Hendra Kurnia Rakhma, S.Kep.

, Ns
Pokok Bahasan
Definisi  Etiologi  Patofisiologi  Penatalaksanaan medis dan keperawatan

Definisi
Acute Lung Injury (ALI) Sindrom inflamasi paru akut dg pe↑an permeabilitas
vascular, ditandai dg:  Bilateral diffuse pulmonary infiltrate on chest radiograph
 200 mmHg < PaO2 / FiO2 < 300 mmHg, irrespective of the level of PEEP  No
clinical evidence of elevated left atrial pressure, atau  Pulmonary capillary
wedge pressure (PCWP) < 18 mmHg
Definisi
Acute Respiratory Distress Syndrome (ARDS) Sindrom inflamasi paru akut dg pe↑an
permeabilitas vascular, ditandai dg:  Bilateral diffuse pulmonary infiltrate on
chest radiograph  PaO2 / FiO2 < 200 mmHg, irrespective of the level of PEEP  No
clinical evidence of elevated left atrial pressure, atau  Pulmonary capillary
wedge pressure (PCWP) < 18 mmHg
Radiograph

Bilateral widespread infiltrate Normal Thorax

Penyebab ARDS
Direct Lung Injury (Pulmonary ARDS)
Aspiration or other chemical pneumonitis Infectious pneumonia Trauma: lung
contusion, penetrating chest injury Near drowning Fat embolism

Distant Injury (Non pulmonary ARDS)

Inflammation; sepsis syndrome Multiple trauma Shock, hypoperfusion Acute
pancreatitis
Web of Causation
Direct Lung Injury Distant Lung Injury Pe↓an aliran darah ke paru Merangsang
platelet teragregasi Melepaskan serotonin, bradikinin& histamin Menginflamasi dan
merusak membran alveloli Me↑an permeabilitas kapiler Cairan pindah ke ruang
interstitial Dlm jangka wkt lama menjadi Fibrosis Takipnea Dyspnea takikardi

Pola nafas inefektif

Protein & cairan banyak keluar ke interstitial Pe ↑ an tekanan osmotik interstitial
Merusak surfaktan & me↓an produksi surfaktan di alveoli Penumpukan secret PO2 me↓
PCO2 me↑ Kerusakan pertukaran gas Bersihan jalan nafas inefektif Alveoli kolaps
hypoxaemia Asidosis metabolik Mental confusion Odem paru Kelebihan volume cairan
Tanda dan Gejala ARDS
O2 sangat susah masuk ke sirkulasi darah krn alveoli terisi cairan. Alveoli menjadi
collapse
› Sesak dan nafas cepat › Nafas dangkal › Tekanan darah me↓ › HR me↑ › Perubahan
status kesadaran atau susah berkonsentrasi

Hasil Lab: non-spesifik

Hypoxaemia Elevated alveolar-arterial oxygen gradient
Prinsip Penatalaksanaan
 

Treat the primary problem ! Physiologic support

 

Of the lungs Other organs Lungs Sepsis Other

Avoid complications
  

Disease modifier
Adequate Oxygenation


Better Q relative to V
 

Pulmonary vasodilator Increase cardiac output (fluid/other) PEEP Inverse ratio

ventilation Recruitment manuvers Patient position Dry lungs are happy lungs

Better V relative to Q
   

Fluid management overall


Asuhan Keperawatan Klien dgn ARDS


Pengkajian


Keluhan Utama


Sesak napas Inhalasi racun (rokok, kimia corrosive) Aspirasi cairan (gastric,
tenggelam, hydrocarbon, ethylene glycol) Shock (traumatic, hemorrhagic, bacterial,
pneumonia septic) Drug overdose (heroin, methadone barbiturat) Trauma kepala,
thorax

Riwayat Penyakit Sekarang

 

 
Pemeriksaan Fisik


 

  

B1 breath: dyspnea, takipnea (RR me↑), shallow breath B2 blood: hipotensi,

takikardia B3 brain: susah bekonsentrasi, pe↓an kesadaran B4 bladder: B5 bowel: B6
bone: -
Diagnosa Keperawatan


 

Pola nafas inefektif b.d pe↓an compliance paru Kerusakan pertukaran gas b.d kolaps
alveoli Bersihan jalan nafas inefektif b.d penumpukan secret sekunder akibat kolaps
alveoli Kelebihan volume cairan b.d odem paru
Pola nafas inefektif


Tujuan


Pola nafas menjadi efektif selama masa perawatan Tidak ada tanda distress napas:


Kriteria Hasil


RR= 12 – 20 x/mnt, flaring nostril (-), tracheal tug (-), intrekking (-)


Intervensi
 

Posisi semi fowler atau slide head up 30-45° Bebaskan jalan napas dengan kepala
posisi ekstensi Bantu pernafasan dengan oksigen (intubasi dan ventilasi jika
diperlukan) Pertahankan istirahat klien
Kerusakan pertukaran gas


Tujuan


Masalah kerusakan pertukaran gas teratasi selama masa perawatan SpO2 98-100%
Analisa gas darah:
  

Kriteria Hasil
 

PaO2 80 – 100 mmHg PaCO2 35 – 45 mmHg pH 7,35 – 7,45



Intervensi
 

Kolaborasi pemberian diuretik (furosemid / lasix) Monitor evaluasi BGA, pulse

oxymeter, foto thorax