dr.

Edwardo Refno
Advisor : dr. Eva Delsi, Sp. EM.
 Respiratory failure is a clinical condition that happens when the respiratory
system fails to maintain its main function which is gas exchange, in which
PaO2 lower than 60 mmHg and/or PaCO2 higher than 50 mmHg.

 Type 1(hypoxemic) respiratory failure: in which PaO2 < 60 mmHg with

normal or subnormal
 Type 2 (hypercapnic) respiratory failure: in which PaCO2 > 50 mmHg.
Hypoxemia is common and it is due to respiratory pump failure.

 Etiology : CNS causes, disorders of pheripheral nervous system, upper and

lower airways obstruction, abnormities of the alveoli.

 Pathophysiology
 Hypoventilation, V/P mismatch, shunt
IDENTITAS
PASIEN
Nama Ny. Sariyah
Umur 67 tahun
Alamat Danasari kidul Rt.04 Rw.3
Nusawungu Cilacap
Pekerjaan Petani
Status Menikah
No. RM 373975
9 April 2019 JAM 12.35 WIB
Tgl pemeriksaan
Keluhan utama : penurunan kesadaran, sesak napas

Airway tidak patent Triple manuver

Breathing Gasping O2 via BVM 15
Lpm
Circulation Nadi :99x/menit Fluid challenge
,Adequate, 200cc
irreguler, CRT <2
“, TD 149/61
mmHg
Disability E1V1M1, pupil
isokor, RC (+/+)
GDS 99

Triase ke P1 (gawat darurat)

 Pasien datang sesak nafas sejak 7
hari sebelum masuk rumah sakit.
Pasien di rawat di RS medika
lestari 1 hari smrs dan tidak sadar
sejak tadi pagi.

 RPD : Tidak Ada, DM (-),

Hipertensi (-)
 PEMERIKSAAN FISIK

MATA : CA-/-,
SI-/-

COR :
BJ 1-2 Reguler,
bising (-) PULMO : PEMERIKSA FISIK
Suara dasar vesikuler AN
: +/+, wheezing KU SESAK
(+/+), rhonki (+/+)
Tekanan 149/61 mmHg
Darah
Abdomen : Nadi 99x/menit
Soepel ,
RR 15 x/menit
peristaltik (+)
Suhu 36,5 C
Spo2 100 %

EKSTREMITAS :
Akral hangat
CRT <2”
Edem :-/-
Analisa Gas 9/4/2019 13.03
Darah
PH 7,0 v 7,35-7,45mmHg
PCO2 142,8 ^ 35-45 mmHg
PO2 298,0 ^ 80-105
HCO3 31,9 ^ 22,0-26,0 mmol/l
O2 saturasi 100 ^ 75-99 %
BE -4,3 -3,00-3,00mmol/l
Hasil : Asidosis Respiratorik Terkompensasi
Sebagian
Analisa Gas 9/4/2019 14.49
Darah
PH 7,2 v 7,35-7,45mmHg
PCO2 78,1 ^ 35-45 mmHg
PO2 463,0 ^ 80-105
HCO3 30,2 ^ 22,0-26,0 mmol/l
O2 saturasi 100 ^ 75-99 %
BE 2,3 -3,00-3,00mmol/l
Hasil : Asidosis Respiratorik Terkompensasi Sebagian
PEMERIKSAAN HASIL NORMAL
9/4/2019
Leukosit 15,96 High 3,6 -11 rb/ul
Eritrosit 4,51 3,8-5,2 juta/L
Hemoglobin 13,2 11,7-15,5 gr/dl
Hematokrit 49,2 High 35-47%
MCV 109,1 High 80-100 fL
MCH 29,2 26- 34 pg
MCHC 26,8 Low 32-36 g/dl
Trombosit 156 140-440 rb/ul
Hitung jenis
Basofil 0,1 0,0-1,0 %
Eosinofil 0,4 Low 2,0-4,0 %
Neutrofil 91,9 High 50,00-70,0 %
Limfosit 5,8 Low 25,0-40,0 %
Monosit 1,8 Low 2,0-8,0 %
Faal ginjal
Ureum 73 High 15-39 mg/dl
Kreatinin 0,19 Low 0,6-1,1 mg/dl
PEMERIKSAAN HASIL NORMAL
9/4/2019
Faal hati
SGOT 23,6 0-35 U/L
SGPT 38,20 High 0-35 U/L
ELEKTROLIT
Natrium 139,9 135-147 mEq/L
Kalium 5,59 High 3,5-5,0 mEq/L
Kalsium 7,02 Low 8,40-10,20 mg/dL
Rongent Thorax dari RSU Medika Lestari,
Thorax AP
 Hasil :

- Pulmo Normal

- Cardiomegali
 DIAGNOSIS  ER MANAGEMENT :
 O2 15 L/m via BVM
 - IVFD RL challenge 200cc – 20
Gagal Nafas tipe 2
PPOK tpm
CHF  - Ca. glukonas 1 ampul IV pelan
Pneumonia
 - Ketamin 50mg
 - Atracurium 25mg
 - ETT No. 7
 - Drip NE start 0,5
mcg/kgBB/menit
 - Midazolam 3mg
PEMERIKSAAN 11/4/2019 HASIL NORMAL
Urine rutin
Warna Kuning Kuning
Kekeruhan Agak keruh
Keasaman 6,5 5,7
Berat jenis 1,025 1,015-1,025
Leukosit + Negative
Nitrit Negative Negative
Protein urin 1+ Negative
Reduksi Negative
Keton Negative Negative
Bilirubin Negative Negative
Urobilinogen Negative Negative
Darah +/- Negative
Lain-lain Negative Negative
Sedimen
Silinder Granula kasar 1-2 Negative
Leukosit 10-15 1-4
Eritrosit 5-8 0-1
Epitel Squamosa 3-6 5-15
Kristal ca. oxalat Negative Negative
Kristal amorf urat Negative Negative
Kristal uric acid Negative Negative
Kristal calcium phospat Negative Negative
Kristal urinezuur kristalen Negative Negative
PEMERIKSAAN HASIL NORMAL
12/4/2019
Leukosit 16,64 High 3,6 -11 rb/ul
Eritrosit 4,63 3,8-5,2 juta/L
Hemoglobin 13,6 11,7-15,5
gr/dl
Hematokrit 47,9 High 35-47%
MCV 103,4 High 80-100 fL
MCH 29,3 26- 34 pg
MCHC 28,4 Low 32-36 g/dl
Trombosit 175 140-440 rb/ul
Gds 220 High 70-105 mg/dl
ELEKTROLIT
Natrium 140,2 135-147
mEq/L
Kalium 4,90 3,5-5,0 mEq/L
PEMERIKSAAN 13/4/2019 HASIL NORMAL
Leukosit 13,26 High 3,6 -11 rb/ul
Eritrosit 4,69 3,8-5,2 juta/L
Hemoglobin 13,6 11,7-15,5 gr/dl
Hematokrit 48,9 High 35-47%
MCV 104,2 High 80-100 fL
MCH 29 26- 34 pg
MCHC 27,8 Low 32-36 g/dl
Trombosit 178 140-440 rb/ul

PEMERIKSAAN HASIL NORMAL

14/4/2019
Leukosit 15,25 High 3,6 -11 rb/ul
Eritrosit 4,55 3,8-5,2 juta/L
Hemoglobin 13,6 11,7-15,5
gr/dl
Hematokrit 44,2 35-47%
MCV 97,2 80-100 fL
MCH 29,8 26- 34 pg
MCHC 30,7 Low 32-36 g/dl
Trombosit 108 Low 140-440 rb/ul
PEMERIKSAAN 15/4/2019 HASIL NORMAL
Leukosit 16,43 High 3,6 -11 rb/ul
Eritrosit 4,47 3,8-5,2
juta/L
Hemoglobin 13,5 11,7-15,5
gr/dl
Hematokrit 43,5 35-47%
MCV 97,3 80-100 fL
MCH 30,2 26- 34 pg
MCHC 31,0 Low 32-36 g/dl
Trombosit 141 Low 140-440
rb/ul
TANGGAL SUBJEC OBJECTIVE DX TX
TIVE
9/9/2019 - TD : 160/65 Gagal Levofloxacin 500mg
HR : 80 nafas Cefotaxime
RR : 12 MPS 2x 62,5
Ranitidine 2x1 amp
Azitromicin 1x500mg
Antasida 3x2cth
OBH syr 3x II cth

TANGGAL SUBJEC OBJECTIVE DX TX

TIVE
10/9/2019 - TD : 180/90 Gagal Levofloxacin 500mg
HR : 120 nafas Cefotaxime
RR : 14 PPOK MPS 2x 62,5
Ranitidine 2x1 amp
Ca glukonas
Azitromicin 1x500mg
Antasida 3x2cth
OBH syr 3x II cth
TANGGAL SUBJECTIV OBJECTIV DX TX
E E
11/9/2019 - TD : 160/90 PPOK Levofloxacin 500mg
HR : 120 Cefotaxime
RR : 16 Ranitidine 2x1 amp
Fartisan 2x100mg
Azitromicin 1x500mg
Antasida 3x2cth
OBH syr 3x II cth
TANGGAL SUBJECTIV OBJECTIVE DX TX
E
12/9/2019 - TD : 150/110 PPOK Levofloxacin 500mg
HR : 110 Cefotaxime
RR : 19 Ranitidine 2x1 amp
Fartisan 2x100mg
Azitromicin 1x500mg
Antasida 3x2cth
OBH syr 3x II cth
TANGGAL SUBJECTIV OBJECTIVE DX TX
E
13/9/2019 - TD : 130/70 PPOK,gagal Levofloxacin 500mg
HR : 100 nafas Cefotaxime
RR : 21 Ranitidine 2x1 amp
Fartisan 2x100mg
Respar 1x1 amp
Azitromicin 1x500mg
Antasida 3x2cth
OBH syr 3x II cth
TANGGA SUBJECTI OBJECTIV DX TX
L VE E
14/9/2019 - TD : 160/90 PPOK Levofloxacin 500mg
HR : 120 Cefotaxime 3x1gr
RR : 20 Ranitidine 2x1 amp
Fartisan 2x100mg
Resfar 1x1 amp
Azitromicin 1x500mg
Antasida 3x2cth
OBH syr 3x II cth

TANGGA SUBJECTI OBJECTIV DX TX

L VE E
15/9/2019 - TD : 120/80 PPOK Levofloxacin 500mg
HR : 90 Cefotaxime 3x1gr
RR : 21 Ranitidine 2x1 amp
Fartison 2x100mg
Resfar 1x1 amp
Meropenem 2x500 mg
MPS 2x62,5 mg
PCT 1x1gr
Azitromicin 1x500mg
Antasida 3x2cth
OBH syr 3x II cth
TANGGAL SUBJECTIVE OBJECTIV DX TX
E
16/9/2019 Penkes HR : - Cardia RJP
RR : - c arrest Bagging
Pupil Injeksi epinefrin 3 ampul
midriasis
max, RC (-
/-)

Pasien dinyatakan meninggal pukul 19.35

RESPIRATORY FAILURE
 Respiratory failure is a clinical condition
that happens when the respiratory system
fails to maintain its main function which is
gas exchange, in which PaO2 lower
than 60 mmHg and/or PaCO2 higher
than 50 mmHg.
Brain

Spinal cord

Nerves

Intercostal
muscles

Chest wall
Airway
Pleura
Diaphragm
 TYPE 1  TYPE 2
 (hypoxemic) respiratory
failure: in which PaO2 < 60  (hypercapnic)
mmHg with normal or respiratory failure: in
subnormal PaCO2.In this which PaCO2 > 50
type the gas exchange is mmHg. Hypoxemia is
impaired at the level of common and it is due
aveolo-capillary membrane.
Examples of type I to respiratory pump
respiratory failure is failure.
carcinogenic or non-
cardiogenic pulmonary
edema and severe
pneumonia.

Also respiratory failure is classified according to its onset, course and

duration into acute, chronic and acute on top of chronic respiratory failure.
 CNS causes.

 Disorders of peripheral nervous system

 Upper and lower airways obstruction

 Abnormities of the alveoli

 Respiratory Muscle Disorders and Chest

Walls
 Hypoxemic failure
 Ventilation/Perfusion (V/Q) mismatch
 Shunt

 Hypercapnic failure
 Increased dead space ventilation

Hypoventilation
 Nervous system  Neuromuscular
failure transmission failure

 Muscle failure  Airway failure

 Chest wall and  Alveolar unit failure

pleural space failure (type I)

 Pulmonary vasculate
failure (type I)
 Symptoms and signs  Symptoms and signs
of hypoxemia of hypercapnia
 Dyspnea,irritability  Headache
 Confusion,  Change of behavior
somnolence, fits  Coma
 Tachycardia,  Papilloedema
arrhythmia  Warm extremities
 Tachypnea
 Cyanosis

Symptoms and signs of the underlying disease

Examples:
Fever, cough, sputum production, chest pain in cases of pneumonia.
 Signs and symptoms
 Physical findings
 Hypotension
 Hypertension
 Wheezing
 Stridor
 Elevated jugular venous pressure
 Tahycardia and arrhytmias
 Arterial blood gases (ABG)

 Chest radiography

 Investigations needed for detecting the underlying

cause of the respiratory failure these may include:
 Complete blood count (CBC)
 Sputum, blood and urine culture
 Blood electrolytes and thyroid function tests
 Pulmonary function tests
 Electrocardiography (ECG)
 Echocardiography
 Bronchoscopy
 ABC’ s
 Ensure airway is adequate
 Ensure adequate supplemental oxygen and
assisted ventilation, if indicated
 Support circulation as needed
 Treatment of a specific cause when possible
 Infection
 Antimicrobials, source control
 Airway obstruction
 Bronchodilators, glucocorticoids
 Improve cardiac function
 Positive airway pressure, diuretics, vasodilators,
morphine, revascularization
 Mechanical ventilation
 Non-invasive
 Invasive
 Lung complications

 Cardiac complications

 Neurological complications

 Renal

 Gastro-intestinal

 Nutritional
 Respiratory failure is a medical emergency,
secure and maintain the airway, breathing and
circulation rapidly to live saving.

 The goal of providing adequate oxygen is to

avoid a lack of oxygen supply to the tissues
and cause complications such as brain
hypoxia.

 Arterial blood gases is mandatory to confirm

the diagnosis of respiratory failure
1. Punet Katyal, MBBS, MSHI, Pathophysiology of Respiratory Failure and Use of
Medical Ventilation, Thoracic.org
2. Eman Shebl, Bracken Burns. Respiratory Failure, ncbi.nlm.nih.gov.