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    Duratul Fahlia
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    This document discusses acute respiratory distress syndrome (ARDS). It begins with an introduction noting the original description of ARDS in 1967 and its revised definition in 1994. It then covers the etiology, risk factors, pathogenesis, clinical manifestations, diagnosis, management, and prognosis of ARDS. The pathogenesis involves increased permeability of the alveolar-capillary membrane leading to pulmonary edema. Common risk factors include sepsis, multiple trauma, and gastric aspiration. Symptoms include rapid onset dyspnea, cyanosis, and bilateral pulmonary infiltrates on chest imaging. Management involves treating the underlying cause, providing cardiorespiratory support including mechanical ventilation, and administering therapies targeted at lung injury such as nitric oxide. Mortality increases with the number

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    This document discusses acute respiratory distress syndrome (ARDS). It begins with an introduction noting the original description of ARDS in 1967 and its revised definition in 1994. It then covers the etiology, risk factors, pathogenesis, clinical manifestations, diagnosis, management, and prognosis of ARDS. The pathogenesis involves increased permeability of the alveolar-capillary membrane leading to pulmonary edema. Common risk factors include sepsis, multiple trauma, and gastric aspiration. Symptoms include rapid onset dyspnea, cyanosis, and bilateral pulmonary infiltrates on chest imaging. Management involves treating the underlying cause, providing cardiorespiratory support including mechanical ventilation, and administering therapies targeted at lung injury such as nitric oxide. Mortality increases with the number

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    Download as PPT, PDF, TXT or read online from Scribd
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    93 views26 pages

    ARDS

    Uploaded by

    Duratul Fahlia
    This document discusses acute respiratory distress syndrome (ARDS). It begins with an introduction noting the original description of ARDS in 1967 and its revised definition in 1994. It then covers the etiology, risk factors, pathogenesis, clinical manifestations, diagnosis, management, and prognosis of ARDS. The pathogenesis involves increased permeability of the alveolar-capillary membrane leading to pulmonary edema. Common risk factors include sepsis, multiple trauma, and gastric aspiration. Symptoms include rapid onset dyspnea, cyanosis, and bilateral pulmonary infiltrates on chest imaging. Management involves treating the underlying cause, providing cardiorespiratory support including mechanical ventilation, and administering therapies targeted at lung injury such as nitric oxide. Mortality increases with the number

    Copyright:

    Attribution Non-Commercial (BY-NC)
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    Download as ppt, pdf, or txt
    of 26

    ARDS

    (Acute Respiratory Distress Syndrome)

    2/11/2013

    INTRODUCTION
    1967, Ashbaugh and colleagues Distress Syndrome Adult Respiratory 1994, AECC Acute Respiratory Distress Syndrome

    ETIOLOGY Pulmonal Nonpulmonal


    2/11/2013

    ALI ARDS

    Underlyng Diseases

    ARF

    RF CF NF MF MODS / MOFS

    DEFINITION
    ARDS acute clinical illness characterized by:
    The Development of bilateral pulmonary infiltrates on chest radiographs Severe hypoxemia (PaO2/FiO2200). Absence of congestive heart failure

    ALI ARF
    2/11/2013 3

    PENYEBAB ARDS I . LANGSUNG II. TIDAK LANGSUNG

    2/11/2013

    Langsung
    Aspirasi Tenggelam Inhalasi asap atau bahan kimia toksik Kontusio paru Keracunan Oksigen Pneumoni
    2/11/2013 5

    Tak langsung :
    Syok berat Sepsis Pankreatitis Emboli lemak Transfusi berlebihan Pasca transplantasi paru
    2/11/2013 6

    RISK FACTORS
    The most frequently seen are sepsis, followed by multiple trauma and gastric aspiration

    2/11/2013

    PATOGENESIS
    Belum diketahui dengan pasti diduga terletak pada membran alveoli

    2/11/2013

    Berbagai sebab ARDS


    membrana basal bertambah permiabilitasnya aliran cairan dari intra ke ekstra vaskuler edema
    2/11/2013 9

    Membran alveoli TD 2 tipe sel


    1. Sel epitel tipe 1 (Pneumosit tipe I / A)
    2. Sel epitel tipe II ( Pneumosit tipe II/B)

    2/11/2013

    10

    Sec. Umum Patogenesis ARDS 1.Edema paru 2.Shunting dalam darah paru 3.Fibrosis pada jar. Paru
    2/11/2013 11

    Edema paru : Permiabilitas kapiler meningkat Tek. Hidro. Jar menurun Tek. Hidro. Kapiler & arteri meningkat Tek. Onkotik & tek.hidro limpa menurun
    2/11/2013 12

    Shunting dlm aliran darah paru


    Rusaknya sel tipe I & II surfaktan menurun Alveoli kehilangan keluwesan paru atelektasis Autorefleksi pd arteri kontraksi arteriol shunting
    2/11/2013 13

    Fibrosis paru merupakan hal yang selalu terjadi akan tetapi fase bervariasi : Fase eksudat Fase proliferasi Fase penyembuhan
    2/11/2013 14

    PATHOPHYSIOLOGY
    Acute phase of ARDS

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    15

    Pathogenesis

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    CLINICAL MANIFESTATION
    Vary considerably : depending on the underline diseases and the number and type of organ other that are failing Symptoms : Rapid onset of dyspnoe (12 48 hr) of the predisposing event, tachypnea, dry cough, retrosternal discomfort, agitation Cyanosis if moderate to severe of ARDS Ronchi and whezing Tachycardia but jugular pressure is normal
    2/11/2013 17

    2. laboratorium
    ABG Analyzes
    Initially show hypoxemia with respiratory alkalosis, if progress hypoxemia with respiratory acidosis

    In septic : leukopenia or leucocytosis thrombocytopenia if systemic inflammation.


    2/11/2013 18

    Radiologi :
    Infiltrat paru difus bilateral edema ( Snow Strom Apperance)

    2/11/2013

    19

    MANAGEMENT
    Therapeutic goal :
    1. Treatment of the underlying precipitating event 2. Cardiorespiratory support :
    Mechacincal ventilation PEEP Fluid management

    2/11/2013

    20

    3. Specific therapies targeted at the lung injury Drugs to correct physiological abnormalities
    Nitric oxide Surfactant, etc

    Drugs used to supress lung inflammation


    Corticosteroid Prostaglandins, etc

    2/11/2013

    21

    DD
    Kegagalan nafas ARDS Hipoksemia atau hiperkapnia Hanya hipoksemia Dpt merupakan serangan pd Akut ( < 48 jam ) keggl kronis Kelainan primer paru atau diluar Kelainan primer paru paru Hiperkapnia tidak dapat Dapat merupakan disebabkan oleh ARDS keggl pernafasan dgn tipe hipoksemia
    2/11/2013 22

    PROGNOSIS
    Deaths :
    20% cause of respiratory failure 80% cause of sepsis + MOF

    Mortality rate with organ failure :


    Respiratory failure Failure 2 organs Failure 3 organs Failure 4 organs Failure 5 organs 40% 54% 72% 84% 100%

    Poor prognostic :
    Older than 65 years Sepsis
    2/11/2013 23

    CONCLUSSION
    ARDS is one of the most common diagnosis in critical setting The biggest treatment challenges for the physician Etiology
    Direct lung causes Indirect lung causes Outcome Multi factorial Advance supportive care Early detection Effective treatment of co morbid diseases Techniques of mechanical ventilation

    2/11/2013

    24

    Case Presentation
    A 18-year-old girl developed acute onset of severe dyspnea after getting 1000 cc of blood transfusion. On physical examination revealed BP 100/ 80, pulse rate 120, RR 40, and T 36,80 C. There was rales on both of her lung. ABG showed PaO2 43,0 mmHg, PCO2 35 mmHg. Chest X-ray revealed bilateral pulmonary infiltrates and no cardiomegaly. She had mechanical ventilation and administered antibiotic, corticosteroid and diuretic. Everyday she got better and on the 6th day she was recovery.
    2/11/2013 25

    2/11/2013

    26

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