respiratory disorders (abdurahman s).ppt

8/13/2019 RESPIRATORY DISORDERS (Abdurahman S).ppt

1/19

RESPIRATORY DISORDERS

Dr. Abdurahman Sukadi, dr., SpAK


2/19


3/19

MANAGEMENT

Temperature : 36,50

C

37,50

COksigenFluid TherapyMinimal HandlingPositionChest Radiograph

AntibioticsBlood pressure monitoring

Arterial Blood gas Analysis and pH

Laboratorium : Blood Count and differential Culture


4/19

MECONIUM ASPIRATION

Definition :Aspiration of mecoinum-stained amniotic

fluid by the fetus in utero or by the newborn

during labor and delivery


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PATHOPHYSIOLOGYPhysiologic meconium passage

(particulary if postdates)

Fetal compromised (hypoxia, cord

compression, etc.)

meconium passage

Meconium stainned amniotic fluid

Post partumaspiration

In uterogasping

Meconium aspiration

Continued

compromise

Peripheralairway

obstruction

Proximalairway

obstruction

Inflammatoryand chemicalpneumonitis Remodeling of

pulmonaryvasculature

Complete

Atelectasis

V/Q mismatch

Partial

Ball valve effect

Air - trapping

Air - leaks

AcidosisHypoxemiaHypercapnia

Persistentpulmonaryhypertension


6/19

THERAPYDelivery Room Management

Meconium in amniotic fluid

Meconium in amniotic fluid

Thin Thick

Infantactive

Infantdepressed

Suctiontrachea

Observe

Resuscitate PRN Resuscitate PRN


7/19

GENERAL MANAGEMENT

Temperature

Metabolic

Cardiopulmonary FunctionFluid

Antibiotics

OKSIGEN PaO2 : 50 80 mmHg.


8/19

TRANSIENT TACHYPNEA OF

THE NEWBORN (TTN)

DEFINITION : Also known as wet lung and type II respiratory

distress syndrome. It is a benign disease of near

term, term or large prematur infants who haverespiratory distress shortly after delivery thatusually resolves within 3 days.

PATHOPHYSIOLOGY

Delayed resorption of fetal lung fluid Pulmonary immaturity

Mild surfactan deficiensy


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DIAGNOSIS

CLINICAL PRESENTATION :

Term infant

Family with risk factor Tachypnea ( > 60 x/min)

LABORATORIUM :

Hypoxemia Mild respiratory acidosis

Improvement within 24 hours


10/19

RADIOLOGIC : Hyperaeration, mild cardiomegaly

Sunburst

Resolves within 2 3 days

THERAPY

Oksigen

Fluid restriction

Resolves within 48 72 hours


11/19

A P N E A

DEFINITION :

Absence of respiratory, with or without

bradycardia or cyanosis

CLASSIFICATION :

Central Apnea

Obstructive Apnea Mixed Apnea


12/19

ETIOLOGY, based on :

Disease

Gestational age Post natal age

PATHOPHYSIOLOGY

Immaturity of respiratory control Sleep realted response

Protective reflexes

Muscle weakness

All of the above point to an immaturerespiratory control mechanism in thepretern infant


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14/19


15/19

THERAPY

Preventive

Aminophyllin

Continuous positive airway presure

(CPAP)

Mechanical ventilation


16/19

HYALINE MEMBRANE DISEASE

(RESPIRATORY DISTRESS

SYNDROME)

DEFINITION :

Respiratory distress syndrome in a preterm

newborn with respiratory difficulty,including tachypnea, chest retraction and

cyanosis, that persists or progresses over

the first 48 96 hours of life and with a

characteristic chest x

ray film (uniformreticulogranular pattern and air

bronchograms)


17/19

PATHOPHYSIOLOGYPrematurity

Surfactant synthesis and release

Alveolar surface tension

Atelectasis

Hypoxemia, Hypercarbia

Acidosis (respiratory and metabolic)

Pulmonary vascular resistance andvasoconstriction

Pulmonary capillary leak

Hyaline membranes ( diffusion block)


18/19

DIAGNOSIS

Preterm infant, respiratory difficulty

Chest x ray : Uniform reticulogranular

Pattern and Air BrochogramsLaboratorium :

Blood count : No Infection

Blood culture : Negative

Arterial Blood gas : Hipoxemia and Acidemia

L/S Ratio : < 2 : 1


19/19

THERAPY :

Temperature

Oksigen

Fluid and Electrolyte

Circulation

Antibiotics

respiratory disorders (abdurahman s).ppt

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