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NTERAKS
JANTUNG PARU
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INTRODUCTION
UNIT KARDIORESPIRASI
JANTUNG
SISTIM PEMBULUH DARAH
FUNGSI PARU
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VENTILASI
FUNGSI KARDIOVASKULAR
MYOCARDIAL RESERVE
CIRCULATING BLOOD VOLUME
BLOOD FLOW DISTRIBUTION
AUTONOMIC TONE
ENDOCRINOLOGIC RESPONSE
LUNG VOLUME
INTRATHORACIC PRESSURE
SURROUNDING PRESSURE
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RESPONS KARDIOVASKULAR
TERHADAP
MANUVER VENTILASI MEKANIK
BASELINE DARI FUNGSI SISTIM
KARDIOVASKULAR PASIEN
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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""')*+,
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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
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LUNG VOLUME
INTRATHORACIC PRESSURE
RESPON HEMODINAMIK
TERHADAP VENTILASI
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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
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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
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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
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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
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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
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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'+
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$5 0 5 10
2
3
4
5
6
7
Ve%&us re'ur%
ure
ITP
ITP
*l&&+Fl&,
(L-m)
R.g/' r'er.l Pressure (mmHg)
erese .% ITP '/' +erese Pr '& el&, er& rel'.e '& 'm ressure
.%rese e%&us re'ur% &%l l.m.'e+ m&u%'6 .%reses .% ITP
r&gress.el +erese e%&us re'ur% '& &mle'e .rul'&r s'%+s'.ll
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HEMODYNAMIC EFFECTS OF VENTILATION
BASED ON CARDIOPULMONARY STATUS
So*l/ 8e "le! ++9
S$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 $+&e'+;%eo!+ '/ +*% "'.e% &' WoB '/ ITP %
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F*'/#e'+l o "!/&o$*l#o'!
&'+e!"+&o'
SPONT VENT LUNG VOLUME ITP
IPPV LUNG VOLUME ITP
Mo%+ e#o/'#&" /&e!e'"e% 8e+
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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
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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
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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
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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
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Le%%!/ '/ "o
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C' '/ A8!#9
S+'+la! !e"l*" +# 4> ARDS )a*+e#*"
'a0*@ ;&! 0&')a!ale TV a#$ *&*alPEEP
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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
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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 $a# DO85
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COPD
Ma"ala@ *a'a @e'&$+#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$e'a
1;!&' PPV *& ")*2
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Intrinsic plus etrinsic PEEP !"lters #e$%&'n"$ic (uncti%n)
ecept t#e et PEEP is &eli*ere&+el%, t#e intrinsic le*el %( PEEP
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We'&'. o $+&e'+%
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MOHSENIFAR AND COLLEAGUES>
Pa*+e#*" w@& 0&l$ #&* 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#*"
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