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Definisi
Acid-Base Information
•pH
•PCO2
•HCO3 [calculated vs measured]
Oxygenation Information
•PO2 [oxygen tension]
•SO2 [oxygen saturation]
PaO2 [oxygen tension]
SaO2 [oxygen saturation]
a = arterial
Pulse Oximeter Measures SaO2
http://umed.med.utah.edu/MS2/renal/AcidBaseTables/img001.JPG
5-step approach to
arterial blood gas interpretation
In summary:
Byrd RP. Mechanical ventilation [serial on Internet]. Medscape. [update 26 April 2012; cited 20 Januari 2013]. Available from:
http://emedicine.medscape.com/article/304068-overview#showall.
Assist mode ventilator
Byrd RP. Mechanical ventilation [serial on Internet]. Medscape. [update 26 April 2012; cited 20 Januari 2013]. Available from:
http://emedicine.medscape.com/article/304068-overview#showall.
Controlled mode ventilation
Byrd RP. Mechanical ventilation [serial on Internet]. Medscape. [update 26 April 2012; cited 20 Januari 2013]. Available from:
http://emedicine.medscape.com/article/304068-overview#showall.
• ↑ vol tidal ↑ airway pressure
• Peak airway pressure > 45 cmH2O persisten risiko barotrauma
• Plateu pressure dihitung pada akhir inspirasi,
u/mempertahankan tidak ada aliran ekspirasi <30 cmH2O
mencegah barotrauma
• Ventilator diprogram u/ tidak mengizinkan aliran ekspirasi pada
akhir inspirasi dalam waktu tertentu (biasanya setengah detik)
Byrd RP. Mechanical ventilation [serial on Internet]. Medscape. [update 26 April 2012; cited 20 Januari 2013]. Available from: http://emedicine.medscape.com/article/304068-overview#showall.
Initial FIO2
Byrd RP. Mechanical ventilation [serial on Internet]. Medscape. [update 26 April 2012; cited 20 Januari 2013]. Available from:
http://emedicine.medscape.com/article/304068-overview#showall.
Positive end-expiratory pressure
• akhir ekshalasi, PEEP mempertahankan tekanan jalan
napas pasien di atas atmosfir tekanan yang
melawan pengosongan paru yang pasif.
• dicapai dengan mempertahankan aliran tekanan positif
di akhir ekshalasi.
• Efektif bila pasien dgn peny paru difus (↓kapasitas
residual fungsional/FRC)
• FRC ↓ karena kolaps/ instabilitas alveolar ↓ area
pertukaran udara shunt intrapulmoner (darah tidak
teroksigenasi kembali ke jantung)
• PEEP ↑ tek & vol alveolar memperbaiki ventilation-
perfusion match, ↓ shunt
Byrd RP. Mechanical ventilation [serial on Internet]. Medscape. [update 26 April 2012; cited 20 Januari 2013]. Available from:
http://emedicine.medscape.com/article/304068-overview#showall.
Positive end-expiratory pressure
Byrd RP. Mechanical ventilation [serial on Internet]. Medscape. [update 26 April 2012; cited 20 Januari 2013]. Available from:
http://emedicine.medscape.com/article/304068-overview#showall.
Indikasi
Apneu dengan
henti napas,
Gagal Napas Syok
termasuk kasus
akibat intoksikasi
Disfungsi
Insufisiensi jantung
neurologis
Fauci, Braunwald, Kasper, Hauser, Longo. Harrison’s Principles of Internal Medicine. 17th ed. USA: McGrawHill Companies; 2008.
Laghi F, Tobin MJ. Indications for Mechanical Ventilation. In: Tobin MJ. Principles and Practice of Mechanical Ventilation. 2 nd ed. USA:
McGraw Hill; 2006. p. 129-47.
Goal ventilasi mekanik
Respiratory Hipoksemia
apneu
distress berat
Post operasi:
Hiperkapnia
gagal napas Syok
berat
dan trauma
Tobin MJ. Principles and Practice of Mechanical Ventilation. 2rd Ed. New York : McGraw-Hill Companies,Inc; 2006. p 148-51.
Respiratory distress
Tobin MJ. Principles and Practice of Mechanical Ventilation. 2rd Ed. New York : McGraw-Hill Companies,Inc; 2006. p 148-51.
Hipoksemia berat
• Respon oksigen 100% identifikasi patof, DD, terapi
• Shunt
– pneumonia, gagal jantung kongestif, atelektasis lobaris,
emboli paru.
– Perbaikan dgn PEEP
– PEEP ↑ ruang rugi anatomis & alveolar kapiler kolaps
dan paru tidak mendapat perfusi
Tobin MJ. Principles and Practice of Mechanical Ventilation. 2rd Ed. New York : McGraw-Hill Companies,Inc; 2006. p 148-51.
Hiperkapnia berat Hiperkapnia
Menekan
sisitem
saraf pusat
Tobin MJ. Principles and Practice of Mechanical Ventilation. 2rd Ed. New York : McGraw-Hill Companies,Inc; 2006. p 148-51.
Hipoksemia post operatif
Tobin MJ. Principles and Practice of Mechanical Ventilation. 2rd Ed. New York : McGraw-Hill Companies,Inc; 2006. p 148-51.
Trauma multipel flail chest
Tobin MJ. Principles and Practice of Mechanical Ventilation. 2rd Ed. New York : McGraw-Hill Companies,Inc; 2006. p 148-51.
Syok
Tobin MJ. Principles and Practice of Mechanical Ventilation. 2rd Ed. New York : McGraw-Hill Companies,Inc; 2006. p 148-51.
Komplikasi Ventilasi Mekanik
Gangguan hemodinamik:
Depresi jantung, gangguan
venous return, curah Barotrauma: tension
pengosongan lambung,
jantung, dan tekanan darah pneumotoraks, emfisema
penurunan mobilitas, dan
menurun, sehingga subkutis, emboli udara
memperlama proses
mengurangi aliran darah ke vaskuler.
pemulihan
pencernaan dan ginjal
Whiteley SM. Complications of Artificial Ventilation. In: Whiteley SM, ed Intensive Care. 2nd ed. Philadeplhia: Churcill Livingstone; 2006.
hal. 107-10.
Hess DR, MaIntyre NR. Mechanical Ventilation. In: Jones & Bartlett Learning, LLC. Diunduh dari
samples.jbpub.com/9781449655594/60038_CH22_462_500.pdf. Diakses pada 23 Januari 2012, pukul 20.00 WIB.
Terima kasih