VENTILATOR IN ACUTE BRAIN INJURY

TEUKU YASIR
JCCA 2022
PASIEN ICU
MODSMOF
MOST

VENLIAATOR
IABP
ICBP
PACING

Ventilator Brain Injury organ crosstalk

AKI
MCI
POST OP
 PROBLEM HYPOPERFUSI PASIEN SAKIT KRITIS

• OTAK ORGAN YANG SULIT RECOVERY

• PERLINDUNGAN OTAK
• PERLINDUNGAN ORGAN LAIN

BANTUAN VENTILATOR PADA GANGGUAN ORGAN

SELAIN PARU ???
APA ISINYA…???

kapan intubasi ???

pada pasien ARDS

no recommendation !!, no Evidance

BECOME AN EXPERT….

Share and publish !!!!!

5
 BEBERAPA HAL YANG MUNGKIN BISA MEMBANTU

• BELAJAR TTG FISIOLOGI OTAK, BAGAIMANA CARA MEMONITOR BRAIN PERFUSI DAN
PERFUSI ORGAN LAIN
• BELAJAR TTG VENTILATOR CARA MEMPERGUNAKAN VENTILATOR YANG AMAN

KOMBINASIKAN
KEDUANYA

LIHAT KONDISI
PASIEN/LINGKUNGAN
LUNGS NEED PROTECTION
Perioperative
from multiple potentially GDT
injurious factors
Normal lungs
CPB, sepsis, trauma, lung
ischaemia–reperfusion,
and blood product transfusion

Injured lungs need

Anaesthetic management
mechanical ventilation LPS
British Journal of Anaesthesia 105 (S1): i108–i116 (2010
 LUNG PROTECTION..?

• OTHER ORGANS..?
• ICU ORGAN CROSS TALK
• MULTIPLE ORGANS PROTECTIONHOLISTIC MEDICINE
• BRAINORGAN LIMITED RECOVERYPROTECTION PRIORITY

BILA PARU BUTUH VENTILATOR SUPPORT ?? IDEAL UNTUK PROTEKSI OTAK..?

PARU RUSAKHYPOSIA OTAK JUGA MERANA

RISK FACTOR
LUNG INJURY
N ENGL J.2013; 369: 428-37
LPS…?
• 6 mL/kg predicted body weight (not actual body weight) is most
commonly quoted as this was the intervention arm of the practice
defining ARDSNet ARMA trial and is physiologically normal for a
healthy person
• Prevent ALI/ARDSMOF
Conclusions:
Clinicians managing patients with ARDS
should personalize decisions for their
patients
Am J Respir Crit Care Med Vol 195, Iss 9, pp 1253–1263, May 1, 2017
Ann. Intensive Care (2019) 9:69
Low of laplace

Papadakos 2007
MEKANISME PEMBUKAAN PADA ALVEOLUS YANG
KOLAPS
PEEP TERBAIK UNTUK TETAP PARU TERBUKA
KESIMPULAN

• PASIEN ICU PASIEN MULTIPLE PROBLEM

• ORGAN CROSSTALK
• GUIDELINE ???
• BELAJAR HOLISTIK DAN PRESICION MEDICINE
• VENTILATOR ADALAH ALAT BANTU ORGAN, BUKAN TERAPI MENYEMBUHKAN
PENYAKIT, KARENA ITU PERLU MEPERHATIKAN FAKTOR LAIN UNTUK SUKSESNYA
BANTUAN VENTILATOR
 s ih
k a
i m a
T er