Gagal Napas: Pembimbing Dr. Ngakan Putu Parsama Putra, SPP (K) Presenter Dr. Muli Yaman

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GAGAL NAPAS

PEMBIMBING
dr. Ngakan Putu Parsama Putra, SpP (K)

Presenter
dr. Muli Yaman

1
Introduction
Respiratory disfunction clinically significant to
Respiratory Impairment
produce discomfortness

Respiratory disturbance, strong enough to


Respiratory insufficiency hamper daily certain activities, that can be
measured from the mechanic of breathing
and or from gas exchange

Increase and worsening respiratory effort


Respiratory distress
that can be seen from clinical apperance

• Disturbance of 1 (one) aspect or more


Respiratory Failure
respiratory function and life threatening

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[Slide Prof. Menaldi Rasmin,SpP(K), 2015]
Respiratory Failure

Respiratory failure is a clinical


condition that happens when the
respiratory system fails to maintain
its main function, which is gas
Introduction
exchange, in which PaO2 lower
than 60 mmHg and/or PaCO2 higher
than 50 mmHg.

Shebl, E. and Burns, B., 2018. Respiratory failure. 3


Type of Respiratory Failure

Type 1 (hypoxemic) Type 2 (hypercapnic)


respiratory failure respiratory failure

* PaO2 < 60 mmHg with normal or * PaCO2 ≥ 45 mmHg, PaO2 < 60


subnormal PaCO2. In this type, the gas
exchange is impaired at the level of mmHg
alveoli-capillary membrane. Examples of
type I respiratory failures are
carcinogenic or non-cardiogenic
pulmonary edema and severe
pneumonia.

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Buku Ajar Pulmonologi dan Kedokteran Respirasi, 2018
Type 1. Hypoxaemic Respiratory Failure

5
Suh, E.S. and Hart, N., 2012. Respiratory failure. Medicine, 40(6), pp.293-297.
Type 2. Hypercapnic Respiratory Failure : an imbalance between neural
respiratory drive, the load on the respiratory muscles and capacity of the
respiratory muscles

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Suh, E.S. and Hart, N., 2012. Respiratory failure. Medicine, 40(6), pp.293-297.
Etiology
• CNS causes due to depression of the neural drive to breath as in cases of
overdose of a narcotic and sedative.
• Disorders of the peripheral nervous system: Respiratory muscle and chest
wall weakness as in cases of Guillian-Barre syndrome and myasthenia gravis.
• Upper and lower airways obstruction: due to various causes as in cases of
exacerbation of chronic obstructive pulmonary diseases and acute severe
bronchial asthma 
• Abnormalities of the alveoli that result in type 1 (hypoxemic) respiratory
failure as in cases of pulmonary edema and severe pneumonia.

Shebl, E. and Burns, B., 2018. Respiratory failure. 7


Etiology
Respiratory Failure type I Respiratory Failure type II

Pneumonia Myastenia Gravis

Pulmonary edema Tetanus

Pneumothorax Chronic Obstructive Pulmonary Disease

Asthma Cervical trauma and Head Trauma

Pulmonary Embolism Pulmonary Edema

Artery Pulmonary Hypertension Severe Asthma

Pneumokoniosis Acute Respiratory Distress Syndrome

Acute Respiratory Distress Syndrome

Buku Ajar Pulmonologi dan Kedokteran Respirasi, 2018 8


Symptoms and signs of hypoxemia
• Dyspnea,irritability
• Confusion
• Agitate
• Tachycardia
• Tachypnea
• Cyanosis

Buku Ajar Pulmonologi dan Kedokteran Respirasi, 2018 9


Symptoms and signs of hypercapnia
• Decreased of consciousness
• Change of behaviour
• Bradicardia
• Hypotension
• Tachypnea
• Letargy
• Cyanosis

Buku Ajar Pulmonologi dan Kedokteran Respirasi, 2018 10


• Arterial blood gases (ABG)  confirm the
diagnosis of respiratory failure.
• Chest radiography  detect chest wall, pleural
and lung parenchymal Lesions.
• Cause of the respiratory failure may include:
• Complete blood count (CBC)
• Sputum, blood and urine culture Evaluation
• Blood electrolytes and thyroid function tests
• Pulmonary function tests
• Electrocardiography (ECG)
• Echocardiography
• Bronchoscopy

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Shebl, E. and Burns, B., 2018. Respiratory failure.
Evaluation
• AaDO2 ( Alveolar-arterial difference in oxygen tension)
Value Etiology Hypoxemia

<20 mmHg Normal

20-40 mmHg V/P mismatch

40-60 mmHg Shunt

>60 mmHg Diffusion disturbance

Buku Ajar Pulmonologi dan Kedokteran Respirasi, 2018 12


Treatment / Management
• Correction of Hypoxemia
• Correction of hypercapnia and respiratory acidosis
• Ventilatory support for the patient with respiratory failure

Shebl, E. and Burns, B., 2018. Respiratory failure. 13


Management A systematic or ‘ABC’ (‘Airway, Breathing,
Circulation’) approach with prompt
application of high-flow oxygen therapy
(15 litre/min) via a facemask fitted with a
reservoir bag.
If the patient is not alert and responsive then
simple measures to maximize airway patency e
such as a jaw thrust manoevre or use of an
oropharyngeal airway e should be performed and
an anaesthetist called immediately to assist.

It is also appropriate to ask for early assistance


from outreach teams or inform the high-
dependency unit (HDU) or intensive care unit
(ICU) as ongoing management may need to be
continued in one of these settings.

It is important to stress that high-flow oxygen


therapy should always be given to a patient
who is hypoxic.
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Burt, C.C. and Arrowsmith, J.E., 2009. Respiratory failure. Surgery (Oxford), 27(11), pp.475-479.
Escalation therapeutic strategy, integrative supports
and management of acute respiratory failure.

Scala, R. and Heunks, L., 2018. Highlights in acute respiratory failure. 15


Common indications for mechanical
ventilation
• Apnea with respiratory arrest 
• Tachypnea with respiratory rate >30 breaths per minute
• Disturbed conscious level or coma
• Respiratory muscle fatigue
• Hemodynamic instability
• Failure of supplemental oxygen to increase PaO2 to 55-60  mm Hg
• Hypercapnea with arterial pH less than 7.25

Shebl, E. and Burns, B., 2018. Respiratory failure. 16


Differential Diagnosis
• Cardiogenic shock
• Cor pulmonale 
• Diaphragmatic Paralysis
• Dilated Cardiomyopathy
• Myocardial Infarction 
• Pulmonary Embolism

Shebl, E. and Burns, B., 2018. Respiratory failure. 17


Complications
• Lung complications: for example, pulmonary embolism irreversible scarring of the
lungs, pneumothorax, and dependence on a ventilator.
• Cardiac complications: for example, heart failure arrhythmias and acute myocardial
infarction.
• Neurological complications: a prolonged period of brain hypoxia can lead to irreversible
brain damage and brain death.
• Renal:  acute renal failure may occur due to hypoperfusion and/or nephrotoxic drugs.
• Gastro-intestinal: stress ulcer, ileus, and hemorrhage
• Nutritional: malnutrition, diarrhea hypoglycemia, electrolyte disturbances

Shebl, E. and Burns, B., 2018. Respiratory failure. 18


REFERENCE

1. Shebl, E. and Burns, B., 2018. Respiratory failure.


2. Burt, C.C. and Arrowsmith, J.E., 2009. Respiratory
failure. Surgery (Oxford), 27(11), pp.475-479.
3. Suh, E.S. and Hart, N., 2012. Respiratory
failure. Medicine, 40(6), pp.293-297.
4. Scala, R. and Heunks, L., 2018. Highlights in acute respiratory failure.
5. Buku Ajar Pulmonologi dan Kedokteran Respirasi, 2018

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THANK YOU

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