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
Scaderea anxietatii si
hiperinflatiei 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
-activitatii fizice
-tolerantei la efort
- cunostiintelor despre afectiune
- independentei
- controlului simptomatologiei
- calitatii vietii
- supravietuirii.
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