Foreword


It used to be a building lacked a roof though, and now the roof is ready as well. This building is called Critical Care Medicine. I have been building it for Georgia for more than 30 years.At the former Soviet Union countrie’s it call Reanimatologi end at the Europeans countries Intensive Care Medicine. Critical Care Medicine provides the service that costs enormously much. It can be considered to be a luxury for a country the medical practice of which employs the laws of limited resources. The laws had to be found and one had to make them work for Georgia. For today the process is over. Though it is still unavailable for poor countries like Georgia, and the most of the world population resides within these poor countries. From that point of view the example of Georgia will be useful for them. It will give a chance to the doctors living in these countries to save lives of millions of people, which could not be done before. It is much needed as well for the doctors working in the zones of military conflicts and catastrophes, because they too suffer from a common resource deficit. It will be useful for developed countries as well since apart from thrifty and prudent way of spending resources, it represents the newest technologies in treatment. The process was hard and no support was ever provided. Furthermore: the past similar to the present meant struggling on a daily basis. Separate pages of this struggle are based on more than 75 000 critical care patients, more than 56 000 among of who came back to life, they might make a whole town. The experience shows that the only place where how to treat critical care patients can be learned is a patient’s bed, thus, for those wishing to enter this hardest profession I might give just one advice - stay at the patient’s bed. Well, however, I’ve got another advice as well: Being a doctor involves genuine creativity and just by means of the more copying of existing knowledge of others one can not prove the fact that (s) he is an accomplished doctor. One is strictly required to contribute into the treasure of collective knowledge.I created the following terms: “Critical Medicine”; “Death Immunology”; “Critical Care Medicine while having resource deficit”; “Subconsciousness management under critical conditions” “Nanotechnology in Critical Care Medicine”,”New Life”,”New Death” and some others. This sure means that scientific researches in these directions has been carried by me and diagnostic and treatment methods of the patients belonging to this sphere were designed by me as well, among them an ” alternative method for prolongation of life expectancy”, “antilethal immunoglobulin”, “antilethal anatoxin”, “antilethal immunosorbent”, “death factor accentuation method”, “immunological memory definition method”, “endogenic toxaemia registration method”, “treatment method for respiratory distress syndrome in adults”,” cytokinemic storm repression method”, “Subconsciousness management in critical care patients”. Well considering all this, I would love to give some advice to my colleagues: Do create something and let others study it. They often ask me – what is the most important thing a critical care doctor has to know and what is the most essential knowledge a critical care doctor has to be absolutely skilled. Well this, on the one hand, involves blood circulation failure, Respiratory failure, Nervous System Failure, liver failure, Kidney failure, treatment management and, on the other hand, this includes as well performing tracheostomy, intubation of trachea, blood vessels catheterization, plasmapheresis, hemosorption or any other manipulations. And of course one thing is unspeakably certain, and this one means deep knowledge of all the abovementioned methods. Not because it was me initiating all this, the truth is, that development of ongoing events take their course in this very direction: a critical care doctor has to master perfectly the complex field of human immunology. And in the end, out of my 561 disciples I would like to thank those residents and junior doctors of critical care medicine who for all their efforts in helping me at refining separate chapters of this book with great diligence, among them: Zv.Kheladze, N.Kadjaia, T.Kadjaia, S.Makharashvili, Ts.Kharaishvili, E.Kartsivadze, K.Mumladze, N.Ramishvili, L.Lobjanidze, M.Chikvaidze , M.Dvalidze, T.Djanelidze, , N.KervalisSvili, L.Begiashvili, M.Mikadze, A.Bokolishvili, N.Muradashvili, Kh.Fruidze, L.Urushadze, D.Kalandia, S.Begiashvili and others. And one more thing: It is one of the first edition of Critical Care Medicine Manual ever published within Georgia and other countries. I understand that there might be some inaccuracies in this book, and I will be much grateful for informing of any kind of textual inaccuracy, so that inaccuracies and inconsistencies can be corrected in the following editions.

Zurab Kheladze





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Critical Care Medicine Institute
Main directions of Institute’s activities comprise: training of medical personnel, scientific research, medical practice, and publishing periodicals.