????s? ?2 se ????? s?????t??s? (s???? 100) ??a
  s??t?µ? ??????? d??st?µa (30 sec).
• ??st??a?? f?s????????? ???? ??a t? ?e?st?p???s?
  t?? e????se?? ()
• ?p?t??p? ???µ??e?? efa?µ??? ap?ste???µ????
  ?a?t???, d?at???s? as???a? t?? ???????.

21

• ???? ??? ??????F?S? (1)
• ?p????? ??????? ? e??te???? d??µet??? t?? ?a
  µ?? ?epe??? t? µ?s? t?? es?te????? d?aµ?t??? t??
  ??? s????a, p???e?µ???? ?a ep?t??peta? ? e?s?d??
  a??a st??? p?e?µ??e? ?at? t?? a?a???f?s?.
  ?e?a??te?? d??µet??? s?et??eta? µe t?? a???s? t??
  ???d???? t?a?µat?sµ?? t?? ß?e????????.
• ????? e?s?d?? ? ???? t?? ??????? s???st?ta? ?a
  f???e? ?? t?? t??p?da (a?s??s? a?t?stas??) ?a?,
  af?? ap?s???e? ?at? 1cm, ?a a????e? ? a?a???f?s?.
  Se as?e?e?? ??a???? ?a ß?????, µ????te?? ß????
  e??a? a??et?. ???s??? st?? e?e??sµ? t??
  p?e?µ????ast????? (pt?s? p?es??, ?a?d?a???
  s????t?ta?) ?a? st?? p?????s? pa????sµ???? ß??a.

22

• ???? ??? ??????F?S? (2)
• ????t??? p?es? µeta?? 80-150mmHg. ?????te?e?
  p??se?? µp????? ?a p???a??s??? t?a?µat?sµ? t??
  ß?e????????, ?p??a?µ?a ? ate?e?tas?a. ? a???t???
  p?es? p??pe? ?a efa?µ??eta? s??e??? a??? µ???
  ?a??? t? ?????? ???eta? p??? ta ???.
• ?????e?a a?a???f?s?? µeta?? 10-15sec.
  ?e?a??te?? d????e?a µp??e? ?a p???a??se?
  t?a?µat?sµ? t?? ß?e???????? ? ?p??a?µ?a.
• ????µ?? pe?asµ?t?? t?? ??????? ta e????sta
  d??at?, ??? pe??ss?te?a ap? 3 t? f???.
• ?a?t?????? pa?a???????s? pa?aµ?t??? ßas????
  monitoring.

23

• ???? ??? ??????F?S?
• ?a?e?a epa?as??des? as?e?? st?? pa???? ?2,
  epa?af??? ???µ?se?? se pe??pt?s? ?pe????????s??
  ?a? epa?e?t?µ?s? t?? a?ap?e?st???? ?at?stas??
  (a???as? ???a?a).
• ?????????? e??s??s? as?e??.
• ?fa??es? ?a?t??? ?a? p??s?µ? ?e????.
• ???se?t??? pa?a???????s? pa?aµ?t??? ßas????
  monitoring (t??????st?? ??a ta ep?µe?a ?ept?).

24

• ???G??S????S?

?a?????s? ???s?? e??aµpt?? ????pt????
ß?????s??p??? - e?????a ???s?? ?a? ?µes?
ep?s??p?s? t?a?e?a?-ß?????? ap? t? p??s?p???, -
s?et??? ??es? ??a t?? as?e??, - de? apa?te? t?
??????s? ?e????? a?a?s??s?a? ?a? ???
d?as?????s??, - ?aµ???? ???d???? ep?p?????.
25

• S???T??S ????????S (1)
• ??a???st????
• - ??e???? ??s?? ??? s????a ? d?aßat?t?ta?
  ae?a?????.
• - ??t?µ?s? ß?aß?? t?a?e?a?-ß?????? ap?
  t?a?µat?sµ? t?? ???a?a ? d?as?????s?.
• - Se pe??pt?s? a?µ?pt?s??, p??sd????sµ?? t??
  s?µe??? a?µ???a??a?.
• - ?a???s?a ate?e?tas?a?.
• - ??e?a ß??ß? ap? t?? e?sp??? ??s???.
• - ???? ?a???e??e??? ? ß????????e??d??? ??p??s?
  (BAL).
• - ??e?µ????? ap?st?µa.
• - ?etastat??? ??s?? ????st?? p??t?pa???? est?a? ?
  ?pe????t??? s?????? ????st?? a?t??????a?.

26

• S???T??S ????????S (2)
• Te?ape?t????
• - ?p?µ?????s? ????? s?µ?t??.
• - ?pe?ß?????? ß???????? e????se?? ?a?
  ate?e?tas?a.
• - ??a?µat?p???s? d?s????? ??? d?as?????s??.
• - ??ast??? st???s?? t?? ae?a?????.
• - ??t?µet?p?s? a?µ?pt?s??.
• - ???e??e???t??? e?t?µ?s? d??at?t?ta? e?t?µ??.
• - ?fa??es? ?e?p?asµ?t?? t?? ?e?t????? ae?a?????
  µe ???s? laser.

27

• ???????S? (1)
• ????eta? ?? ? ap??e?a a?µat?? ap? t? ?at?te??
  a?ap?e?st??? a?a??a?a ? d?af????? d?????s? ap?
  t?? ?e?d?a?µ?pt?s? a?µa p?? p?????eta? ap? t?
  st?µat??? ?????t?ta, t? ??????a-????f?????a ? t?
  ?ast?e?te????.
• ?????te?a a?t?a a?µ?pt?s??
• - f?e?µ???d?? p?e?µ????? ??s?? f?µat??s?,
  ß????e?tas?a, ?e???t??? p?e?µ???t?da, ap?st?µa,
  ???µ??? ap? µ???te?,
• - ?e?p?as?a,
• - ?a?d?a??e?a??? d?ata?a??? a?e???sµa a??t??
  p?e?µ????? eµß???, a??e?a??? d?sp?as?e? ??p.,
• - a?µat???????? d?ata?a??? a?t?p??t??? a????,
  ???µß???t?pe??a, ?e??a?µ?a,
• - ?at???e??? ??? d?as?????s?.

28

• ???????S? (2)
• ????????s? as?e?? ?st?????, f?s??? e??tas?,
  p??t???t?ta, a???µ?? a?µ?peta????, ?/a ???a???,
  ?.?.G.
• ?s???? ?p???a p?? ? a?µ?pt?s? ?fe??eta? se
  ?a?d?a??e?a?? d?ata?a?? ? ???µ??? t??
  a?ap?e?st???? de? e?de????ta? ß?????s??p?s?
  a?t??eta, e?de????ta? ?ta? a?t? de? ?p????e? µet?
  ap? ??a 24??? eµpe?????? a?????.
• ?a???? a?µ?pt?s? (gt600ml/24???) ?fe??eta?
  s?????? se a?µ???a??a ß???????? a?t?????,
• - apa?a?t?t? ? p??stas?a t?? ae?a????? (p???µ??),
• - ???s?µ?t?ta gt75,
• - apa?a?t?t?? ? e?t?p?sµ?? ?a? ? d?????s? t??
  a?t?a? t??.

29

• ???????S? (3)
• ??????s??p?s? p??? t?? pa?s? t?? a?µ?pt?s??
  a???ß?? ?a????sµ?? s?µe???-a?t??????a? st? 99
  (lt50 µet? t?? pa?s?).
• Se µa???? a?µ?pt?s?, p??t?µ?ta? t? ??aµpt?
  ß?????s??p?? e?????te?? ap?µ?????s?
  a?µat??-???µß?? (µe?a??te?? d??µet???
  a?a???f?s??).
• ??t?µet?p?s? a?µ???a??a? t?p??? ????s? ??????
  N/S, ad?e?a????? ? ßa??p?ess????, ep?p?µat?sµ??
  µe ?a?et??a Fogarty, ? ?a?t???as? a??e???,
  d?????s? a?t?a? (p.?. d?ata?a??? p????) p??a??
  ? a????? eµß???sµ?? t?? a?t???a? ? ? ?e?????????
  ?e?ape?a.

30

• ???????????S ???G??S????S?S (1)
• ?p???te?
• - ???e??? ?at?????a e?pa?de?µ???? p??s?p????.
• - ???e??? ?at??????? ?p?d?µ??.
• - S?ßa?? a?µ?d??aµ??? ast??e?a.
• - ?d??aµ?a d?at???s?? d?aßat?t?ta? ae?a????? ?at?
  t? d?ad??as?a ?a?????spasµ??, d?as?????s? µe ???
  s????a µ????? µe??????.
• - ??e???? ?a?d?a?? ?s?a?µ?a ? ?a????e?? a????µ?e?.

31

• ???????????S ???G??S????S?S (2)
• S?et????
• - ?? s??e???s?µ?? as?e?e??.
• - ?s?e?e?? µe ????? e?d??????a p?es?.
• - S?µpt?µat???? as?e?e?? µe ?s?µa ????? ?e?ape?a.
• - ?s?e?e?? µe s?ßa??? d?ata?a??? p????, ?ta?
  ????eta? apa?a?t?t? ? ???? ß?????? (a?µ???a??a
  pe??????).
• - ?d??aµ?a ??????s?? epa????? p????t?ta? ?2 ?at?
  t? ß?????s??p?s? ?a? ??a 4 ??e? µet? (?at? µ?s?
  ??? pt?s? t?? Pa?2 ?at? 20 st? d????e?a
  e??tas??).
• ???ta ?a sta?µ??eta? t? p??sd???µe?? ?fe??? µe
  t?? p??a??t?ta ep?p?????.

32

• ????????S ???G??S????S?S (1)
• T??s?µ?t?ta 0,01-0,1, µe????e? ep?p????? 2-5.
• ?s?e?e?? µe ?s?µa ep???epe?? se ?a?????spasµ?,
  ß?????spasµ?.
• ?s?e?e?? µe ?a?d?a??e?a??? d?ata?a???
  ep???epe?? se a????µ?e? ?a? st??????.
• ???s??atasta?µ???? a???µ???? ???d???? ???µ??e??
  ???? t?a?µat?sµ??.
• ???asµa ß?????s??p??? µ?s? t?? f?????a
  ???d???? ?a?????spasµ??, eµet??, e?s??f?s??.
• ???asµa ß?????s??p??? st?? t?a?e?a
  ß?????spasµ??, t?a?µat?sµ?? ??????a.
• ?peµßat??? ???s? ß?????s??p?s?? a?µ???a??a,
  p??et??, ßa?t???a?µ?a.

33

• ????????S
• ???G??S????S?S (2)
• ? ???s?µ?t?ta ?fe??eta? ??????
• - st? ??????s? ?pe?ß?????? d?s??
  ?atast????-a?a???s?a? p?????s? ?p???a?,
• - st?? t?p??? a?a?s??s?a p?????s? a????µ???,
  spasµ??,
• - se a?ap?e?st??? a?a??p? ap? a?µ???a??a ? ??t???
  ?p?tas?,
• - se ?a?????spasµ?, ß?????spasµ? ? ?a?d?a??
  a?a??p?.
• ?a?????spasµ?? a?ta?a??ast???? s?sp?se?? t??
  fa???????? µ???, p?? p???a???? spasµ? ?a?
  s????e?s? t?? f???t???? ???d?? µe s???pe?a t??
  ad??aµ?a e?sp????.
• ???e? ep?p????? p?e?µ???a, p?e?µ????a?a?.

34

• ???????S?? ???G??S????S?S (1)
• ???et??µas?a as?e??
• - p????f???s? ?a? s??a??es?,
• - ap?f??? ????? t??f?? 4-8 ??e? p??? t?? ??a???
  (???d???? e?s??f?s??),
• - t?p???t?s? as?e?? se ?pt?a ??s?,
• - t?p??? a?a?s??s?a ??d??a??? se ???? ? gel,
• - ??????s? e?af???? ?atast???? µ?da????µ?,
  p??p?f???, fe?ta???? (p??s??? st?? ae??sµ?),
• - p??et??µas?a ß?????s??p??? ??pa?s?, ??e????.
• ???at?t?ta ß?????a?a???f?s?? ?a? epe????sa?
  d?as?????s??.

35

• ???????S?? ???G??S????S?S (2)
• ?a?a???????s? pa?aµ?t??? as?e??
• - pa?µ??? ???µet??a e?t?µ?s? ???????s??,
  a?a?????s? ?p??a?µ?a?,
• - ??G, ?a?d?a?? s????t?ta, a?t???a?? p?es?
  (a?µat??? ? ???),
• - p?es? ae?a????? se d?as?????µ????? as?e?e??
  ??e???? ??µat?µ??f?? ?a? µ???st?? p?es?? ????
  a???s?? t?? e?sp?e?st????-e?p?e?st????
  a?t?st?se??.
• ??????s? ?2 se ??? t? d????e?a t?? d?ad??as?a?
  (?at? p??t?µ?s? FiO21,0).

36

• ???????S?? ???G??S????S?S (3)
• ?p?f??? e?d??e???? ?et???? te??-e?p?e?st????
  p?es?? (auto-PEEP ???? a???s?? e?p?e?st????
  a?t?st?se??) µp??e? ?a ?d???se? se ßa??t?a?µa ?
  µe??s? ?a?d?a??? pa????? apa?te?ta? ? ???s? ???
  s????a µe d??µet?? gt8,5mm.
• ?????? ?d?? pa???e? t? µ???st? ??es? ??a t??
  as?e??. St?µat??? ?d?? p??t?µ?ta? st??? as?e?e??
  µe d?ata?a??? p???? ? d?s???? ?????? a?at?µ?a.
• ???????ta? ??s?, µ??e???, s??µa, ????? ?a?
  d?aßat?t?ta ae?a?????, ????t???t?ta f???t????
  ???d??, pa???s?a d????se??, f?e?µ????, e????se??.

37

• ?????????T?S? ???? ?? ???G??S????S?
• Se d?as?????µ????? as?e?e??
• - ???? a?t?????af?a? ???a?a (ap???e?sµ??
  p?e?µ????a?a),
• - epa?af??? ???µ?se?? t?? a?ap?e?st??a.
• Se µ? d?as?????µ????? as?e?e??
• - ??????s? ?2 ??a t?? ep?µe?e? 2-4 ??e?,
• - de? ep?t??peta? ? ???? ?e???-t??f?? ??a t??
  ep?µe?e? 1-2 ??e? (d??s? t?p???? a?a?s??s?a?).
• ?a?a???????s? ??t???? s?µe??? t??????st?? ??a 2
  ??e?.
• ?p???e?sµ?? p?e?µ???a? (?d??? se as?e?e?? gt60
  et?? ? µe e?d?s??p???? ß??ße?).

38

• S?????????S?
• ?a?e?a ?ata??af? d??aµ???? p?e?µ?????? ????? ?a?
  ????t???t?t?? (se s????t?s? µe t? ?????) ?at? t?
  d????e?a e?sp???? ?a? e?p???? µe p??sp??e?a ??a
  t?? ?a????sµ? t?? p?s? ap?te?esµat??? ?a? ??????a
  ?? p?e?µ??e? µp????? ?a ?eµ?s??? ?a? ?a ade??s???
  µe a??a.
• ???aµ??? e?p??? ? ap???ste?? d???µas?a t??
  a?ap?e?st????.
• ?a???e? p????? p????f???e?, apa?te? e????sta
  µ??a??µata.
• ?? µe?a??te?? p?s?st? t?? p?e?µ???pa???
  pa???s???e? d?ata?a??? st? d???µas?a.

39

• ??S???? ???S???

VC ??t??? ????t???t?ta VT a?ap?e?µe???
????? TLC ????? p?e?µ????? ????t???t?ta IC
e?sp?e?st??? ????t???t?ta FRC ?e?t???????
?p??e?p?µe?? ????t???t?ta IRV e?sp?e?st????
efed????? ????? ERV e?p?e?st???? efed?????
????? RV ?p??e?p?µe??? ?????
40

• ????????S S?????????S?S (1)
• ?????e?s? ??s?µ?t?? a?ap?e?st????
• - s?µpt?µata ???a????? p????, ß??a?, d?sp???a,
  s????µ??,
• - f?s??? e???µata ?????s?, µe??s? a?ap?e?st????
  ????, a??µa??e? ???a????? t????µat??,
• - e??ast???a?? e???µata a?t?????af?a ???a???,
  a???a a?µat??.
• ??t?µ?s? ßa??t?ta? ? e??????? ??s?µ?t??
• - a?ap?e?st??? ?????a ap?f?a?t???
  p?e?µ???p??e?a, ??st??? ???s?, sa???e?d?s?,
• - ?a?d?a??e?a?? s?µf???t??? ?a?d?a?? a?ep???e?a,
  p?e?µ????? ?p??tas?,
• - ?e???µ???? p???ap?? s??????s?, ßa???
  µ?as???e?a.

41

• ????????S S?????????S?S (2)
• ????????s? ???d???? as?e??? p??? ap? ?e?????????
  ep?µßas?
• - ???a?a ??ße?t?µ?, p?e?µ??e?t?µ?,
• - ?a?d??? a??t?stefa??a?? bypass, a?t??at?stas?
  ßa?ß?d??,
• - ?e????? ?e?????????? ??????ste?t?µ?, ?ast????
  bypass,
• - µetaµ?s?e?s? ???????
• ????????s? a?ap???a? (??µ???-asfa??st???
  ??µata).

42

• ???????????S S?????????S?S
• ??e?e? d?ata?a??? p?? ep??e????? t?? e?t??es?
  t?? d???µas?a? ?a?t?a, ?µet??.
• ??µ?pt?s? ????st?? a?t??????a? p??a??
  ep?de???s?.
• ?a???s?a p?e?µ????a?a.
• ???sfat? ?e????????? ep?µßas? ???a?a, ?????a? ?
  ?f?a?µ??.
• ???sfat? ?µf?a?µa µ???a?d??? ? asta??? st??????.
• ?a???s?a ???a????? a?e???sµ?t??.

43

• ??????? S?????????S?S
• ? as?e??? se ?a??st? ??s? (??es?), ??e?s?µ?
  µ?t?? µe ???p, efa?µ??? st?µat?? st? ???? t??
  s????a t?? sp???µet???.
• ?f??eta? ?a a?ap??e? f?s????????, µ???? ?a
  ep?te???e? µ?a sta?e??? p??t??? a?ap??? (µet? ap?
  4-5 a?ap????).
• ?a??t???eta? ?a e?sp?e?se? a??? ?s? pe??ss?te??
  µp??e? (µ???? t?? TLC) ?a? a???????? ?a f?s??e?
  p??? ta ???, ß?a?a ?a? ??????a, ?s? pe??ss?te??
  µp??e? (µ???? t?? RV).
• ?pe?d? ?? ????? e?a?t??ta? ap? t?? p??sp??e?a
  p?? ?ataß???e? ? as?e???, ? pa??t???s? p??pe? ?a
  e??a? ??t??? ?a? s??e???, µ???? ?a µ? µp??e? ?a
  ß?e? ???? p?s?t?ta a??a ap? t??? p?e?µ??e?.
• ? d?ad??as?a epa?a?aµß??eta? t??????st?? 3 f????
  ?a? a??????e?ta? ? µ???st? p??sp??e?a.

44

• ?????????? S?????????S?S
• ???aµ??? ??t??? ????t???t?ta (FVC) ? ????? t??
  a??a p?? µp??e? ?a e?p?e?s?e? µe t? µ???st?
  p??sp??e?a µet? ap? t? µ???st? d??at? e?sp???. Se
  f?s???????? ?t?µa FVCVC.
• ???aµ??? e?p?e?µe??? ????? (FEV) ? ????? t??
  a??a p?? e?p??eta? se ??a s???e???µ??? ????? ?at?
  t?? e?t??es? µ?a? FVC. ?p?te?e? µ?t?? t?? ????
  t?? a??a.
• FEV1 ? ????? t?? a??a p?? e?p??eta? se 1sec.
• ?e??t?? Tiffeneau FEV1 / FVC x 100. ?p?te?e?
  µ?t?? t?? a?t?st?se?? t?? ae?a?????.
• ???aµ??? e?p?e?st??? ??? µeta?? 25-75 t?? FVC
  (FEF25-75) ? µ?s?? ???? t?? e?p?e?st???? ????
  ?at? t? d????e?a t?? µ?s?? tµ?µat?? t?? FVC.
  ?p?te?e? de??t? ap?f?a??? t?? µ????te???
  ae?a?????.

45

• S????G????? ??? ??????? ???S-?G???

46

• ??????S??? S?????????S?S (1)

? µ???st? ??? p??pe? ?a ep?te???e? sta p??ta
200ml.
? µ???st? t?µ? st?? ?aµp??? st?? e?p?e?st??? f?s?
p??pe? ?a e??a? ??e?a.
47

• ??????S??? S?????????S?S (2)

?e? p??pe? ?a ?p???e? pt?s? st? ??? p??? t?? t?µ?
t?? FEV1
H e?sp??? p??pe? ?a ep?st??fe? st? s?µe??
e?????s??.
48

• ??T???G???S ???????S ???S-?G???

?s?e?e?? µe ?????a ap?f?a?t??? p?e?µ???p??e?a.
?s?e?e?? µe ap?f?a?? a??te??? ae?a?????.
49

• ???????S???? ???G???

50

• ???????? ???????S???O?

• ?p?f?a?t???? t?p?? p?e?µ???p??e?e? ?s?µa -
  d?s????a e?p???? µe??s? e?p?e?st???? ta??t?t??,
  a???s? TLC ?a? RV.
• ?e?????st???? t?p?? p?e?µ???p??e?e? p?e?µ?????
  ???s?, pa??sa???a, ??f?s?????s?, ?e???µ???? ??s??
  - d?s????a e?sp???? µe??s? p?e?µ?????? ?????.
• FVC ?a? FEV1 µe?????ta? t?s? st?? ap?f?a?t????
  ?s? ?a? st?? pe?????st???? p?e?µ???p??e?e?.
• ?e??t?? Tiffeneau f?s???????? t?µ? gt80.
• ?p?f?a?t???? p?e?µ???p??e?e? lt80.
• ?e?????st???? p?e?µ???p??e?e? gt80.

51

• ????G?S? ??S???????O? F?????O? (1)
• ?????e? s?µa?t??? ? ?e?ape?t???? de??t??
  (ep???µ?t??/a?ep???µ?te? e????e?e?) t? f??µa??
  ?????e?ta? se µ???? d?s?, d?a t?p??? ?a?
  ap????f?ta? e????sta ap? t? s?st?µat???
  ?????f???a.
• ?e????µa ?????e?d?? d????µa s?µat?d??? µ?sa se
  µ?a a???a f?s? s?µat?d?a
• - ???? ? ste?e? ??s?a (µ??f? ?????),
• - a??et? µ????? µe?????? ?ste ?a µ??
  a?a?a?t????ta? ap? ta a?at?µ???-f?s????????
  eµp?d?a t?? ae?a?????.
• ??ap??es? e?sp?e?µe??? s?µat?d??? d?aµ?t???
  1-5µm ?a???????? st??? µ?????? ae?a??????
  (6?-17? ?e??? ß??????).

52

• ????G?S? ??S???????O? F?????O? (2)
• ?a?????te? e?ap??es?? s?et???? µe t?? as?e??
• - e?sp?e?st??? ??? (?s? ta??te?? t?s?
  ?e?t????te?? ? e?ap??es?),
• - e?sp?e?st???? ?????? (?s? µ????te???),
• - e?sp?e?µe??? ????? (?s? µ????te???),
• - a?at?µ??? ?atas?e?? ß??????, pa?????????
  µetaß????.
• ???? te????? e?sp???? ae????µat??
• - a?a????s? s?s?e??? ?a? t?p???t?s? t?? µp??st?
  ap? t? st?µa,
• - ßa??? e?p???,
• - p???d?t?s? s?s?e??? ?at? t? d????e?a t?? ??eµ??
  ?a? ßa???? e?sp???? (ap? t?? FRC ?? t?? TLC),
• - e?sp?e?st??? ?p???a 10sec (e?ap??es? p??? t?
  d?µ??????a e?p?e?st???? ?e?µat?? a??a).

53

• ????G?S? ??S???????O? F?????O? (3)
• ???t???a e?sp?e?st???? s?s?e???
• - e?????a ???s?? e?af???, p???ap??? d?se??,
• - ap?te?esµat???t?ta ß??t?st? e?ap??es?,
  ?at?????? ??a ??e?e?-?????e? pa??se??,
• - asf??e?a e????st? st?µat?fa??????? e?ap??es?,
  ap??s?a ß?aße??? p?????t????,
• - ?aµ??? ??st??.
• ???ß??µata st? ???s?
• - ????? te????? ???e??? s??t???sµ??
  e?sp?e?st???? p??sp??e?a? - p???d?t?s??,
• - ß?????? f????,
• - p??s?ete? ??s?e? p?????s? ß?????spasµ??.

54

• ??F?????????S
• G?a t? ??????s? µe????? d?se?? fa?µ???? ? a?t??
  p?? de d?at??e?ta? se e?sp?e?st???? s?s?e???
• - f??µa?? se µ??f? ????? d?a??µat??,
• - e?sp?e?µe?a s?µat?d?a pa?????ta? e?te ap?
  µ??a??sµ? s?µp?esµ???? a??a ? ap? ??µata
  ?pe?????,
• - ep?st?µ?a µe ßa?ß?da e?sp????/e?p???? de
  f???e? st? st?µa t?? as?e?? f??µa?? ?at? t?
  d????e?a t?? e?p????,
• - ???p??? ?efe??p???t?? p??sa?µ??? d?s?? µe ß?s?
  t?? sp???µet????? pa?aµ?t???? t?? as?e??.
• ?da????? ?efe??p???t??
• - e????st?? (µ????? ß?????),
• - ?efe??p???s? a?a??a?a? d?s?? se 5-10min, ?????
  ?a af??e? µe???? ?p??e?µµa,
• - ?efe??p???s? fa?µ???? ???? t?? ?at???????,
  µ??e??? s?µat?d??? 1-5µm.