pertimbangan respirasi

7/23/2019 pertimbangan respirasi

1/26

fendy


2/26

Lung DevelopmentFive phases:

Embryonic

PseudoglandularCanalcular

Saccular

alveolar


3/26

Embryonic phaseOriginates in the 3!ee"old embryo

#entral diverticulum from caudal end of the

laringptracheal grovee of the foregutDiverticulum gro!s caudally primitive

trachea

$th!ee"s: the end of diverticulum divides

t!o primary lung buds : 3 right% & left


4/26

' th!ee" gestation :

Lobar buds bronchopulmonary segments

#ascular component


5/26

Pseudoglandular phase( th)'th!ee"s of gestation : pulmonary

vasculature

)'th

!ee"s: all the bronchial air!ayshavebeen formed* gro!th occur only byelongation and !idening of e+isting air!ays

,espiratory epithelium begins to di-erentiate

Cilia appear in pro+imal air!ays


6/26

Develop cartilago to support air!aysstructures

Smooth muscle cells increase.lteration in the development of vascular

structures% cartilago% smooth muscle pulmonary disorders


7/26

Canalicular phase)'th/ &$th!ee"s of gestation: basic structure

of the gase+changing portion of the lung:formed 0 vasculari1ed

Comple+ irregular pattern


8/26

2erminal Sacculus phase&$th/ term:

ntertitial tissue : less prominent

.irspace !alls : thinningf


9/26

.lveolar phase4arrier bet!een the gas in the alveoli 0 the

blood in the capillaries% 3 layer:

Processes of the type cells4asement membrane

Endothelial cells


10/26

Pulmonary Physiology2he 5rst fe! breath:

Pulmonary arterial PO&increase% PCO &

decreasePulmonary vasodilatation

#ascular resistance decrease

Constriction of the ductus arteriosus

Loss of maternal P6


11/26

Clossure ductus venosus :

7mbilical blood 8o! stop

Systemic vascular resistance increaseleftside heart pressure increaseclossure foramenovale 9right to left shunt clossure

Fetal circulation postnatal circulation

.ny disturbance; failure of any of these events : < persistence; recurrence of fetal circulation

< respiratory failure


12/26

4reathing

Process comple+

Contaction of inspiratory muscle negativepressure in trachea fresh air into the lung

O&upta"e 0 CO&elimination di-usion acrossthe ultra thin alveolar capillary membrane

Fuel the cell of body !ith O&for metabolism

=aintain appropriate acidbase status by

regulation of CO& Disfunction in any part of this process

respiratory failure mechanical ventilatorysupport


13/26

=onitoring>on invasive:

Pulse o+imetri

Capnometry

nvasive :

.rterial catheteri1ation

Pulmonary artery catheteri1ation


14/26

Pulse o+ymetry.dvantages: ,apid response

>on invasive

Disadvantages: nsensitive to large changes in arterial PO&at the upper

end of o+ygenated ?b dissociation curve

Falsely elevated SaO&reading: presence of carbo+y?b

and met?b Physical factors : poor peripheral perfusion% abnormally

thic" or edematous tissue at side of sensornplacement% nail polish% e+cessive ambient light

inaccurate readings


15/26

.rterial catheteri1ation.dvantages:

=ost accurate continuous measurement PaO&

and PCO&Disadventages:

nvasive

nvolves ris" of: infection% emboli1ation%

thrombosis% 9 anemia

>eed for CD? case


16/26

=echanical ventilatorPressurecontrolled ventilation

#olumecontrolled ventilation


17/26

Pressurecontrolled

ventilation.dvantage: Carefull control of PP% mean air!ay pressure

avoiding barotrauma

Disadvantage: 2idal volume depend of inspiratory time and

compliance!hen lung compliance changesduring the course of illnesstidal volume

may change dramatically 9 avoidundervantilation as compliance !orsens oroverdiatention; barotrauma as complianceimproves


18/26

#olumecontrolledventilation.dvantage:

Consistent delivered tidal volume

Disadvantages: .ctually volume gas in@ected into ventilator

circuit not volume of gas deliverd into thepatientA lung

?umidi5cation% compression of gas% distentionof the compliant circuit% lea" around uncu-edendotracheal tubecontribute in accurate

control of delivered tidal volumeB


19/26

=odes of ventilation Control =ode

.ssistControl =ode

ntermittent =andatory #entilation Synchroni1ed ntermittent =andatory ventilation

Pressure Support #entilation

Continuous Positive .ir!ay Pressure and

Positive EndE+piratory Pressure nverse ,atio ventilation

?ighfreuency #entilation


20/26

.d@uncts to mechanical

#entilationProne positioning

nhaled nitric o+ide

Pharmacologic in .,DS: PgE% acetylcysteine%highdoses Cort+% surfactan


21/26

=anagement of ,espiratory

Failure nadeuate o+ygenation leading to hypo+emia

or

nadeuate ventilation leading to hypercarbia

First step:

Establish an adeuate air!ay% o+ygenated

Still inadeuateendotracheal tube :

)'age of child

$


22/26

2he goal of mechanical

#entilation,estore alveolar ventilation and o+ygenation

to!ard normal !ithout causing in@ury from

barotrauma or o+ygen to+icity

=aintaining PaO&Gmm?g

PaCO& $' mm?g

p? (%3(%$

=i+ed venous o+ygen saturation H(I


23/26

#entilator settingnitial Pressuredcycled ventilator:

FiO&J )I

,ate &3 breaths ;mntPPJ&3 mm?g

PEEPJ 3mm?g

nspiratory ratioJ):&

nitial tidal volume 'G ml;"g


24/26

Keaning

Process during !hich mechanical ventilationslo!ly !ithdra!n% allo!ing the patient to assume

an increasing amount of !or" of breathingB

?emodynamically stable Spontaneously maintain an acceptable PaCO&

FiO&H %$

PP H 3 PEEP H

#entilator assisted breaths H )+;mnt

,atio of dead space gas;tidal volumeH %'

9normal O%3


25/26

Complication of =echanical

ventilation 4arotrauma

O+ygen to+icity

4ronchopulmonary dysplasia >osocomial pneumonia

BBBBB Deep #ein 2hrombosis

pulmonary emboli

laringeal trauma

trachea stenosis

sinusitis


26/26

2han"s

Documents

pertimbangan respirasi