ANALISA SINTESA KEPERAWATAN KRITIS VENTILATOR MEKANIK DI ICU RSUD dr. GOETENG TAROENADIBRATA PURBALINGGA
OLEH: LITA HENI KUSUMAWARDANI KUSUMAWARDANI G1B212071
KEMENTERIAN PENDIDIKAN NASIONAL UNIVERSITAS JENDERAL SOEDIRMAN FAKULTAS KEDOKTERAN DAN ILMU-ILMU KESEHATAN JURUSAN KEPERAWATAN POGRAM PROFESI NERS PURWOKERTO 2013
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A. DEFINISI
Ventilator mekanik merupakan alat bantu pernapasan bertekanan positf atau negatif yang menghasilkan aloiran udara terkontrol pada jalan napas pasien sehingga mampu mepertahankan ventilasi dan pemberian oksigen dalam jangka waktu yang lama (Purnawan & Saryono, 2010). Tujuan pemasangan ventilator mekanik adalah mempertahankan ventilasi alveolar secara optimal dalam rangka memenuhi kebutuhan metabolik pasien, memperbaiki hipoksemia, dan memaksimalkan transportsi oksigen (Purnawan & Saryono, 2010).
B. INDIKASI PEMASANGAN
1. Gagal nafas, pasien dengan distres pernafasan gagal nafas, henti nafas (apnu) maupun hipoksemia yang tidak teratasi dengan pemberian oksigen merupakan indikasi ventilator mekanik. Idealnya pasien telah mendapat intubasi dan pemasangan ventilator mekanik sebelum terjadi gagal nafas yang sebenarnya. Distres pernafasan disebabkan ketidakadekuatan ventilasi dan atau oksigenasi. Prosesnya dapat berupa kerusakan paru (seperti pada pneumonia) maupun karena kelemahan otot pernafasan dada (kegagalan memompa udara karena distrofi otot). 2. Insufisiensi jantung. Tidak semua pasien dengan ventilator mekanik memiliki kelainan pernafasan primer. Pada pasien dengan syok kardiogenik dan CHF, peningkatan kebutuhan aliran darah pada sistem pernafasan (sebagai akibat peningkatan kerja nafas dan konsumsi oksigen) dapat mengakibatkan jantung kolaps. Pemberian ventilator untuk mengurangi beban kerja sistem pernafasan sehingga beban kerja jantung juga berkurang. 3. Disfungsi neurologist, pasien dengan GCS 8 atau kurang yang beresiko mengalami apnu berulang juga mendapatkan ventilator mekanik. Selain itu ventilator mekanik juga berfungsi untuk menjaga jalan nafas pasien. Ventilator mekanik juga memungkinkan pemberian hiperventilasi pada klien dengan peningkatan tekanan intra cranial.
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Ventilator tekanan negatif merupakan jenis ventilator yang pertamakali ditemukan dan sering dikenal sebgai iron lung. Alat ini berfungsi menciptakan tekana negatif pada ruangan tabung yang menutupi tubuh hingga leher psien. Tekanan negatif yang dihasilkan dapat memperbesar rongga dada sehingga menimbulka tekanan negatif intratorakal yang kemudian memicu aliran udara dari atmosfer menuju paru-paru. Sedangkan ekpsorasi ekpsorasi terjadi secara pasif, ketika tekanan negatif dari ventilator dihentikan , maka tekanan intratorakal meningkat sehingga udara terdorong keluar dari paru-paru. Ventilator ini digunakan untuk mengatasi gagal napas yang disebabkan oleh gangguan ventilasi. Kasus-kasus yang berkaitan dengan gannguan ventilasi terutama disebabkan oleh penyakit neuromuskuler dan penyakit saraf pusat. Keuntungan dari ventilator tekanan negatif adalah bekerja layaknya pernapasan normal sehingga tidak membuthkan tindakan intubasi. 2. Ventilator tekanan positif Ventilator ini bekerja dengan memberikan tekanan positif pada daerah di luar paru-paru yakni jalan napas. Kondisi ini membuat tekanan intrapleural semakin lebih negatif dibandingkan dengan tekanan atmosfer, sehingga udara dengan mudah masuk memasuki paru-paru. Penggunaan ventilator mekanik tekanan positif pda umumnya membutuhkan tindakan intubasi (pemasangan selang ETT). Sedangkan yang tidak membutuhkan pemasangan jalan napas buatan terbatas hanya pada mode bilevel ventilation dan CPAP (continues positive airway pressure). Ventilator tekanan positif inilah yang kemudian mengalami perkembangan dalam hal fungsinya. fungsin ya. Berdasarkan mekanisme kerjanya ventilator mekanik tekanan positi dapat dibagi menjadi 3, yaitu yang pertama volume cycle yang memiliki prinsip kerja ventilator akan memberikan udara inspirasi hingga mencapai volume yang telah disetting, ciri khasnya adalah volume tidal pasien akan tetap tetapi tekanannya berubah-ubah. Yang kedua adalah pressure cycle yaitu memiliki prinsip kerja terus melakukan isnpirasi hingga tekanan yang telah diseting sebelumnya tercapai, pada ventilator ini tekanan tidak berubah-ubah, sedangkan volume tidal selalu berubah-ubah sesuai dengan kondisi lapang paru pasien. Yang ketiga
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oleh waktu dan kecepatan inspirasi (jumlah napas permenit). Dalam time cycle waktu inspirasi maupun rasio inspirasi dan ekspirasi I:E disetting.
D. ISTILAH-ISTILAH ISTILAH-ISTILAH DALAM VENTILATOR MEKANIK
1. FiO2 dan PaO2. FiO2 adalah fraksi atau konsentrasi oksigen dalam udara yang diberikan kepada pasien. Sedangkan PaO2 adalah tekanan parsial oksigen yaitu perbedaan konsentrasi antara oksigen di alveolus dan membran. 2. I:E Ratio Perbandingan antara waktu inspirasi dan ekspirasi. Nilai normal 1:2 3. Volume Tidal. Jumlah udara yang keluar masuk paru dalam satu kali nafas, atau sama dengan jumlah udara yang diberikan ventilator dalam satu kali nafas. Nilai normal 10 – 15 15 ml per kgBB untuk dewasa dan 6-8 ml per kgBB untuk anak. 4. Minute Volume. Jumlah udara yang keluar masuk dalam satu menit, atau jumlah udara yang diberikan ventilator dalam satu menit. Nilainya = volume tidal x RR 5. PEEP dan CPAP. Positive end expiratory pressure (PEEP) atau tekanan positif akhir ekspirasi digunakan untuk mepertahankan tekanan paru positif pada akhir ekspirasi untuk mencegah terjadiya kolaps paru dan meningkatkan pertukaran gas dalam alveoli. Nilai antara 5-15 mmHg, maksimal 12 mmHg untuk anak. Continuous positive airway pressure (CPAP) identik dengan PEEP, yaitu pemberian tekanan positif pada saluran nafas selama siklus pernafasan. 6. Pressure atau Volume Limit . Batas atas tekanan atau volume yang diberikan pada pasien. Volume limit yang terlalu tinggi dapat berakibat berakibat trauma paru.
E. CARA KERJA VENTILATOR MEKANIK
1. Triggering/inisiating a. Prinsionya memulai/memerintah sehingga ventilator bekerja, pemicunya bisa berasal dari : b. Mesin : Atas dasar waktu c. Pasien : Karena terjadi perubahan aliran udara / tekanan 2. Pembatasan/limitation a. Variabel yang dibatasi antara lain b. Volume
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a. Volume yang masuk tercapai b. Tekanan (Pressure) yang masuk tercapai c. Volume inspirasi terlampaui d. Aliran udara mencapai setting e. waktu 4. Fase Ekspirasi Pada fase ini bisa diberikan tekanan (PEEP) ataupun tidak Peran perawat dalam tindakan ventilator a. Menetapkan ventilasi mekanik siap pakai b. Menentukan setting mode ventilator c. Menetukan Parameter mode ventilator d. Mengatur alarm pada posisi ON e. Memposisikan pasien agar merasa nyaman
F. MODE PENGATURAN
1. Mode control ( pressure pressure control, volume control, continuous mode). mode). Pasien mendapat bantuan pernafasan sepenuhnya, pada mode ini pasien dibuat tidak sadar (tersedasi) sehingga pernafasan di kontrol sepenuhnya oleh ventilator. Tidal volume yang didapat pasien juga sesuai yang di set pada ventilat or. Pada mode control klasik, pasien sepenuhnya tidak mampu bernafas dengan tekanan atau tidal volume lebih dari yang telah di set pada ventilator. Namun pada mode control terbaru, ventilator juga bekerja dalam mode assis t-control yang memungkinkan pasien bernafas dengan tekanan atau volum tidal lebih dari yang telah di set pada ventilator. 2. Mode Intermitten Mandatory Ventilation (IMV) Pada mode ini pasien menerima volume dan frekuensi pernafasan sesuai dengan yang di set pada ventilator. Diantara pernafasan pemberian ventilator tersebut pasien bebas bernafas. Misalkan respiratory rate (RR) di set 10, maka setiap 6 detik ventilator akan memberikan bantuan nafas, diantara 6 detik tersebut pasien bebas bernafas tetapi tanpa bantuan ventilator. Kadang ventilator memberikan bantuan saat pasien sedang bernafas mandiri, sehingga terjadi benturan antara
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3. Mode Synchronous Intermitten Mandatory Ventilation (SIMV) / Asissted Mode
Mode ini sama dengan dengan mode IMV hanya saja ventilator tidak memberikan bantuan ketika pasien sedang bernafas mandiri. Sehingga benturan terhindarkan. 4. Mode pressure support atau mode spontan . Ventilator tidak memberikan bantuan inisiasi nafas l agi. Inisiasi nafas sepenuhya oleh pasien, ventilator hanya membantu pasien mencapai tekanan atau volume yang di set di mesin dengan memberikan tekanan udara positif.
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SISTEM VENTILATOR MEKANIK A. Karakteristik Karakteristik Secara Umum dan Fisik:
1. Sumber Tenaga a. Tenaga listrik b. Tenaga paru-paru c. Kombinasi keduanya 2. Tekanan a. Tekanan Positif b. Tekanan Negatif 3. Sistem Kontrol a. Sistem buka dan tutup saluran nafas untuk mengontrol fungsi ventilasi b. Panel Kontrol Hanya dapat dilakukan oleh satu jenis variabel pada saat bersamaan antara tekanan volume dan flow
B. Ada 4 Fase Cara Kerja Ventilasi Mekanik
1. Triggering/inisiating Pemicu untuk memulai/memerintah sehingga ventilator bekerja, dari : a. Mesin : Atas dasar waktu b. Pasien : Karena terjadi perubahan aliran udara / tekanan 2. Pembatasan/limitation a. Volume b. Pressure 3. Cycling (perpindahan dari fase inspirasi ke ekspirasi) Fase ekspirasi dimulai setelah :
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a. Menetapkan ventilasi mekanik siap pakai b. Menentukan setting mode ventilator c. Menetukan Parameter mode ventilator d. Alarm pada posisi ON e. Pasien merasa nyaman
C. Setting Mode Ventilasi Mekanik
1. CMV ( PCV,VCV) Sejumlah udara yang diinspirasikan oleh mesin kepada pasien yang dibatasi oleh volume control (VC) atau Pressure control (PC) > Parameter VCV > Parameter PCV a. TV a. RR b. RR b. Inspirasi Time c. FiO2 c. Inspirasi Pressure d. I : E Ratio d. P E E P e. P E E P e. FiO2 f. Sensitivity / Trigger 2. ACMV 3. Syinchronous Intermittent Mandatory Ventilation ( SIMV ) Mode ini menekankan pada mandat yang telah ditentukan sehingga pasien bernafas pada waktu-waktu tertentu Terkadang mode ini diberikan bersamaan dengan pressure support (PS) dengan SIMV Rate ditiadakan > Parameter a. TV
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Dampak : 1) SaO2 dan PaO2 lebih baik. 2) Volume paru 3) Barotrauma 4) Hipotensi akibat CO 4. Pressure Support Ventilation ( PSV ) 5. Continous Positive Airway Pressure ( CPAP ) Dalam mode ini tiap inspirasi disuppor dengan preset constan pressure ( 15 – 35 cmH2O ), pasien harus melakukan trigger ventilator dan biasanya dikombinasi dengan SIMV. Parameter : a. PEEP b. FiO2
D. Assist Controle (AC)
1. Ventilator memulai inspirasi saat pasien menimbulkan sebuah tekanan negatif di dalam sirkuit ventilator 2. Ventilator dapat memberikan nafas bantuan dengan volume/pressure tertentu Parameter a. R R 1) Jumlah napas yang diberikan kepada pasien setiap menit 2) Diset diatas dan dibawah nilai normal 3) 10 – 14 14 x/menit b. FiO2 1) Konsentrasi (%) oksigen yang dihantarkan oleh ventilator ke pasien
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d. Triger Sensitivity 1) Merupakan jumlah usaha nafas pasien yang diperlukan untuk memulai/trigger inspirasi ventilator 2) Setting à flow / pressure 3) Flow lebih baik untuk pasien yang sudah nafas spontan 4) Nilai sensitiviti maksimum; a) P – Trigger Trigger ( 0,5 cm H2O ) b) F – Trigger Trigger ( 0,5 cm H2O ) e. T V 1) Volume gas yang dihantarkan oleh Ventilator pada setiap siklus napas 2) Diset 6 – 8 8 ml/Kg.BB 3) Pada ARDS, gunakan volume lebih kecil 4 – 6 ml/Kg.BB untuk meminimalkan tekanan berlebihan didalam alveoli f. Inspirasi Pressure (IP) 1) Mengatur/ membatasi jumlah pressure/volume cyiled ventilator. a) Pressure berlebih, dapat menyebabkan Barotrauma. sedangkan b) Volume berlebih dapat menyebabkan Valutrauma 2) Jika inspirasi pressure/valume tercapai maka ventilator menghentikan hantarannya dan alarm berbunyi. 3) Peningkatan pressure bila terjadi obstruksi, batuk, retensi sputum, ETT tergigit, fighting atau kingking. 4) Tidak melebihi 35 cm H2O.
E. Setting Alarm Ventilator:
1. Minit volum
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7. Kegagalan Weaning.
G. Sterilisasi Komponen Ventilator
1. Pengertian : a. Antiseptic : Bahan Yang Dipergunakan Untuk Membunuh Atau Menghambat Pertumbuhan Kuman Pada Jaringan Hidup b. Desinfektan : Bahan yang dipergunakan untuk mematikan kuman atau menghambat pertumbuhan mikroorganisme yang berada pada benda mati 2. Tahapan a. CLEANING ® PEMBERSIH 1) Definisi : Membuang semua debu, benda asing atau kotoran 2) Indikasi : Mendahului proses desinfeksi dan sterilisasi 3) Bahan : Sabun atau detergen, air dingin atau air hangat yang mengalir dan seringkali 4) Diperlukan sikat.
b. DESINFEKSI ® TINGGI/HIGH RENDAH/LOW 1) Definisi : Membunuh/menghambat pertumbuhan mikriorganisme. 2) Indikasi : Untuk yang dalam penggunaannya kontak dengan mukosa membran dan alat 3) yang tidak dapat disterilkan misalnya ; alat listrik. 4) Desinfeksi untuk alat ventilator a) Transduser b) Kabel sensor humidifier
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d. PENYIMPANAN ® ALMARI KHUSUS
H. Sirkuit Ventilator
1. Tubing ventilator yang telah dipakai dibersihkan terlebih dahulu dengan sabun atau detergen, air dingin atau air hangat yang mengalir dan seringkali diperlukan sikat. 2. Tubing ventilator yang sudah bersih direndam dalam larutan desinfektan selama kurang lebih 24 jam. 3. Kemudian bilas kembali dengan air hangat yang mangalir (scrub station) 4. Keringkan dengan Tubedryer, bila ada. 5. Sesudah kering Tubing-tubing ventilator tersebut dibungkus : a. Bila memakai sterilisator Ethylene Oxide gas (EtO) dibungkus memakai kertas EtO.. b. Bila memakai sterilisator Autoclave, dibungkus dengan kain. 6. Khusus untuk alat ventilator Transduser, Kabel sensor humidifier, cukup di desinfeksi dengan Cidex (High) dan Alkohol, Saflon 1:3 (low)
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VENTILASI MEKANIK A. Aplikasi klinik
1. Resusitasi jantung paru 2. Gagal nafas 3. Paska operasi besar yang memerlukan bantuan ventilasi untuk memperbaiki homeeostasis, gangguan keseimbangan asam basa serta keadaan anemia 4. Sepsis berat dimana pasien tidak dapat memenuhi peningkatan work of breathing akibat tingginya produksi CO2 5. Pengendalian kadar CO2 sebagai salah satu bagian dari pengelolaan TTIK (misalnya akibat cedera kepala). 6. Sebagai
bantuan
ventilasi
pada
penderita
yang
mempertahankan jalan nafas. 7. Mengurangi beban jantung pada syok kardiogenik
B. Indikasi
Kriteria objektif untuk penggunaan ventilasi mekanik adalah: 1. Laju nafas > 35 2. Volume tidal < 5ml/kg
diintubasi
atas
indikasi
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Nasal lines, pusing, tidak berdaya, cemas, apatis, kelelahan, disorientasi, menarik-narik baju, weak smile 3. Sistem Kardiovaskular Extremitas , hidung ,telinga, teraba dingin, nadi meningkat, disritmia, tekanan darah menurun , peningkatan tekanan nadi, diuresis menurun Bila ragu dengan tanda-tanda yang tampak pada pasien, lebih baik diobservasi di ICU karena sewaktu-waktu perlu ventilasi mekanik dapat dipenuhi daripada di ruangan.
C. Mode Ventilasi
1. Controlled Minute Ventilation (CMV) Mode ventilasi ini sangat mirip dengan dengan mode yang yang dipakai diruang operasi dimana laju nafas dan volume volume
tidal ditentukan oleh klinisi. CMV digunakan digunakan bila bila nafas
spontan tidak ada atau minimal, misalnya pada penderita dengan hipoksia yang berat. 2. Pressure Controlled Ventilasion (PCV) Klinisi mengatur laju nafas dan rasio inspirasi dan ekspirasi. PCV digunakan untuk melimitasi tekanan pada jalan nafas pada paru-paru dengan komplians yang rendah atau resistensi yang tinggi untuk mencegah risiko barotrauma. Dengan demikian akan diperoleh volume tidal dan minute volume yang bervariasi sesuai dengan perubahan komplians dan resistensi.
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frekwensi nafas sehingga merangsang ventilasi spontan. Pressure support
dapat
ditambahkan pada penderita yang sudah bernafas spontan 5. Ventilasi dengan Rasio Terbalik (Inverse Ratio Ventilation) Siklus respirasi adalah satuan waktu yang diperlukan untuk memasukkan dan mengeluarkan udara pada setiap tarikan nafas yang dihasilkan oleh ventilator. Siklus ini dibagi menjadi waktu inspirasi dan ekspirasi .Rasio inspirasi dan ekspirasi ekspirasi yang normal adalah 1:2-3.Pemanjangan relatif waktu inspirasi [invers rasio ventilasi] sering digunakan untuk untuk memperbaiki pertukaran gas gas pada pasen dengan oksigenasi kurang. kurang. Umumnya dipakai ratio 1:1. Cara ini digunakan digunakan baik pada mode pressure control maupun volume control ventilation
D. Pressure Support
Pada keadaan ini terdapat nafas spontan pasien dan tidak ada pengaturan frekuensi nafas. Ventilator akan memberikan tekanan positif pada jalan nafas sebagai respon terhadap upaya pernafasan. Volume tidal bervariasi sesuai dengan komplain rongga dada dan resistensi jalan nafas nafas . Biasanya Biasanya dimulai dengan tekanan 20-30 cm H2O dan diturunkan bila gerakan respirasi pasein membaik. Kadang dapat dikombinasikan dengan SIMV untuk membantu frekuensi pernafasan spontan. Sesuai dengan usaha inspirasi pasen, maka ventilator akan memberikan bantuan tekanan inspirasi. Volume assured pressure
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saat inspirasi. Penderita dapat juga memakai semacam helm kemudian bantuan insprasi diberikan melalui mouthpiece. Ventilator jenis ini ada yang dapat dipakai untuk penderita yang diintubasi tapi dapat bernafas spontan. Tujuannya adalah untuk menghindari atau mencegah penderita dari tindakan intubasi endotracheal. a. Indikasi 1) Hipoksia sehingga kebutuhan laju nafas, upaya na fas dan FiO2 meningkat 2) Hiperkapni dan tampak kelelahan 3) Mencegah supaya jangan sampai diintubasi bila misalnya pada pasien dengan yang mengalami keterbatasan aliran udara secara kronis, pemakaian imunosupresi 4) Mengurangi beban otot pernafasan pada penderita dengan PEEPi yang tinggi (asma, chronic airflow limitasi). Dipergunakan dengan hati2 dan pengawasan ketat. 5) Tehnik fisioterapi untuk untuk meningkatkan Functional Residual Capasity (FRC) 6) Sleep apnoea 7) Suatu tahapan dalam proses penyapihan. 3. Inspiratory Support Tekanan inspirasi yang di berikan oleh ventilator dicetuskan oleh nafas pasien.
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4. Pada awalnyn penderita dengan Resplratory Distress biasanya tidak toleran dengan cara ini. Diperlukan pengamatan yang ketat dan terus menerus untuk membiasakan pasien memakai masker. Sementara itu kita terus mencari mode support dan rasio I : E yang paling optimal. 5. Dosis rendah opiat (diamorfin 2.5mg) untuk menenangkan mene nangkan pasien tanpa menyebabkan depresi nafas harus diberikan secara hati2. 6. Pada beberapa pasien setelah memakai masker yang melekat erat selama beberapa hari dapat timbul gejala clautrophobia . Hal ini dapat diatasi dengan jalan mengistirahatkan beberapa saat secara berkala. 7. Daerah yang mendapat tekanan seperti batang hidung harus dilindungi untuk mencegah perlukaan.
F. Weaning (Menyapih) Ventilasi Mekanik
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Yang paling penting pada penilaian ini adalah keberhasilan pertukaran gas. Oleh karena itu penilaian klinis menjadi sangat penting dan dapat memberikan petunjuk adanya kegagalan pernafasan yang memerlukan bantuan ventilasi.
G. Faktor-Faktor Faktor-Faktor yang Berhubungan dengan Kesulitan Saat Menyapih dari Ventilator Mekanik
1. Kelainan patologi primer yang menetap. 2. Gagal ginjal atau kardiovaskular yang tidak dapat diobati 3. Malnutrisi 4. Sepsis atau pireksia (peningkatan kebutuhan metabolik). 5.Kelebihan cairan 5. Residual dari zat sedatif 6. Ketidakseimbangan elektrolit (terutama Ca, Mg, K, PO4) 7. Anemia
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6. Memberikan kemudahan dalam mengganti sistem bantuan pernafasan(misalnya penderita perlu ventilator lagi).
H. Komplikasi Bantuan Ventilasi
1. Kolaps dari sistem kardiovaskular: Biasanya terjadi pada awal pemakaian ventilasi mekanik dengan tekanan positif. Penyebabnya adalah efek depresi dari obat sedasi, hambatan pada daya dorong torak yang akan mengakibatkan peningkatan venous return ,tamponade ventrikel kiri akibat tekanan intra torak yang positif. Tinggi nya tekanan inflasi dan PEEP akan memperberat keadaan. Perburukan akan terjadi pada penderita yang hipovolumia, sepsis atau syok kardiogenik. 2. Ketidak seimbangan asam basa: Asidosis respiratoris atau alkalosis sangat mungkin terjadi bila minute volume tidak
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8. Intubasi melalui nasotrakea membawa risiko sinusitis
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ASUHAN KEPERAWATAN KLIEN DENGAN VENTILASI MEKANIK
Ventilasi mekanik merupakan terapi defenitif pada klien kritis yang mengalami hipoksemia dan hiperkapnia. Memberikan asuhan keperawatan pada klien dengan ventilasi mekanik dilakukan antara lain pada unit perawatan kritis, medikal bedah umum, bahkan di rumah. Perawat, dokter dan ahli terapi pernafasan harus mengerti kabutuhan pernafasan spesifik klien. Rumusan penting untuk hasil klien yang positif termasuk memahami prinsip-prinsip ventilasi mekanik dan perawatan yang dibutuhkan klien, komunikasi terbuka antara tim kesehatan, rencana penyapihan dan toleransi klien terhadap perubahan pengaturan ventilasi mekanik.
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trakeostomi. Ventilator ini secara luas digunakan pada klien dengan penyakit paru primer. Terdapat tiga jenis ventilator tekanan positif yaitu tekanan bersiklus, waktu bersiklus dan volume bersiklus. Ventilator tekanan bersiklus adalah ventil ator tekanan positif yang mengakhiri inspirasi ketika tekanan preset telah tercapai. Dengan kata lain siklus ventilator hidup mengantarkan aliran udara sampai tekanan tertentu yang telah ditetapkan seluruhnya tercapai, dan kemudian siklus mati. Ventilator tekanan bersiklus dimaksudkan hanya untuk jangka waktu pendek di ruang pemulihan.
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d. Musculosceletal disease e. Ketidakmampuan thoraks untuk ventilasi 2. Kegagalan pertukaran gas a. Gagal nafas akut b. Gagal nafas kronik c. Gagal jantung kiri d. Penyakit paru-gangguan difusi
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berdasarkan atas frekuensi pernafasan yang spontan dari klien, biasanya digunakan pada tahap pertama pemakaian ventilator. c. Intermitten Mandatory Ventilation Model ini digunakan pada pernafasan asinkron dalam penggunaan model kontrol, klien dengan hiperventilasi. Klien yang bernafas spontan dilengkapi dengan mesin dan sewaktu-waktu diambil alih oleh ventilator. d. Synchronized Intermitten Mandatory Ventilation (SIMV)
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G. Pengkajian
Perawat mempunyai peranan penting mengkaji status pasien dan fungsi ventilator. Dalam mengkaji klien, perawat mengevaluasi hal-hal berikut : 1. Tanda-tanda vital 2. Bukti adanya hipoksia 3. Frekuensi dan pola pernafasan 4. Bunyi nafas
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8. Alarm 9. PEEP
Catatan Jika terjadi malfungsi system ventilator, dan jika masalah tidak dapat diidentifikasi dan
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4. Kerusakan mobilitas fisik yang berhubungan dengan ketergantungan ventilator
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yaitu auskultasi paru dan interpretasi gas darah arteri. Perawat sering menjadi orang
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tubuh, papan komunikasi, papan pengumuman. Ahli terapi bahasa dapat membantu
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b. Volume tidal 4-5 cc / kg
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DAFTAR PUSTAKA