air leak syndrome
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Air Leak SyndromeSindroma Kebocoran Udara
KK PERINATOLOGIRSAB HARAPAN KITA
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Pendahuluan Definisi: sekumpulan penyakit
(pneumomediastinum, pneumothorax, pulmonary interstitial emphysema danpneumopericardium) yang patofisiologipenyebabnya sama . Overdinstensi kantungalveoli atau akhir dari saluran pernapasan yang dimulai dengan gangguan integritas jalan napas, menghasilkan kebocoran udara ke ruangsekitarnya
Periode baru lahir Risiko >> Air Leak (kebocoran udara)
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Pendahuluan
Peningkatan frekuensi berhubungan dgn: Frekuensi gagal nafas Penggunaan ventilator Resusitasi bayi VLBW dgn def. Surfaktan Lahir dengan Mekonium Hipoplasia paru (sekunder: hernia diafragma)
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4Paling sering ditemui pada neonatus denganpenyakit paru yang pernafasannya dibantuventilator tapi bisa juga terjadi secaraspontan. Semakin parah penyakit paru yang diderita, semakin sering kebocoran udaraterjadi.
Insidensi
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Insidensi
TTN 10% RDS 27% Aspirasi Meconium 41%
Faktor Risiko Pemakaian ventilator Meconium staining Terapi surfaktan
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Faktor Risiko TerjadinyaSindrom Kebocoran udara
Spontan 0,5% Bantuan ventilator 15-20% CPAP 5% Pewarnaan kuning oleh mekonium /
aspirasi mekonium Terapi surfaktan Upaya keras resusitasi (ventilasi
dengan kantung)
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Patofisiologi
Overdistensi ujung jalan nafas (penyebab paling sering dari semua Pulmonari Air Leaks) ventilasi alveolar yang tidak biasa Air traping Tekanan yang menyebabkan alveoli distensi
(ventilator)
Peningkatan volume paru ada batasnya tekanan mekanik diseluruh alveoli dan dindingbronkhial robek
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Patofisiologi
Barotrauma, penyebab tersering. Disebabkan oleh pemberian tekananpositif dalam paru. Tidak bisa dicegah bilaBBL sakit memerlukan ventilator, tetapiefeknya dapat diminimal
Penyebab lain overdistensi. Gas trapping (MAS, mucous plugs, intubasi terlaludalam)
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Gambaran klinis Spontan: RD, kebutuhan oksigen, Ventilator: sianosis, hypoksemia, hiperkarbia,
asidosis respiratori Gawat nafas atau kondisi klinis yang tiba-tiba
memburuk dan disertai dengan perubahan tanda-tanda vital dan memburuknya gas darah.
Ditemui toraks asimetris pada kasus unilateral. Diagnosis
Diagnosis definitif dengan radiologi (AP, lateral) Pencegahan
Terapi yang baik adalah pencegahan
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- Prognosis Tergantung penyebab penyakitnya Long term outcome tidak ada perbedaan
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-mengurangi barotrauma
-suplemen oksigen, punksi-
-pericardial drain-mengurangi barotrauma
-drain
-pasang drain
Terapi
Interstitial emphysema
PneumothoraxPneumomediastinumPneumopericardiumPerivascularemphysemaSubcutaneous emphysemaPneumoperitoneum
1. Pulmonary interstitium
2. Pleural space3. Mediastinum4. Pericardial
space5. Perivascular
sheat6. Subcutaneous
tissue7. Peritoneal
space
SindromaLetak Air leaks
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Chest tube & WSD
Indikasi : Tension pneumothoraks Pneumothoraks Drain effusi pleura
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Bisturi no 15Trocard trhoraks no 12 FRSatu set WSDAquades steril 500 mlSilk HRTegadermKlem
Satu set alat vena sectioSarung tangan sterilBetadin & alkohol swabIV cath no 18Three way stopcockSpuit 10 ccNaCl 0,9% 25 mlLidokain 2 %
Alat-alat
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