ACUTE RESPIRATORY FAILURE

FAILUR
 Ventilation
• • • • • CO2
Respiration
Oxygenation
• • • • • O2
Anatomy of respiratory system
 Respiratory mechanic
ribs
ribs
vertebral vertebral
sternum column
column
sternum

diafragma diafragma

EXPIRATION INSPIRATION
 Kemoreseptor

Kemosensitif rostral & kaudal

Glomus karotikum & aortikum

 air Air flow air

-4 +2

Intra
thoracal
- 10 -4

Intra
+4
pulmonal
-7

INSPIRATION EXPIRATION
 Lung Volume
6.0

Inspiratory Reserve Volume

2.7
Tidal Volume
2.2

Expiratory Reserve Volume

1.2
Residual Volume

0.0
Dead Space
Volume (L)
ALVEOLI

Tipe-1

Tipe-1I
 Gas transportation
Cl-
HCO3- + H+  H2CO3  H2O + CO2 CO2


HHb  H+ + Hb- Lung
HbO2  Hb + O2 O2
Plasma

Cl-

CO2 CO2 + H2O  H2CO3  H+ + HCO3-



Tissue HHb  H+ + Hb-

O2 O2 + Hb  HbO2
O2 158.0 ruang rugi O2 116.0
CO2 0.3 CO2 32.0
H2O 5.7 H2O 47.0
N 596.0 alveoli O2 100.0 N 565.0
inspirasi CO2 40.0 expirasi
H2O 47.0
N 573.0
jantung kanan jantung kiri

O2 40.0 O2 95.0
CO2 46.0 CO2 40.0
vena arteri
H2O 47.0 H2O 47.0
N 573.0 kapiler N 573.0

O2 40.0
CO2 46.0
H2O 47.0
N 573.0
jaringan
 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,  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
Gangguan transportasi gasRenjatan
Gagal jantung
Trauma/infeksi batang otak
Gangguan neurologik Poliomielitis
Trauma lahir (n.prenikus)
 Criteria for respiratory failure
Clinical
Decreased or absent inspiratory breath sounds
Severe inspiratory retractions
Cyanosis in 40 % O2
Depressed level of consciousness
Poor skeletal muscle tone

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

Three clinical + One physiologic criterion = ARF

Management
 Supportive

 Definitive
 Supportive
 Respiratory
 Circulatory/Hematologic
 Fluid/Electrolyte/Caloric
 Negative pressure (Air shield isolatte)

VENTILATOR
Pressure limited
Volume limited
Positive pressure Time cycle
I/E ratio limited
Time limited

High frequency
 P- P+

Negative pressure ventilator Positive pressure ventilator

 The steps in managing of mechanical ventilation
Choose appropriate goals for ventilation and oxygenatio
Select the modes of ventilation
Determination of initial ventilatory parameters
Set the selected parameters
Initiate the ventilatory support
Confirm the appropriateness of initial setting and make
adjustments accordingly
Anticipate complications
Start weaning when ventilatory support no more require
 • pH Minute Volume
Ventilation• PaCO2
• Rate
• ETCO2
• Tidal Volume
Respiration
• FiO2
• PaO2
Oxygenation • Mean Airway
• SaO2
Pressure (MAP)