Interaksi jantung paru

7/26/2019 Interaksi jantung paru

1/29

NTERAKS

JANTUNG PARU


2/29

INTRODUCTION

UNIT KARDIORESPIRASI

JANTUNG

SISTIM PEMBULUH DARAH

FUNGSI PARU


3/29

VENTILASI

FUNGSI KARDIOVASKULAR

MYOCARDIAL RESERVE

CIRCULATING BLOOD VOLUME

BLOOD FLOW DISTRIBUTION

AUTONOMIC TONE

ENDOCRINOLOGIC RESPONSE

LUNG VOLUME

INTRATHORACIC PRESSURE

SURROUNDING PRESSURE


4/29

RESPONS KARDIOVASKULAR

TERHADAP

MANUVER VENTILASI MEKANIK

BASELINE DARI FUNGSI SISTIM

KARDIOVASKULAR PASIEN


5/29

HUBUNGAN ANTARA AIRWAY PRESSURE,

INTRATHORACIC PRESSURE, DAN LUNG VOLUME

CONSEPT ~ HAS BEEN WIDELY ACCEPTED

PPV - MELALUIAIRWAY PRESSURE

LANGSUNG MEMPENGARUHI HEMODINAMIK Paw = Ple!al P!e""!e a#$ L#% V&l'e

(w!% a""')*+,


6/29

SEBETULNYA

Paw SANGAT TERGANTUNG PADA. POLA VENTILASI

AIRWAY RESISTANCE

LUNG COMPLIANCE

Paw TIDAK MERE/LEKSIKAN P)0

1= T!a#"'!al LV P!e""!e2SECARA AKURAT


7/29

LUNG VOLUME

INTRATHORACIC PRESSURE

RESPON HEMODINAMIK

TERHADAP VENTILASI


8/29

HEMODYNAMIC EFFECTS OF

VENTILATION

ADA 3 KONSEP DASAR YG HRS DIPAHAMI

45 BERNA/AS = E6ERCISE7 KEBUTUHAN O8 DANELIMINASI CO8

85 INSPIRASI . INTRAPLEURAL PRESSURE

LUNG VOLUME

35 BERNA/AS SPONTAN . ITP 7 SEDANGKANVENTILASI TEKANAN POSITI/ 9PPV. ITP


9/29

EFEK HEMODINAMIK AKIBAT

PERUBAHAN PADA VOLUME PARU

PERUBAHAN PADA VOLUME PARU

MENYEBABKAN E/EK PADA.

TONUS SIMPATIS OTONOM

RESISTENSI PEMBULUH DARAH PARU 9

Pl'a!: Va"0la! Re"+"*a#0e


10/29

TONUS SIMPATIS OTONOM

RESP SINUS ARRHYTHMIA

I#")+!a*+-a""&0+a*e$ 0a!$+&a00ele!a*+

Va%all: 'e$+a*e$ !e;le< a!0" l#% +#;la*+ *& #&!'al TV 4> 009?% *@e

@ea!* !a*e

ADH INDUCED /LUID RETENTION


11/29

MECHANICAL VENTILATION-INDUCED CHANGES IN

PULMONARY VASCULAR RESISTANCE (PVR)

RV FRC TLC

PVR

Alveol!

"o#$!e%%&o'

H$o&" $*l#o'!v%o"o'%+!&"+&o'

To+l PVR

Alveol! Ve%%el%

E+!-lveol!

ve%%el%

LUNG VOLUME


12/29

VENTRICULAR INTERDEPENDENCE

Te ee"+ o &'"!e%&'. !&.+ ve'+!&"*l! (RV) vol*#e% o' +e le+

ve'+!&"*l! (LV) /&%+ol&" $!e%%*!e-vol*#e (&ll&'.) !el+&o'%&$0I'"!e%e o' RV vol*#e /e"!e%e LV /&%+ol&" "o#$l&'"e

0 20

0

30

10

40

20

10LV VOLUME (ml)

LVPressure

(mmHg)

50 35 20 0


13/29

HEMODYNAMIC EFFECTS OF CHANGES IN

INTRATHORACIC PRESSURE ON THE LV FILLING AND

E1ECTION PRESSURE

ITP

ITP

THOR! LVE"ECTION

VENOU#

RETURN

I'"!e%&'. ITP /e"!e%e% +e

$!e%%*!e .!/&e'+ o! ve'o*%

!e+*!' '/ LV .!/&e'+

De"!e%&'. ITP &'"!e%e% +e

$!e%%*!e .!/&e'+% o! ve'o*%

!e+*!' '/ LV .!/&e'+


14/29

$5 0 5 10

2

3

4

5

6

7

Ve%&us re'ur%

ure

ITP

ITP

*l&&+Fl&,

(L-m)

R.g/' r'er.l Pressure (mmHg)

erese .% ITP '/' +erese Pr '& el&, er& rel'.e '& 'm ressure

.%rese e%&us re'ur% &%l l.m.'e+ m&u%'6 .%reses .% ITP

r&gress.el +erese e%&us re'ur% '& &mle'e .rul'&r s'%+s'.ll


15/29

HEMODYNAMIC EFFECTS OF VENTILATION

BASED ON CARDIOPULMONARY STATUS

So*l/ 8e "le! ++9

S$o'+ '/ PPV ve $!oo*'/ e#o/'#&""o'%e:*e'"e% '/ #&.+ eve' ve o$$o%&+e

ee"+% o' +e "!/&ov%"*l! %+8&l&+ &' +e/&e!e'+ $o$*l+&o'% o $+&e'+%

D&e!e'+ #o/e% o #e"'&"l ve'+&l+o!

%*$$o!+, 8 v!&'. /e.!ee o +e $+&e'+;%eo!+ '/ +*% "'.e% &' WoB '/ ITP %


16/29

F*'/#e'+l o "!/&o$*l#o'!

&'+e!"+&o'

SPONT VENT LUNG VOLUME ITP

IPPV LUNG VOLUME ITP

Mo%+ e#o/'#&" /&e!e'"e% 8e+


17/29

ITP

ITP

E#PVR

I'"!e%e/ LV

e=e"+&o' P!e%%*!e

I'"!e%e/ LV P!elo/

D&%+ol&" "o#$l&'"e

De"!e%e/

LV P!elo/

De"!e%e/

LV E=e"+&o'

P!e%%*!e

LVPres

sure

LV V&lume

T/e e77e's &7 /%ges .% ITP &% '/e LV ressure$&lume

rel'.&% (E#PVR) ,/e% r+. &%'r'.l.' .s %&rml

ITP = EDV , ESV SV

ITP = EDV , ESV SV


18/29

ITP

ITP

E#PVR

I'"!e%e/ LV

e=e"+&o' P!e%%*!e

I'"!e%e/ LV P!elo/

D&%+ol&" "o#$l&'"e

De"!e%e/

LV P!elo/

De"!e%e/

LV E=e"+&o'

P!e%%*!e

LVPres

sure

LV V&lume

T/e e77e's &7 /%ges .% ITP &% '/e LV ressure$&lume

rel'.&% (E#PVR) ,/e% r+. &%'r'.l.' .s .m.re+ %+

&lume s''us .s e8%+e+

ITP = EDV , ESV SV

ITP = EDV , ESV SV


19/29

ACUTE LUNG IN1URY

PEEP "a#%a* $+)e!l?a# #*?'e')e!*a@a#?a# $+"*e#"+ ale&l" "e@+#%%a&?"+%e#a"+ a!*e!+ le+@ a+?5

Pa$a )!+#"+)#:a )e#+#%?a*a# *e?a#a# ala##a;a" *+$a? 'e!e;le?"+?a# )e#+#%?a*a# ITP7#a'# ?@"" )a$a )a"+e# $%# ALI $+'a#a

*e!a$+ )e#!#a# 0&')l+a#0e )a! $a#$+#$+#% $a$a7 'a?a "e*+a) )e#+#%?a*a#&l'e )a! &le@ e#*+la"+ 'e?a#+? a?a#'e#+#%?a*?a# ITP5


20/29

SINGER AND COWORKERS>

H:)e!+#;la*+ $e*e!'+#e *@e $e0!ea"e

+# CO7 #&* Paw5

H:)e!+#;la*+ 0a# e 0*e!ala#0e$7

+# )a!*7 : ;l+$ !e"00+*a*+ *@a* !e"*&!e

*@e ITBV *& *@e )!e-PEEP leel5


21/29

Le%%!/ '/ "o


22/29

C' '/ A8!#9

S+'+la! !e"l*" +# 4> ARDS )a*+e#*"

'a0*@ ;&! 0&')a!ale TV a#$ *&*alPEEP


23/29

A8!# '/ Yo%&!, Poele!+ '/

"olle.*e%>

Me'a#$+#%?a# '&$e PC 1TV ?e0+l2$%# VC

Ke"+')la# a@wa +#"+$e# )e#!#a#

CO le+@ "e$+?+* )a$a )a"+e# :%'e#%%#a?a# PC


24/29

C!&%+&' '/ "o

APRV 1BIPAP2 $a)a* 'e#+#%?a*?a# )e!;&!'aa#*#% )a$a )a"+e# $e#%a# ALI9ARDS

De#%a# '&$e APRV 'a?a )ea? )!e""!e $a#Mea# Paw a?a# le+@ !e#$a@ "e@+#%%a*!a#"'+"+ ITP a?a# le+@ ?e0+l %a5

De#%a# *!##:a ITP 'a?a e#&" !e*!#

a?a# 'e#+#%?a*7 "ela#*#:a )e!;&!'a a#*#%%a a?a# le+@ a+?7 "e@+#%%a 'e#%!a#%++#"+$e# )e'a?a+a# a"&)!e"&! #*?'e##a#% MAP $a# DO85


25/29

COPD

Ma"ala@ *a'a @e'&$+#a'+? "a#%a*

e!@#%a# $e#%a# $:#a'+0 @:)e!+#;la*+

D:#a'+0 @:)e!+#;la*+ a?a# 'e#:ea?a#

*+'l#:a a*&9+#*!+#"+0 PEEP A*& PEEP PPV a?a# 'e#+#%?a*?a#

&e!$+"*e#"+ ale&la! P)l e#&" !e*!#

A"'a*+0 a**a0*9a0*e COPD $e0!ea"e$

ITP 1'ea# 3> 0'H8O2 )l'a!: e$e'a

1;!&' PPV *& ")*2


26/29

Intrinsic plus etrinsic PEEP !"lters #e$%&'n"$ic (uncti%n)

ecept t#e et PEEP is &eli*ere&+el%, t#e intrinsic le*el %( PEEP


27/29

We'&'. o $+&e'+%


28/29

MOHSENIFAR AND COLLEAGUES>

Pa*+e#*" w@& 0&l$ #&* wea#e$ @a$ a%a"*!+0 )H+ *@a* wa" ""*a#*+all:!e$0e$ ;!&' F53 $!+#% IPPV *& F5>

$!+#% wea#+#%5 Pa*+e#*" w@& "00e";ll: wea#e$ "@&wl+**le 0@a#%e +# )H+ 1F5 *& F525

T@"7 &00l* 0a!$+&a"0la! +#";;+"+e#0:'a: )la: a 'a&! !&le +# ;a+l!e *& wea#

+# 0!+*+0al +ll )a*+e#*"


29/29

Interaksi jantung paru

Documents

Transcript of Interaksi jantung paru