Dr.zul Ventilasi

GANGGUAN VENTILASI

Muhammad Zulkarnain Bus

Ventilasi

Difusi

Perfusi

: peristiwa masuk dan

keluarnya udara ke dalam paru : perpindahan O2 darah alveoli ke

dalam darah dan CO2 dari darah ke alveoli

: distribusi darah ke dalam paru

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings.Role of Pressure in Pulmonary VentilationAir moves in and out of lungs by bulk flowPressure gradient drives flowAir moves from high to low pressureInspirationpressure in lungs less than atmosphereExpirationpressure in lungs greater than atmosphere


Zona konduksi / ruang rugi anatomis : Trakea ~ bronkiolus terminalis Bagian saluran napas tempat aliran udara dari luar ke dalam paru

Zona respirasi :

Bronkiolus respiratori ~ alveolus Berfungsi untuk proses pertukaran gas (difusi)

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings.Minute VentilationTotal volume of air entering and leaving respiratory system each minuteMinute ventilation = VT x RRNormal respiration rate = 12 breaths/minNormal VT = 500 mLNormal minute ventilation =500 mL x 12 breaths/min = 6000 mL/min


Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings.Alveolar VentilationVolume of air reaching the gas exchange areas per minuteAlveolar ventilation = (VT x RR) (DSV x RR)Normal = 4200 mL/min(500 mL/br x 12 br/min) (150 mL/br X 12 br/min)


Pulmonary volumes and capacitiesPulmonary volumes (by using spirometer):

Tidal volume is the volume of air inspired or expired with each normal breath = 500ml in young adult man.

Inspiratory reserve volume is the extra volume of air that can be inspired over and beyond the normal tidal volume = 3000ml.

Expiratory reserve volume is the extra amount of air that can be expired by forceful expiration after the end of a normal tidal expiration ~ 1100ml.

Residual volume is the extra volume of air that still remain in the lungs after the most forceful expiration ~ 1200ml.

The pulmonary capacitiesComprises more than one volume:

Inspiratory capacity is the volume of air inspired by a maximal inspiratory effort after normal expiration = 3500ml = inspiratory reserve volume + tidal volume.

The functional residual capacity is the volume of air remaining in the lungs after normal expiration = 2300ml = expiratory reserve volume + residual volume.

The vital capacity is the volume of air expired by a maximal expiratory effort after maximal inspiration ~ 4600ml = inspiratory reserve volume + tidal volume + expiratory reserve volume.

Total lung capacity is the maximum volume of air that can be accommodated in the lungs ~ 5800ml = vital capacity + residual volume.

Minute respiratory volume is the volume of air breathed in or out of the lungs each minute = respiratory rate x tidal volume = 12 X 500ml = 6000ml/min.

All lung volume and capacity are about 20 to 25% less in women than in men and are greater in athletic persons than in small and asthenic persons.

Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings.Pulmonary Function Tests:Forced Vital Capacity (FVC)Maximum volume inhale followed by exhale as fast as possibleLow FVC indicates restrictive pulmonary disease


Copyright 2008 Pearson Education, Inc., publishing as Benjamin Cummings.Pulmonary Function Tests:Forced Expiratory Volume (FEV)Percentage of FVC that can be exhaled within certain time frame FEV1 = percent of FVC that can be exhaled within 1 secondNormal FEV1 = 80%If FVC = 4000 ml, should expire 3200 ml in 1 secFEV1 < 80% indicates obstructive pulmonary disease


Forced capacity (FVC & FEV1)Normal

Obstructive

Restrictive

Gangguan pada faal paru :

A. Gangguan ventilasi

B. Gangguan difusi

C. Gangguan perfusi

A. Gangguan ventilasi

Restriksi

Obstruksi

MeasurementDefinitionAverage Adult Values ( m L )Tidal volume (VT)Each normal breath500Inspiratory reserve volume (IRV)Maximal additional volume that can be inspired above VT3000Expiratory reserve volume (ERV)Maximal volume that can be expired below VT1100Residual volume (RV)Volume remaining after maximal exhalation1200Total lung capacity (TLC)RV+ERV+VT+IRV5800Functional residual capacity ( FRC)RV + ERV2300

Restriksi : gangguan pengembangan paru oleh sebab apapun

Semua volume statis paru mengecil : KV, KPT, VR, VCE, KRF

VEP1 / KVP masih diatas 75% Gambaran flow volum loop = N (ukuran lebih kecil)

Obstruksi : gangguan saluran napas

baik struktural / fungsional

yang menimbulkan

perlambatan arus respirasi

Beberapa volume meningkat yaitu VR & KPT KV dapat turun atau normal

VEP1 / KVP < 75%

Kelainan restriksi

Parameter = KV

KV 80 - 120% nilai prediksi = N

KV < 80% nilai prediksi = restriksi KV > 120% = hiperinflasi

1. Kelainan parenkim paru :

Tumor paru

Pneumonia Abses paru Edema paru Atelektasis Fibrosis paru : ~ TB

~ Penyakit paru fibrosis

~ Pneumokoniosis : asbestosis, silikosis ~ Penyakit kolagen : RA, LE, sarkoidosis ~ Penyakit interstisial paru

2. Kelainan pleura :

Efusi pleura

Pneumotoraks

Pleuritis sicca / schwarte Tumor pleura

3 Kelainan dinding dada / tulang :

Patah iga

Obesitas

Pektus ekskavatus Skoliosis

Khiposis Gibbus

Kelainan obstruksi

1. Intra luminer :

2. Ekstra luminer :

~ tumor paru

~ sumbatan oleh sekret ~ benda asing

~ tumor yang menekan bronkus

~ jaringan peyanggah kurang (emfisema)

3. Penebalan mukosa (hiperplasia & hipertrofi) : bronkitis kronik

Documents

Dr.zul Ventilasi