pneumonia aspirasi
DESCRIPTION
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Aspirasi Pneumoniaigk oka nurjayasmf anak rsud sanjiwani gianyar
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2Objectives
Discuss background, epidemiology, and pathogenesis of aspiration pneumonia
Discuss risk factors for aspiration pneumonia
Discuss diagnosis, treatment, and monitoring response to therapy
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3Pneumonia Aspirasi
Terbawanya bahan diorofaring atau isi lambung pada saat respirasi kesaluran nafas bawah dan dapat menyebabkan kerusakan parenkim paru
Kejadiannya cukup sering
Akibatnya menjadi Pneumonia
2 factor yang mempengaruhi :
1. Daya tahan tubuh Host
2. Kandungan bakteri penyebab infeksi
“True” aspiration pneumonia caused by normal flora
Oral cavity
Nasopharynx
Gastrointestinal bacteria
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4Epidemiologi
Insiden
Tersering di diagnosis di RS
Tidak konsinten
Etiologi
Kebanyakan kasus oleh kuman anaerob
CA: usually anaerobes alone
HA: usually anaerobes + aerobes, polymicrobial
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5Patogenesis
Mekanisme pertahanan normal peradangan maupun infeksi
KU lemah & keracunan alkohol / obat /tidak sadar pengaruh obat bius / kondisi kesehatannya lemah resiko pneumonia
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6PNEUMONITIS KIMIA
Pneumonitis kimia : terhirup bersifat iritasi : infeksi, terhirup biasanya asam lambung,
segera sesak nafas, denyut Jantung meningkat, demam & dahak kemerahan dan sianosis
Reaksi inflamasi seluler ( sitokin, TNF alpha, dan interleukin-8)
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7ASPIRASI BAKTERI
Bakteri tertelan dan masuk paru-paru Bakteri yg berperan : anaerobic organisms
alone or in combination with aerobic and/or microaerophilic organisms
Aspirasi pneumonia komuniti : bakteri anaerobik e/ tersering & stapilokokus aureus, haemophilus influenza & dan Enterobacteriae
Aspirasi pneumonia nosokomial e/ organisme gram-negatif termasuk Pseudomonas aeruginosa & biasanya pada pasien dengan intubasi
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8OBSTRUKSI MEKANIK
Terhirupnya partikel /benda asing Anak Manuver Heimlich bronkoskopi
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9Risk factors for aspiration
Reduced consciousness
Neurologic deficits
GI disorders
Anesthesia
Protracted vomiting
Large volume tube feedings
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10Signs/Symptoms
Sputum berbau busuk
Common pneumonia symptoms
Fever > 38°C
Leukocytosis/leukopenia
Productive cough
Penurunan kadar oksigen
Sianosis
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11Diagnosis
Suspect pneumonia if:
New or progressive infiltrate seen on chest x-ray AND signs/symptoms of systemic infection
Lower respiratory tract sampling
Bronchoalveolar lavage or protected specimen brush
Culture specimen
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12Dd/
In children, bronchiolitis, croup or laryngotracheobronchitis, epiglottitis, asthma, reactive airway disease, respiratory distress syndrome, and foreign bodies should be considered.
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Treatment Treat hypoxemia/provide oxygen
Empiric antibiotic selection depends on setting/patient characteristics
No clear guidelines on which regimen is best
If nosocomial, more virulent bacteria s/b targeted
CA:
clindamycin, metronidazole
OR
β-lactam/ β-lactamase inhibitor
HA:
GNB coverage + clindamycin, metronidazole +/- vancomycin
13
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14Monitoring Response to Therapy
Vitals
Tmax, HR
WBC
Should be trending down
Chest X R
Should see improvement
Oxygenation
Kadar O2 darah meningkat
hould be able to ↓ supportive oxygenation
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15KOMPLIKASI DAN MORTALITAS
Gagal nafas akut.
Mortalitas pneumoni aspirasi
komuniti 5 % , nosokomial 20 %.
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16PROGNOSIS
Jika tidak ada komplikasi maka angka mortalitas peneumonitis 5%, sedangkan pada aspirasi massif dengan atau tanpa sindrom Mendelson mencapai 70%.