Ventilasi Mekanik pada Acute Respiratory Distress Syndrome

Oleh :

dr. Hendra Gunawan SpPD

Ventilasi mekanik sangat sering dibutuhkan dalam tata laksana acute respiratory distress syndrome (ARDS). Inflamasi pada ARDS terjadi akut pada kapiler alveoli, sehingga terjadi gangguan pertukaran oksigen yang berat. Ventilasi mekanik dibutuhkan untuk menjamin pertukaran gas terjadi secara optimal. Namun, penggunaan ventilasi mekanik harus berhati-hati, karena dapat menyebabkan jejas pada paru dan gagal organ multipel.[1-4]

Acute respiratory distress syndrome (ARDS) adalah kondisi yang banyak ditemukan terutama pada intensive care unit (ICU), dengan mortalitas antara 27‒45%. ARDS dapat disebabkan oleh berbagai faktor, dengan etiologi tersering adalah pneumonia, termasuk COVID-19. Ventilasi mekanik merupakan tulang punggung dari manajemen ARDS.[1-3]

Volume Tidal dan Frekuensi Napas

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Referensi

1.ARDS Definition Task Force, Ranieri V, Rubenfeld G, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526-33.
2.Fanelli V, Ranieri V. Mechanisms and clinical consequences of acute lung injury. Annals of American Thoracic Society. 2015;2015(12 (Suppl1)):S3-8.
3.Griffiths MJ, McAuley DF, et al. Guidelines on the management of acute respiratory distress syndrome. BMJ Open Resp Res. 2019;2019(6):e000420.
4.Sklar MC, Patel BK, et al. Optimal Ventilator Strategies in Acute Respiratory Distress Syndrome. Seminars in Respiratory and Critical Care Medicine. 2019;40(1):081-93.
5.Fan E, Del Sorbo L, et al. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. American Journal of Critical Care Medicine. 2017;195(9):1253-63.
6.Papazian L, Aubron C, et al. Formal guidelines: management of acute respiratory distress syndrome. Annals of Intensive Care. 2019;2019(9):69.
7.Bein T, Grasso S, et al. The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia. Intensive Care Medicine. 2016;42(5):699-711.
8.Nakstad E, Opdhal H, et al. Manual ventilation and open suction procedures contribute to negative pressures in a mechanical lung model. BMJ Open Respir Res. 2017;4(1):e000176.
9.Lovisari F, Fodor GH, et al. Effect of PEEP and I:E ratio on cerebral oxygenation in ARDS: an experimental study in anesthetized rabbit. BMC Anesthesiology. 2019;19(110):2019.
10.Sembroski E, Bhardwaj A. Inverse Ratio Ventilation Treasure Island (FL): StatPearls Publishing; 2018. https://www.ncbi.nlm.nih.gov/books/NBK535395/.
11.Moran I, Bellapart J, et al. Heat and moisture exchangers and heated humidifiers in acute lung injury/acute respiratory distress syndrome patients. Effects on respiratory mechanics and gas exchange. Intensive Care Medicine. 2006;32(4):524-31.
12.Ahmed R, Boyer T. Endotracheal Tube Treasure Island (FL): Statpearls Publishing; 2019. https://www.ncbi.nlm.nih.gov/books/NBK539747/.
13.Varshney M, Sharma K, et al. Appropriate depth of placement of oral endotracheal tube and its possible determinants in Indian adult patients. Indian Journal of Anaesthesia. 2011;55(5):488-93.
14.Haas C, Eakin R, Konkle M. Endotracheal Tubes: Old and New. Respiratory Care. 2014;59(6):933-55.

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