179128939 Ventilasi Mekanik 1 Ppt

8/20/2019 179128939 Ventilasi Mekanik 1 Ppt

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A.PROSESRESPIRASIRESPIRASI


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PENGERTIAN

PERTUKARAN O2 DAN CO2 ANTARATUBUH DG LINGKUNGAN


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PENGERTIAN

TAHAPANPERTUKARAN GAS

LINGKUNGAN LUAR DG PARUVENTILASIDIFUSI GASTRANSPORT GAS

KAPILER DG SEL

RESPIRASI SELULERREAKSI-REAKSI METABOLISME


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FUNGSI

Memperoleh O2 u !u" #el !u$uhMe %el&m& '#& CO2 (% )&h'#&l"' oleh #el!u$uh

Mem$u' % p' '#Me & %"'!"' *e ou# re!urKe#e&m$' %' '#'m $'#'Pro)u"#& #u'r'+ $&,'r'+ me ' %+ !er!' '+me %h&rupPer!'h' ' )' "e"e$'l'M&"#&+ )e.e"'#& )' mel'h&r"'


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STRUKTUR DAN FUNGSI ORGAN


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PERCABANGAN BRONKUS


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ALVEOLI


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VENTILASI

INSPIRASI EKSPIRASI


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OTOT PERNAFASAN

SPIROMETRI


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MEKANISME PERNAPASAN

INSPIRASIPROSES AKTIF /G MEMBUTUHKAN

ENERG/ INTERAKSI ANTARA 0

Compl&' ,e or"

El'#!&, or"T#ue re#!' ,e or"

A&r '( re#!' ,e or"


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I #p&r'#& !er1')& "e!&"' !e"' ' 'l*eolu# le$&h "e,&l)&$' 'h !e"' ' '!mo#.&r+"e!&"' )&'.r'%m' $er"o !r'"#&$e!u" (' me 1')& )'!'r )' me e"' & '$)ome )'me %' %"'! &%' #eh& %%' me (e$'$"' pem$e#'r'ro %%' !or'"# )' p'ru-p'ru +me %em$' % (' p'ru2me %'"&$'!"' pe ru ' !e"' ' 'l*eolu# #eh& %' u)'r'$er%er'" me uru! %r')&e !e"' ' )'r& '!mo#.&r "e )'l'mp'ru-p'ru+h'l & & '"' $erl' %#u % !eru#-me eru# #'mp'&!e"' ' )'l'm 'l*eolu# #'m' )e %' !e"' ' '!mo#.&r

I #p&r'#&


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EKSPIRASIPro#e# p'#&. "'re ' el'#!&, re,o&l p'ru 3

r' %"' )')'T)" perlu e er%(4&"' !er)'p'! pe (emp&!' )& $ro "&'l

!er)e %'r $u (& !'m$'h' per '.'#'


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Ter1')& "e!&"' !e"' ' 'l*eolu# le$&h !& %%&)'r& !e"' ' '!mo#.&r rel'"#'#& )&'.r'%m')' o!o! & !e"o#!' e"#!er ' me %'"&$'!"'re,o&l el'#! )& )& % )')' )' p'ru #eh& %%'!er1')& pe & %"'!' !e"' ' 'l*eolu# )'me uru "' *olume p'ru+)e %' )em&"&'u)'r' $er%er'" )'r& p'ru-p'ru "e '!mo#.&r

E"#p&r'#&


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Compl&' ,e

U"ur' "em'mpu' me %em$' %Peru$'h' *olume "'re ' peru$'h'!e"' '

∆V5∆P

L' ' )'r& elastic recoil

Ke,e )eru %' "em$'l& "e "e')''#emul'


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A&r '( re#!' ,e

Pe (e$'$ $ro ,ho,o #!r&"#& 0*'%'l p'r'#(mp'!he!&, "'re '&r&!'#&

Se"re#& me)&'!or "&m&' & lo"'l )'r&m'#! ,ell 6h!'m& e 3 leu"o!r&e e7Pe uru ' "')'r CO2

Pe (e$'$ $ro ,ho)&l'!'#& 0 A)re 'l& p')' β-2 re,ep!or S(mp'!hom&me!&"


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a. VENTILASI 0 Pro#e# "elu'rm'#u" (' u)'r' )'r& '!mo#.er"e)'l'm 'l*eol& '!'u #e$'l&" ('D&pe %'ruh& oleh 0#!'!u# '#'m $'#')' "')'r PO2 )'l'm )'r'h+ "er1'#!&m #'r'. )' o!o!-o!o! per 'p'#'


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b. DIFUSI 0 Pro#e# per!u"'r' %'# (' %$er')' )& 'l*eol& )e %' pem$uluh)'r'h "'p&ler D&pe %'ruh& oleh 0

"oe.&e )&.u#& %'# !erh')'p mem$r' +lu'# )'er'h permu"'' mem$r' )'"e!e$'l' mem$r' re#p&r'#& #er!'

per$e)'' !e"' ' )& )'l'm 'l*eol&


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B. VENTILASI MEKANIK


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B'%'&m' ' Ve !&l'!or Be"er1' 0

Tu1u' Pem$el'1'r'8 Me 1el'#"' #!em *e !&l'#& me"' &" 3

"l'#&.&"'#& ('2 Me 1el'#"' ,'r'-,'r' me %o !rol

#(#!em )' 'ru# #(#!em

9 Mem'h'm& pr& #&p "er1' *e !&l'!or : M'#'l'h-m'#'l'h (' % )'p'! !er1')&

#el'm' me %%u '"' *e !&l'!or


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Pe %er!&' 0 - Ve !&l'#& me"' &" ')'l'h 'l'! per 'p'#'

$er!e"' ' po#&!&. '!'u e%'!&. (' % )'p'!memper!'h' "' *e !&l'#& )' pem$er&'o"#&%e #el'm' '"!u (' % l'm' (Bruner danSuddarth, 2001)

- Ve !&l'#& me"' &" ')'l'h 'l'! me"' &" )&m' '"l&e me er&m' $' !u' *e !&l'#& u !u"memper!'h' "' *e !&l'#& 'l*elo'r (' %')e"u'! 6Hu)'" )' G'llo+ 2;;87


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I )&"'#& Pe %%u '' Ve !&l'#&Me"' &"

. -ekanis Re#p&r'#& r'!e < 9= > 5 me &!T&)'l *olume "ur' % )'r& = ,,5"% BBM'"#&mum inspirasi force )'r& 2 mmH%G'%'l '.'# '"u! )er!'& '#&)o#re#p&r'!or&" (' % !&)'" $' )&'!'#& )e %'

pe %o$'!' $&'#' Ap e'


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). OksigenasiP'O2 "ur' % )'r& ?; mmH% )e %' F&O2room '&r 28 @

P'O2 "ur' % )'r& ; mmH% )e %' F&O2:; @P'O2 "ur' % )'r& 8;; mmH% )e %' F&O28;; @H&po"#em&' (' % !el'h me )'p'! !er'p&o"#&%e m'"#&mum 'mu !&)'" ')'per$'&"'


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+. Venti$asiP'CO2 le$&h )'r& ?; mmH%

Ke!e !u' !er#e$u! )&'!'# !&)'" $erl'"up')' "l&e )e %' COPD )' #!'!u#'#m'!&"u#


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Pe"a$atan Untuk !e&asanganVenti$asi &ekanik :

4'l' 'p'# $u'!' 6 ETT '!'u!r',heo#!om( !u$e 7Me#& Su,!&oOro.'r& %'l !u$eM' ome!er ,u.. Re#u#&!'!&o $'%Ve !&l'!or (' % !er)&r& )'r& 0 A&r )r&*eo"#&%e )' u)'r' l'& ('+ me#&*e !&l'!or )' -,&r"u&!


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S/STEM VENTILASI MEKANIK

Se,'r' umum )' .&" !er$'%& '!'#$e$er'p' "'r'"!er!&" 08 Sum$er Te '%' -Te '%' L!r&" -Te '%' P'ru-p'ru

- Kom$& '#& "e)u' ('


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2 Te"' '-Te"' ' Po#&!&.

-Te"' ' Ne%'!&.

9 S(#!em Ko !rol


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ANATOMY OF MECHANICALVENTILATOR

One Way Inspiratory Valve

Selonoid Valve

d Valve

O2

O2 AIRBlender

AIR

E!piratory Valve

"eated "#$idi%er WaterTrap

KE PATIENT

Ba&teria 'ilter T(er$o$eter

Ne)#li*er


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No"&a$ /"eat ing S!ontaneous

I #p&r'#& E"#p&r'#&

6 7

6-7


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Bre'!h& % Ve !&l'!or

A

BC

D E

In(alation E!(alation

6 7

6-7

A0 S!'r! o. I h'l'!&o A-C0 I h'l'!&o Ph'#eB-C0 I #p&r'!or( P'u#eC0 Be%& & % o. E>h'l'!&oC-E0 E>h'l'!&o Ph'#e


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Cur*e Mo)e


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Cur*e

SIMV A5CV

CMV


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A)' : F'#e C'r' Ker1' Ve !&l'#&Me"' &"

. T"igge"ing0inisiatingyang &e&u$ai0&e&e"inta se ingga 1enti$ato" beke"'a( !e&i,unyabisa be"asa$ da"i :

a. -esin : Atas dasa" %aktu b. Pasien : Ka"ena te"'adi !e"uba an a$i"an uda"a 0 tekanan). Pe&batasan0$i&itation

Va"iabe$ yang dibatasi anta"a $aina. Vo$u&eb. P"essu"e

+. 2y,$ing 3!e"!inda an da"i #ase ins!i"asi ke eks!i"asi4 Fase eks!i"asidi&u$ai sete$a :a. Vo$u&e yang &asuk te",a!ai

b. Tekanan 3P"essu"e4 yang &asuk te",a!ai,. Vo$u&e ins!i"asi te"$a&!auid. A$i"an uda"a &en,a!ai settinge. %aktu

5. Fase eks!i"asi !ada #ase ini bisa dibe"ikan tekanan 3PEEP4 atau tidak


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P"insi! Ke"'a Venti$ato" TekananPositi#

Vo$u&e ,y,$e 0S&"lu# & #p&r'#& '"' $erhe !& $&l'

*olume #u)'h !er,'p'& Be#'r ('*olume u)'r' (' % m'#u" "e p'ru-p'ru !er%' !u % p')' !&)'l *olume

'!'u m& u!e *olum (' % )&!e !u"'p')' me#& *e !&l'!or


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P"essu"e 2y,$e 0S&"lu# & #p&r'#& '"' $erhe !& $&l'

pre##ure #u)'h !er,'p'& Be#'r ('*olume u)'r' (' % m'#u" "e)'l'mp'ru-p'ru !er%' !u % p')' $e#'r ('pre##ure (' % "&!' #e!!& % T&)'l*olume '"' $eru$'h-u$'h #e#u'&)e %' "o )& p'ru-p'ru


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Ti&e 2y,$e 0Per 'p'#' (' % )&l'"u"' )&'!ur

)e %' '"!u 4uml'h u)'r' (' %)&pomp'"' '"' $erhe !& #e#u)'h'"!u (' % )&!e !u"' + #eh& %%'

'"' !er1')& pro#e# e"#p&r'#&


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PARAMETER VENTILATOR


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. Res!i"asi Rate 3RR4

4uml'h 'p'# (' % )&$er&"' p')'#e!&'p 'p'# p'#&e #e!&'p me &!De! '!'# )' )&$' 'h &l'& orm'l9;-:; >5me &! 6B'(&7+ 2;-2= >5me &!6' '" "e,&l7+ )' 8;-8: >5me &!6De '#'7


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+. Tida$ Vo$u&e 3 TV 4

Volume %'# (' % )&h' !'r"' oleh*e !&l'!or p')' #e!&'p #&"lu# 'p'#

)e! ?- ml5"% BBP')' ARDS+ %u '"' *olumele$&h "e,&l :-? ml5K% BB u !u"

mem& &m'l"' !'"' ' $erle$&h')&)'l'm 'l*eol&


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5. Ins!i"asi : Eks!i"asi Ratio 3I:E Ratio4

802 5 808+ merup'"' &l'& orm'l.&olo% & #p&r'#& e"#p&r'#&Ter"')' % )&perlu"' .'#e& #p&r'#& (' % #'m' 5le$&h l'm'

)&$' )& % e"#p&r'#& u !u"me & %"'!"' P'O2


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6. Ins!i"asi P"essu"e 3 IP 4

Me %'!ur5mem$'!'#& 1uml'h pre##ure5*olume,(,l&e) *e !&l'!or

Pre#ure $erle$&h+ )'p'! me (e$'$"' B'ro!r'um'Se)' %"'Volume $erle$&h )'p'! me (e$'$"' V'lu!r'um'

4&"' I #p&r'#& pre##ure5*olume !er,'p'& m'"'*e !&l'!or me %he !&"' h' !'r' (' )' 'l'rm$er$u (&Pe & %"'!' pre##ure $&l' !er1')& o$#!ru"#&+$'!u"+ re!e #& #pu!um+ ETT !er%&%&!+ .&%h!& % '!'u"& %"& %T&)'" mele$&h& 9= ,m H2O


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7. FiO) 3 F"aksi Oksigen 4

Ko #e !r'#& 6@7 o"#&%e (' %)&h' !'r"' oleh *e !&l'!or "e p'#&eKo #e !r'#& 28 8;; @

A 'l 8;;@ !&)'" $oleh !erl'lu l'm'D'p'! )& e' & % $er!'h'p

Se!!& % 8;;@ $&l' ')' !& )'"' !er!e !u(' % me %& !erup#& pem$er&' *e !&l'#&+$er&"' o"#&%e 8;;@ #el'm' 8= me &!


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8. PEEP 3 Positi1e End Eks!i"ato"yP"essu"e 4

PEEP ')'l'h #e1uml'h !e"' ' (' % )'"' oleh*e !&l'!or )''! '"h&r e"#p&r'#& p'#&e Tu1u' ('')'l'h u !u" mem$u'! 'l*eol& '%'r !e!'p !er$u"'6!&)'" "ol'p#7 Be#'r (' !e"' ' PEEP $' )&mul'&)'r& = #'mp'& 2; ,m H2O

D'mp'" 0 S'O2 )' P'O2 le$&h $'&"

Volume p'ru B'ro!r'um'

H&po!e #& '"&$'! CO


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9. T"igge" Sensiti1itas 3A&bangRangsang4

Flo !r&%%er 6L5Me &!7Pre##ure !r&%%er 6-,m H 2 O7


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. A$a"&

Se!&'p *e !&l'!or mempu ('& 'l'rmSe,'r' umum 'l'rm (' % !er)'p'!p')' *e !&l'!or ')'l'h 'l'rm u !u"*olume+ !e"' ' 1'l' '.'#+ $'!'#!e"' ' + 'p e'+ )' !emper'!ur

u !u" hum&)&.&"'#&


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SETTING MODE VENTILASI MEKANIK

8 CMV 6 PCV+VCV72 ACMV9 S(& ,hro ou# I !erm&!!e ! M' )'!or(

Ve !&l'!&o 6 SIMV 7: Pre##ure Suppor! Ve !&l'!&o 6 PSV 7= Co !& ou# Po#&!&*e A&r '( Pre##ure 6 CPAP 7

2 t" $ d t " V ti$ ti 32 V4


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2ont"o$ -andato"y Venti$ation 32-V4

P'r'me!er Mo)e VCV ' TV $ RR

, F&O2 ) I 0 E R'!&o

e P E E P . Se #&!&*&!( 5 Tr&%%er

% Upper5lo er pre##ure l&m&! 0

:;-=; ,m H 2O Al'rm Upper5lo er e>p&re) m& u!e *olume

P'r'me!er Mo)e PCV' RR$ I #p&r'#& T&me

, I #p&r'#& Pre##ure) P E E Pe F&O2

. Al'rm Upper5lo er e>p&re) m& u!e *olume

Se1uml'h u)'r' (' % )&& #p&r'#&"' oleh me#& "ep')'p'#&e (' % )&$'!'#& oleh *olume ,o !rol 6VC7 '!'uPre##ure ,o !rol 6PC7

C&r& "h'# p')' mo)e & & &'l'h+ p'#&e $er#&.'! p'#&.+ 'r!& (' !&)'" ')' u#'h'u !u" me %' 'l& per '.'#' Ber'r!& #emu' *'r&'$el )'l'm per '.'#'!er%' !u % #epe uh (' p')'Ve !&l'!or


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Syn, "onous Inte"&ittent -andato"y Venti$ation 3SI-V4

Mo)e & & me e"' "' p')' m' )'! (' % !el'h )&!e !u"'#eh& %%' p'#&e $er '.'# p')' '"!u- '"!u !er!e !u+

Ter"')' % mo)e & & )&$er&"' $er#'m'' )e %' pre##ure#uppor! 6PS7 )e %' SIMV R'!e )&!&')'"'

P'r'me!er 0

' TV $ SIMV R'!e , I #p&r'#& T&me ) Pre##ure Suppor! e F&O2 . P E E P

P')' pr& #&p (' mo)e & & p'#&e )&$er& "e#emp'!' u !u" $er 'p'# #po !' 6#e )&r&7


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2ontinous Positi1e Ai"%ay P"essu"e 32PAP4

/'&!u '.'# #po !' 'mu p')' '"h&r e"#p&r'#& m'#&h')' !e"' ' po#&!&. 6PEEP7D'l'm mo)e & & !&'p & #p&r'#& )uppor )e %' pre#e!,o #!' pre##ure 6 8= 9= ,mH2O 7+ p'#&e h'ru#mel'"u"' !r&%%er *e !&l'!or )' $&'#' (' )&"om$& '#&)e %' SIMV

P'r'me!er 0' PEEP$ Pre#e! #uppor , F&O2


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Assist 2ont"o$e 3A24

Ve !&l'!or memul'& & #p&r'#& #''! p'#&e me &m$ul"'#e$u'h !e"' ' e%'!&. )& )'l'm #&r"u&! *e !&l'!or Ve !&l'!or )'p'! mem$er&"' '.'# $' !u' )e %'*olume5pre##ure !er!e !uP'r'me!er

' R R$ F&;2, I 0 E R'!&o) Tr&%er Se #&!&*&!(

e T V. I #p&r'#& Pre##ureDe %' )em&"&' (' % me e !u"' .re"ue #& per '.'#' ')'l'hp'#&e + #e)' % *e !&l'!or me e !u"' $e#'r (' *olume

!&)'l 6V-ACMV7 '!'u !e"' ' 6P-ACMV7


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Classifcation o the Modes oVentilationClassifcation o the Modes oVentilation

S ontaneo!s"entilation

S ontaneo!s"entilation

Vol!#e cont$olled"entilation

Vol!#e cont$olled"entilation

%$ess!$e cont$olled"entilation

%$ess!$e cont$olled"entilation

+ I%%V & CMV '+ I%%VAssist & A(C '+ SIMV+ MMV+ VCV

+ %CV+ BI%A%+ BI%A% Assist+ A%RV

+ C%A%

+ ASB & %SV '+ %%S

KEUNTUN;AN DAN KERU;IAN -ODE KONVENSIONAL


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KEUNTUN;AN DAN KERU;IAN ODE KONVENSIONALVENTILATOR

-ODE KEUNTUN;AN KERU;IAN

CMV - O!o! per '.'#' $' !&r'h'!

- I !er'"#& p'#&e )%*e !&l'!or "ur' %- Perlu #e)'#& ,u"up- Po!e #&'l me %%' %%u

hemo)& 'm&"

ACMV - P'#&e (' % me e -!u"'"e$u!uh' ('

- Ker1' o!o! '.'# "ur' %

- Po!e #&'l me %%' %%uhemo)& 'm&"

- Ce )eru % h&per*e !&-l'#&(' % !&)'" ')e"u'!

SIMV - I !er'"#& p'#&e )%*e !ol'!or le$&h $'&"

- Kur' % me %%' %%uhemo)& 'm&"

- D&$' )& % )e %' ACMV"er1' o!o! '.'#me & %"'!

PSV - P'#&e le$&h ('m' - B&l' 'p eu $er$'h'('

P-CMV - PIP )&$'!'#&- Per$' )& %' I5E

!er"o !rol

- Po!e #&'l !er1')& h&per5h&po*e !&l'#& p')' ,omp-l&' ,e p'ru (' % !er-%' %%u


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EANING VENTILATOR

P'r'me!er (' % me %&)e !&.&"'#&"'"e#&'p' p'#&e u !u" e' & %

$* $ & d "i ! $ !


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. me u 1u""'per$'&"'Se"re#& m& &m'lSu'r' '.'# orm'l

).


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) g , ,

out !ut yang adekuat

+. Kekuatan otot !e"na!asanRR J 2= >5me &!Ke"u!' & #p&r'!&. e%'!&. < -2; ,m H 2 OT&)'l Volume #po !' :-= ml5"% BBK'p'#&!'# *&!'l 8;-8= ml5"%Minnute ventilation =-8; L5me &!


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6 Ti k t K d " k ! b ik


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6. Tingkat Kesada"an ,uku! baik7. Status Nut"isi dan id"asi baik

8. Tidak ada #akto" yang &engganggu!"oses %eaning :I .e"#&

A em&'Dem'mF'!&%ueSleep deprivation

N(er&D!e #& A$o)emeBAB !&)'" orm'l


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9. Se,a"a -enta$ Sia! Untuk di =eaning

Te ' % )' r&le"#T&)'" ')'5mem&l&"& ' #&e!'# (' % m& &m'lBer#em' %'!

Ke$u!uh' (' % m& &m'l !erh')'p #e)'#&

)' o$'! l'& (' (' % )'p'!me (e$'$"' )epre#& per 'p'#'


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-ETODE =EANIN;

8 M' u'l e' & % 0 D&mul'& #el'm' =me &! )'l'm 8 1'm )' me & %"'!#e,'r' $er!'h'p

2 Ve !&l'!or e' & % 0 SIMV )&!uru "'8-2>5h'r& #'mp'& )e %' !oler' #&B&'#' (' )&mul'& )'r& 8;>5me &! )')&!uru "' #e)&"&! )em& #e)&"&! #'mp'&'"h&r (' "l&e $er '.'# #e )&r& )e %'!&)'l

KRITERIA UNTUK -EN;AK


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KRITERIA UNTUK -EN;AK5me &! )'r& &l'&#e$elum ('

2 Te"' ' )'r'h '&" '!'u !uru 2;mmH%

9 Fre"ue #& '.'# $eru$'h 8;>5me &!+ RR <2=>5me &!+ '!'u J >5me &!

: Se#'" '.'#+ p' &"+ (er&+ )' lem'h

= D!r&m'+ pe %%u '' o$'! $' !u '.'#+pe & %"'!' P'CO 2 + pH J +9=

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179128939 Ventilasi Mekanik 1 Ppt