Lung

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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 PParuaru--paruparu(lung function test)(lung function test)

Peak flow meter


Spirometer

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Lung Function TestLung Function Test• Untuk mendiagnosis gangguan paru-paru dan seberapa

h t b tparah gangguan tersebut• Beberapa macam test :

- spirometry 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

the multibreath tests.

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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, FEV1 menentukan 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 kapasitas vital paksa

Volume udara yang dapat dihembuskan paksa pada satu detik pertama

Umumnya dicapai dalam 3 detikNormalnya: 4 liter

Normalnya 3,2 liter


Normalnya: 4 liter

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

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Spirogram normal yang menunjukkan FVC, FEV1, dan FEF25-75%

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 obstruksinyaFEV1: 60-75% = mildFEV1: 40-59% = moderateFEV1: <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• TLC berkurang sebagai Gold Standard

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ObstructiveJalan 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.

MixedEkspirasi 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 gases is a measurement of how much oxygen and g yg

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 provideseffectiveness 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 and the body's general metabolic state.


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Blood gases test/analysis• The blood gases test is

performed by collecting a sample of blood through asample 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 Hg60‐80 mmHg : hipoksemia ringan40‐60 mmHg : hipoksemia sedang< 40 mmHg : hipoksemia berat


Persentasi kejenuhan oksigen

SaO2 95‐97%

Konsentrasi ion hidrogen pH 7,35 – 7,45Bikarbonat HCO3

‐ 22 – 26 mEq/L

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Gangguan asam-basa pH HCO3- PCO2

Perubahan asam-basa pada asidosis dan alkalosis

Asidosis respiratorik ↓

Alkalosis respiratorik ↓ ↓

Asidosis metabolic ↓ ↓ ↓

Alkalosis metabolik


Respiratory acidosis

• Respiratory acidosis is a condition that occurs when the lungs cannot remove all of the carbon dioxide the body producescannot 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 balancebody s acid‐base balance.

• Acute respiratory acidosis is a severe condition in which carbon dioxide builds up very quickly and before the kidneys can return the body to a state of balance.


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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 asmedicines, 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 cause respiratory alkalosis.


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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.


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