Parameter pemantauan penyakit saluran nafas

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Parameter pemantauan

penyakit saluran nafas

• Uji fungsi paru

• Analisis gas darah

2010/10/23 Zullies Ikawati's Lecture Notes 1

Uji

Uji FFungsi

ungsi P

Paru

aru--paru

paru

(lung function test)

Peak flow meter

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Lung Function Test

• Untuk mendiagnosis gangguan paru-paru dan seberapa

h

t

b t

parah gangguan tersebut

• Beberapa macam test :

- spirometry

Æ

rutin

- gas diffusion test

- body plethysmography, dll.

2010/10/23 3

y p

y

g p y,

Lung diffusion testing measures how well oxygen passes from the air sacs in the

lungs into the blood

a very sensitive lung measurement

used to detect lung pathology that

Body plethysmography

used to detect lung pathology that

might be missed with conventional

pulmonary function tests.

This method of obtaining the absolute

volume of air within one's lungs may

also be used in situations where also be used in situations where

several repeated trials are required or

where the patient is unable to perform

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Spirometri

Peak flow meter

PEF = Peak Expiratory Flow

Peak flow meter sering digunakan oleh pasien asma untuk mengukur jumlah udara yang dapat dihembuskan dari paru-paru. Jika saluran nafas menyempit atau tersumbat karena asma, nilai peak flow akan menurun karena pasien tidak dapat menghembuskan udara dengan sempurna. Peak flow meter berguna untuk memonitor pasien asma sepanjang waktu dan dapat untuk menentukan apakah pengobatan asma berhasil atau tidak.

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Kapasitas dan volume statis paru

Volume statis paru-paru

• Volume tidal (VT) = jumlah udara yang dihirup dan dihembuskan

setiap kali bernafas pada saat istirahat. Volume tidal normal bagi 350-400 ml

350-400 ml.

• Volume residu (RV) = jumlah gas yang tersisa di paru-paru setelah menghembuskan nafas secara maksimal atau ekspirasi paksa. Nilai normalnya adalah 1200 ml.

• Kapasitas vital (VC) = jumlah gas yang dapat diekspirasi setelah inspirasi secara maksimal. VC = VT + IRV + ERV (seharusnya 80 % TLC) Besarnya adalah 4800 ml

TLC) Besarnya adalah 4800 ml.

• Kapasitas total paru-paru (TLC) = yaitu jumlah total udara yang dapat dimasukkan ke dlm paru-paru setelah inspirasi maksimal. TLC = VT + IRV + ERV + RV. Besarnya adalah 6000 ml.

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• Kapasitas residu fungsional (FRC) = jumlah gas yang

tertinggal di paru-paru setelah ekspirasi volume tidal normal. FRC = ERV + RV. Besarnya berkisar 2400 ml.

K it i i i (IC) j l h d k i l g d t • Kapasitas inspirasi (IC) = jumlah udara maksimal yang dapat

diinspirasi setelah ekspirasi normal. IC = VT + IRV. Nilai normalnya sekitar 3600 ml.

• Volume cadangan inspirasi (IRV) = jumlah udara yang dapat diinspirasi secara paksa sesudah inspirasi volume tidal normal

• Volume cadangan ekspirasi (ERV) = jumlah udara yang dapat diekspirasi secara paksa sesudah ekspirasi volume tidal normal

Parameter: FVC, FEV₁Æmenentukan fungsi paru

Volume dinamis paru-paru

FVC : Forced Vital Capacity FEV₁: Forced Expired Volume in one second

Volume udara maksimum yang dapat dihembuskan secara paksa Ækapasitas vital paksa

Volume udara yang dapat dihembuskan paksa pada satu detik pertama

Umumnya dicapai dalam 3 detik Normalnya: 4 liter

Normalnya 3,2 liter Normalnya: 4 liter

Orang sehat dapat menghembuskan 75-80% atau lebih FVC-nya dalam satu detik Ærasio FEV₁/FVC = 75-80%

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Spirogram normal yang menunjukkan FVC, FEV1, dan FEF_25-75%

Basic of Pulmonary Function Test

• Obstructive Lung Disease = tidak dapat menghembuskan udara

(unable to get air out)

- FEV₁/FVC < 75%

•Semakin rendah rasionya, semakin parah obstruksinya

FEV₁: 60-75% = mild FEV₁: 40-59% = moderate FEV₁: <40% = severe

R i i L Di id k d ik

• Restrictive Lung Disease = tidak dapat menarik napas

(unable to get air in)

• FVC rendah; FEV₁/FVC normal atau meningkat

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Obstructive

Jalan nafas yang menyempit akan mengurangi voulume udara yang dapat dihembuskan pada satu detik pertama ekspirasi. Amati bahwa FVC hanya dapat dicapai setelah ekshalasi yang panjang. Rasio FEV1/FVC berkurang secara nyata. Ekspirasi diperlama dgn peningkatan perlahan pada kurva, dan plateau tidak tercapai sampai waktu 15 detik.

Restrictive

FEV1 dan FVC menurun. Karena jalan nafas tetap terbuka, ekspirasi bisa cepat dan selesai dlm waktu 2-3 detik. Rasio FEV1/FVC tetap normal atau malah meningkat, tetapi volume udara yang terhirup dan terhembus lebih kecil dibandingkan normal

normal. Mixed

Ekspirasi diperlama dengan peningkatan kurva perlahan mencapai plateau. Kapasitas vital berkurang signifikan dibandingkan gangguan obstruktif. Pola campuran ini, jika tidak terlalu parah, sulit dibedakan dengan pola obstruktif.

Blood gases analysis

• Definition

• Blood ggases is a measurement of how much oxygenyg and

carbon dioxide is in your blood. It also determines the

acidity (pH) of your blood. • Why is the Test Performed?

• The test is used to evaluate respiratory diseases and

conditions that affect the lungs. It helps determine the

effectiveness of oxygen therapy The test also provides effectiveness of oxygen therapy. The test also provides

information about the body's acid/base balance, which

can reveal important clues about lung and kidney function

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Blood gases test/analysis

• The blood gases test is

performed by collecting a

sample of blood through a sample of blood through a

needle from an artery. • The test is used to evaluate

respiratory diseases and

conditions that affect the

lungs, and it is used to

determine the effectiveness of

oxygen therapy

oxygen therapy.

• The acid‐base component of

the test also gives information

on how well the kidneys are

functioning.

Nilai-nilai normal gas-gas darah

Pengukuran gas darah Simbol Nilai normal Tekanan karbon dioksida PaCO2 34‐45 mmHg (rata‐rata 40)

> 45 mmHg : hipoventilasi

< 35 mmHg : hiperventilasi

Tekanan oksigen PaO₂ 80‐100 mm Hg

60‐80 mmHg : hipoksemiaringan 40‐60 mmHg : hipoksemiasedang < 40 mmHg : hipoksemiaberat Persentasi kejenuhan oksigen SaO2 95‐97%

Konsentrasi ion hidrogen pH 7,35 – 7,45

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Gangguan asam-basa pH HCO₃- _PCO 2

Perubahan asam-basa pada asidosis dan alkalosis

Asidosis respiratorik ↓ Ç Ç

Alkalosis respiratorik Ç ↓ ↓

Asidosis metabolic ↓ ↓ ↓

Alkalosis metabolik Ç Ç Ç

Respiratory acidosis

• Respiratory acidosis is a condition that occurs when the lungs

cannot remove all of the carbon dioxide the body produces cannot remove all of the carbon dioxide the body produces.

This disrupts the body's acid‐base balance causing body fluids,

especially the blood, to become too acidic

• Chronic respiratory acidosis occurs over a long period of time.

This leads to a stable situation, because the kidneys increase

body chemicals, such as bicarbonate, that help restore the

body's acid‐base balance body s acid‐base balance.

• Acute respiratory acidosis is a severe condition in which carbon

dioxide builds up very quickly and before the kidneys can

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Causes of respiratory acidosis include:

• Diseases of the airways (such as asthma and chronic

obstructive lung disease), which send air into and out of the

lungs

• Diseases of the chest (such as scoliosis), which make the lungs

less efficient at filling and emptying

• Diseases affecting the nerves and muscles that "signal" the

lungs to inflate or deflate

• Drugs that suppress breathing (including powerful pain

medicines such as narcotics and "downers " such as medicines, such as narcotics, and downers, such as

benzodiazepines), especially when combined with alcohol

• Severe obesity, which restricts how much the lungs can

expand

Respiratory alkalosis

• Definition

• Respiratory alkalosis is a condition marked by low levels of

carbon dioxide in the blood due to breathing excessively. • Common causes include:

• Anxiety

• Fever

• Hyperventilation

l d h l d h f b h l • Any lung disease that leads to shortness of breath can also

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Metabolic acidosis

• Definition

• Metabolic acidosis is a condition in which there is too much acid in

the body fluids.

• Metabolic acidosis occurs when the body produces too much acid, or

when the kidneys are not removing enough acid from the body. There

are several types of metablic acidosis:

• Diabetic acidosis (also called diabetic ketoacidosis and DKA) develops

when substances known as ketone bodies, which are acidic, build up

during uncontrolled diabetes

• Hyperchloremic acidosis results from excessive loss of sodium

bicarbonate from the body, as can happen with severe diarrhea

• Lactic acidosis is a buildup of lactic acid.