ARDS
(Acute Respiratory Distress
Syndrome)
oleh :
Zaenab Shahab, [Link]
207 121 0043
Dosen Pembimbing :
dr. Thahri Iskandar Sp.P
Definisi
ARDS (acute respiratory distress syndrome )
merupakan sindrome klinis yang meliputi
sesak berat dengan onset yang cepat,
hypoxemia, dan diffuse pulmonary infiltrates
yang menyebabkan kegagalan respirasi.
What Are Other Names For ARDS?
• Acute lung injury
• Adult respiratory distress syndrome
• Increased-permeability pulmonary edema
• Noncardiac pulmonary edema
• ARDS used to be called stiff lung, shock lung,
and wet lung.
Etiologi
Gejala Klinis
Gejala dan tanda ARDS bervariasi,
tergantung pada penyebab dan
keparahannya. Gejalanya termasuk :
• Severe shortness of breath
• Labored and unusually rapid breathing
• Low blood pressure
• Confusion and extreme tiredness
• Sindroma gawat pernafasan akut terjadi dalam
waktu 24-48 jam setelah kelainan dasarnya.
• Mula-mula penderita akan merasakan sesak
nafas, bisanya berupa pernafasan yang cepat
dan dangkal.
• Karena rendahnya kadar oksigen dalam darah,
kulit terlihat pucat atau biru, dan organ lain
seperti jantung dan otak akan mengalami
kelainan fungsi.
• Hilangnya oksigen karena sindroma ini dapat
menyebabkan komplikasi dari organ lain segera setelah
sindroma terjadi atau beberapa hari/minggu kemudian
bila keadaan penderita tidak membaik.
• Kehilangan oksigen yang berlangsung lama bisa
menyebabkan komplikasi serius seperti gagal ginjal.
Tanpa pengobatan yang tepat, 90% kasus berakhir dengan
kematian. Bila pengobatan yang diberikan sesuai, 50%
penderita akan selamat.
Karena penderita kurang mampu melawan infeksi, mereka
biasanya menderita pneumonia bakterial dalam
perjalanan penyakitnya.
• Gejala lainnya yang mungkin ditemukan:
- cemas, merasa ajalnya hampir tiba
- tekanan darah rendah atau syok (tekanan
darah rendah disertai oleh kegagalan organ
lain)
- penderita seringkali tidak mampu
mengeluhkan gejalanya karena tampak sangat
sakit.
Diagnosa
Pada pemeriksaan fisik dengan menggunakan stetoskop,
terdengar bunyi pernafasan abnormal (seperti ronki atau
wheezing). Tekanan darah seringkali rendah dan kulit, bibir
serta kuku penderita tampak kebiruan (sianosis, karena
kekurangan oksigen).
Pemeriksaan yang biasa dilakukan untuk mendiagnosis ARDS:
Rontgen dada (menunjukkan adanya penimbunan cairan di
tempat yang seharusnya terisi udara) Gas darah arteri, Hitung
jenis darah dan kimia darah, Bronkoskopi.
Kriteria Diagnosis
Penatalaksanaan
Prinsip Umum :
(1) the recognition and treatment of the
underlying medical and surgical disorders (e.g.,
sepsis, aspiration, trauma).
(2) minimizing procedures and their complications.
(3) prophylaxis against venous thromboembolism,
gastrointestinal bleeding, and central venous
catheter infections.
(4) the prompt recognition of nosocomial
infections; and
(5) provision of adequate nutrition.
Algoritma Management ARDS
• The first goal in treating ARDS is to improve the levels of oxygen in your blood. Without oxygen, your
organs can't function properly.
• Oxygen
To get more oxygen into your bloodstream, your doctor will likely use:
• Supplemental oxygen. For milder symptoms or as a temporary measure, oxygen may be delivered
through a mask that fits tightly over your nose and mouth.
• Mechanical ventilation. Most people with ARDS will need the help of a machine to breathe. A
mechanical ventilator pushes air into your lungs and forces some of the fluid out of the air sacs.
• Fluids
Carefully managing the amount of intravenous fluids is crucial. Too much fluid can increase fluid
buildup in the lungs. Too little fluid can put a strain on your heart and other organs, and lead to shock.
• Medication
People with ARDS usually are given medication to:
• Prevent and treat infections
• Relieve pain and discomfort
• Prevent clots in the legs and lungs
• Minimize gastric reflux
Komplikasi
• Pulmonary fibrosis. Scarring and thickening of the tissue between the
air sacs can occur within a few weeks of the onset of ARDS. This
stiffens your lungs, making it even more difficult for oxygen to flow
from the air sacs into your bloodstream.
• Collapsed lung (pneumothorax). In most ARDS cases, a breathing
machine called a ventilator is used to increase oxygen in the body and
force fluid out of the lungs. However, the pressure and air volume of
the ventilator can force gas to go through a small hole in the very
outside of a lung and cause that lung to collapse.
• Blood clots. Lying still in the hospital while you're on a ventilator can
increase your risk of developing blood clots, particularly in the deep
veins in your legs. If a clot forms in your leg, a portion of it can break
off and travel to one of your lungs (pulmonary embolism) — where it
blocks blood flow.
• Infections. Because the ventilator is attached directly to a
tube inserted in your windpipe, this makes it much easier
for germs to infect and further injure your lungs.
• Abnormal lung function. Many people with ARDS recover
most of their lung function within several months to two
years, but others may have breathing problems for the rest
of their lives. Even people who do well usually have
shortness of breath and fatigue and may need supplemental
oxygen at home for a few months.
• Memory, cognitive and emotional problems. Sedatives and
low levels of oxygen in the blood can lead to memory loss
and cognitive problems after ARDS. In some cases, the
effects may lessen over time, but in others, the damage may
be permanent. Most ARDS survivors also report going
through a period of depression, which is treatable.
Terima Kasih