SDRA

FORME PARTICULARE DE INSUFICIENTA

RESPIRATORIE

SINDROMUL DE DETRESA RESPIRATORIE ACUTA LA

ADULT (SDRA)
Forma de IR acuta caracterizata:
-clinic : dispnee severa , tahipnee, cianoza si
hipoxemie refractare la O2
-radiologic : infiltrate alveolare difuze,bilateral
-fiziopatologic :brusca a compliantei pulmonare
sdr. restr. sever
sunt intrapulmonar dr-stg
HTAP (faze tardive)ICDr.
SDRA este o forma speciala de EPAN asociat cu
multiple suferinte viscerale date de un proces
inflamator difuz ce afecteaza celulele endoteliale din
toate organele.

SINDROMUL DE DETRESA RESP. ACUTA

LA ADULT (SDRA)
CONDITII ASOCIATE CU SDRA

Soc (septic, hemoragic,cardiogen,etc)

Infectii (pneumonie virala,pneumonie bacteriana, pneumonii
cu gram negativi,legioneloza,etc.)
Aspiratie de lichid gastric (pH<2.5)
Traumatisme (arsuri, contuzie pulmonara, traumatisme
cerebrale)
Inhalare de gaze toxice (oxigen, NH2,NO2, fosgen, smoke)
Ingestia de medicamente (heroina, barbiturice,thiazide,
salicilati, colchicina, Dextran 40)
Conditii metabolice (acidocetoza diabetica, uremie)
Cauze diverse : Pancreatita acuta , embolii grasoase, lichid
amniotic, transfuzii multiple, CID, eclampsie,
postcardioversie, post by pass cardio-pulmonar.

SINDROMUL DE DETRESA RESP. ACUTA

LA ADULT (SDRA)
PATOGENIE SI MODIFICARI STRUCTURALE

Afectarea pulmonara face parte dintr-un proces inflamator difuz in

care sunt implicate celulele endoteliale capilare din toate organele.
IR acuta progresiva si insuficiente viscerale multiple .

Suferinta endoteliului cap. si epiteliului alveolar :

-congestie si permeab cap.
-trecerea apei si prot. in interst pulm (edem interstitial )
-rupturi capilare
-extravazare masiva de lichid, fibrina, hematii si leuc in interst
-depasirea capac de drenaj limfatic
-umplerea alveolelor cu lichid bogat in proteine
-revarsarea lichidului in jurul spatiilor aeriene membrana hialina.

SINDROMUL DE DETRESA RESP. ACUTA

LA ADULT (SDRA)
PATOGENIE SI MODIFICARI STRUCTURALE

Afectarea difuza a alveolelor pulm. in trei faze :

-faza exudativa (24-96 ore) : edem alv. si insterst.,congestie
cap.,distrugerea cel alv I,.
formarea membranelor hialine.
-faza proliferativa precoce (3-5 zile ) : nr.cel alv II , impiedica
producerea de surfactant.
infiltrare celulara a septurilor alveolare
organizarea membranelor hialine
producerea microatelectaziilor
- faza proliferativa tardiva (7-10 zile ): fibroza membranelor
hialine a septurilor alveolare si ductelor alveolare.

SINDROMUL DE DETRESA RESP. ACUTA

LA ADULT (SDRA)
FIZIOPATOLOGIE

Sindrom restrictiv cu reducerea compliantei pulmonare.

scaderea CPT si CRF
Alveole inundate de edem si colabate
tulburare severa a raportului VA/Q
sunt intrapulmonar dr-stg
Hipoxemie severa refractara caracteristica a SDRA
Hipocapnie la debut datorita reflexelor mecanice si
hipoxemiei ce stimuleaza hiperventilatia
Hipercapnie ulterior prin pierderea funct. si anat. de capilare
pulm. si scaderea cap de difuziune a CO2
HTAP fixa prin alterarea parenc. pul. si oblit. vasc. pulm .-

ICdr.
Cantitatea de colagen creste paralel cu inflamatia
ducand la fibroza interstitiala pulmonara .

SINDROMUL DE DETRESA RESP. ACUTA

LA ADULT (SDRA)
CRITERII DE DIAGNOSTIC
Tablou clinic :
-istoric sugestiv pentru cauzele enumerate la etiologie
-debut brusc si progresie rapida
-dispnee intensa cu tahipnee>20 respiratii/minut, respiratie
laborioasa
-cianoza refractara la oxigenoterapie
-excluderea: EPA cardiogen, afectarea predominanta a cordului
stang, boli pulmonare cronice
-examenul fizic : raluri crepitante difuz.
Modificari radiologice (confirma diagnosticul):
-infiltrate difuze pulmonare interstitiale (initial) apoi si alveolare

SINDROMUL DE DETRESA RESP.

ACUTA
LA ADULT (SDRA)
CRITERII DE DIAGNOSTIC

Explorare respiratorie (confirma diagnosticul )

-PaO2<50mmHg, refractara la oxigenoterapie
-complianta pulmonara <50ml/cm H2O
-hipoxemie refractara la cresterea FiO2 (fraction of inspired
oxygen):
-presiune arteriala pulmonara blocata <18-19 mmHg
Date anatomice:
-plamani grei, umezi (>1000g)
-atelaczie
-membrane hialine
-fibroza
Complicatiile SDRA sunt complicatiile sdr. IRA
Mortalitatea : 10-90%.

Recuperarea Respiratorie.

Recuperarea respiratorie

Recuperarea respiratorie este un

program multidisciplinar de ingrijire
a pacientilor cu afectiuni
respiratorii cronice ce are ca drept
scop cresterea calitatii vietii
pacientului prin cresterea activitatii
fizice , reintegrarea in societate si
recastigarea autonomiei.

Scopurile Recuperarii Respiratorii.

Diminuarea simptomatologiei
Incurajarea participarii la activitati
fizice si sociale
Renuntarea la fumatul activ si pasiv
Schimbarea stilului de viata cu efect
benefic pe termen lung
Prevenirea invaliditatii respiratorii
Cresterea calitatii vietii

Elementele recuperarii respiratorii

Educatia metode practice pentru

constientizarea afectiunii si cresterea
adaptabilitatii la viata cotidiana

Exercitiile fizice-antrenamentul ms.

mb. inf si sup pentru tonifiere si
cresterea rezistentei la efort.

Suportul psihosocial si comportamental

Suport nutritional

Recuperare respiratorie
Educatia pacientului teme abordate

Sistarea fumatului
Patogenia afectiunii de baza
Tipuri de respiratie
Metode de conservare a energiei si self management
Terapia medicamentoasa
Oxigenoterapia
Factorii iritanti si noxele profesionale
Managmentul simptomatologiei clinice
Managmentul exacerbarilor
Controlul factorilor psihosociali, anxietatea, depresia
si atacurile de panica
Nutritia.

Obligatoriu :
(pt integrarea pac in progr. de rec. resp.)
-intelegerea trairilor pac
-recunoasterea comorbiditatilor
-crearea unei zone de confort.

Repetarea programelor de recuperare asigura

beneficiul acestora.

Centrul pentru
controlul
dispneei.
Scaderea
hiperinflatiei

Scaderea
anxietatii si
depresiei.

Imbunatatirea
Ms.scheletici

Rezultatele recuperarii respiratorii

REDUCEREA
- simptomelor resp ( dispneea
-simptomatologiei psihologice
-vizitelor la medic
-zilelor de spitalizare
-adresabilitatii la UPU
-exacerbarilor
-dozelor medicamentoase

Rezultatele recuperarii
respiratorii

IMBUNATATIREA

afectiune

-activitatii fizice
-tolerantei la efort
- cunostiintelor despre
- independentei
- controlului simptomatologiei
- calitatii vietii
- supravietuirii.

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