ACUTE RESPIRATORY FAILUR

Ventilation • • CO2 •••

Respiration
Oxygenation • • O2 •••

Anatomy of respiratory system

Respiratory mechanic
ribs ribs vertebral column sternum vertebral sternum column

diafragma

diafragma

EXPIRATION

INSPIRATION

Kemoreseptor

Kemosensitif rostral & kaudal

Glomus karotikum & aortikum

air -4

Air flow

air

+2 Intra thoracal Intra pulmonal +4

- 10

-4

-7

INSPIRATION

EXPIRATION

Lung Volume

6.0

Inspiratory Reserve Volume

Tidal Volume Expiratory Reserve Volume

2.7 2.2 1.2

Residual Volume Dead Space

0.0 Volume (L)

ALVEOLI

Tipe-1 Tipe-1I

Gas transportation
ClHHb ⇔ H+ + HbHbO2 ⇔ Hb + O2 O2

CO2 HCO3- + H+ ⇔ H2CO3 ⇔ H2O + CO2

Lung

Plasma

ClCO2

Tissue
O2

HHb ⇔ H+ + HbO2 + Hb ⇔ HbO2

CO2 + H2O ⇔ H2CO3 ⇔ H+ + HCO3-

O2 158.0 CO2 0.3 H2O 5.7 N 596.0 inspirasi

ruang rugi

alveoli O2 CO2 H2O N jantung kanan

100.0 40.0 47.0 573.0 jantung kiri

O2 116.0 CO2 32.0 H2O 47.0 N 565.0 expirasi

O2 CO2 H2O N

40.0 46.0 vena 47.0 573.0

kapiler O2 40.0 CO2 46.0 H2O 47.0 N 573.0 jaringan

O2 CO2 arteri H2O N

95.0 40.0 47.0 573.0

Faktor predisposisi

     

Struktur dan fungsi toraks belum sempurna Saluran nafas sempit Alveolus belum berkembang Defisiensi surfaktan Kelainan bawaan Rentan (mudah infeksi saluran nafas)

Anatomical & Physiological difference Neonate vs Adult
• • • • • • • • • • Neonate Adult Lung weight, g 50 800 ∅ of trachea, mm 8 18 ∅ of bronchioles, mm 0.1 0.2 ∅ of alveolus, µ 50-100 200-300 Numbers of alveolus, 106 24 296 Number of airways, 106 1.5 14 Total alveolar surface area, M2 4 80 Total flow resistance, cm H2O/L/sec 68 5.5 Respiratory rate/min 40 20 Tidal Volume, ml/kg 6 7

Croup Sumbatan benda asing Bronkitis Gangguan jalan nafas Asma Pnemonia Edema paru Deformitas toraks Hernia diafragmatika Gangguan mekanik Pernafasan Fraktur iga Etiologi Efusi plura

Anemia berat/intoksikasi Renjatan Gangguan transportasi gas Gagal jantung

Trauma/infeksi batang ot Gangguan neurologik Poliomielitis Trauma lahir (n.prenikus)

Criteria for respiratory failure

inical

Decreased or absent inspiratory breath soun Severe inspiratory retractions Cyanosis in 40 % O2 Depressed level of consciousness Poor skeletal muscle tone

hysiologic PaCO2 > 75 mmHg PaO2 < 100 mmHg in 100 % O2

Three clinical + One physiologic criterion = AR

Management
 Supportive  Definitive

Supportive
 Respiratory  Circulatory/Hematologic  Fluid/Electrolyte/Caloric

(Air Negative pressureshield isolatte)

VENTILATOR Positive

Pressure limited Volume limited Time cycle pressure I/E ratio limited Time limited High frequency

P-

P+

Negative pressure ventilator Positive pressure ventilator

steps in managing of mechanical ventila

se appropriate goals for ventilation and oxyge t ct the modes of ventilation rmination of initial ventilatory parameters he selected parameters te the ventilatory support rm the appropriateness of initial setting and m stments accordingly ipate complications weaning when ventilatory support no more re

Respiration

• pH Minute Volume • • Rate VentilationPaCO2 • ETCO2 • Tidal Volume

• FiO2 • PaO2 Oxygenation • Mean Airway • SaO2 Pressure (MAP)

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