Aspirasi Pneumoniaigk oka nurjayasmf anak rsud sanjiwani gianyar

2Objectives

Discuss background, epidemiology, and pathogenesis of aspiration pneumonia

Discuss risk factors for aspiration pneumonia

Discuss diagnosis, treatment, and monitoring response to therapy

3Pneumonia Aspirasi

Terbawanya bahan diorofaring atau isi lambung pada saat respirasi kesaluran nafas bawah dan dapat menyebabkan kerusakan parenkim paru

Kejadiannya cukup sering

Akibatnya menjadi Pneumonia

2 factor yang mempengaruhi :

1. Daya tahan tubuh Host

2. Kandungan bakteri penyebab infeksi

“True” aspiration pneumonia caused by normal flora

Oral cavity

Nasopharynx

Gastrointestinal bacteria

4Epidemiologi

Insiden

Tersering di diagnosis di RS

Tidak konsinten

Etiologi

Kebanyakan kasus oleh kuman anaerob

CA: usually anaerobes alone

HA: usually anaerobes + aerobes, polymicrobial

5Patogenesis

Mekanisme pertahanan normal peradangan maupun infeksi

KU lemah & keracunan alkohol / obat /tidak sadar pengaruh obat bius / kondisi kesehatannya lemah resiko pneumonia

6PNEUMONITIS KIMIA

Pneumonitis kimia : terhirup bersifat iritasi : infeksi, terhirup biasanya asam lambung,

segera sesak nafas, denyut Jantung meningkat, demam & dahak kemerahan dan sianosis

Reaksi inflamasi seluler ( sitokin, TNF alpha, dan interleukin-8)

7ASPIRASI BAKTERI

Bakteri tertelan dan masuk paru-paru Bakteri yg berperan : anaerobic organisms

alone or in combination with aerobic and/or microaerophilic organisms

Aspirasi pneumonia komuniti : bakteri anaerobik  e/ tersering & stapilokokus aureus, haemophilus influenza & dan Enterobacteriae

Aspirasi pneumonia nosokomial e/ organisme gram-negatif termasuk Pseudomonas aeruginosa & biasanya pada pasien dengan intubasi

8OBSTRUKSI MEKANIK

 

Terhirupnya partikel /benda asing Anak Manuver  Heimlich bronkoskopi

9Risk factors for aspiration

Reduced consciousness

Neurologic deficits

GI disorders

Anesthesia

Protracted vomiting

Large volume tube feedings

10Signs/Symptoms

Sputum berbau busuk

Common pneumonia symptoms

Fever > 38°C

Leukocytosis/leukopenia

Productive cough

Penurunan kadar oksigen

Sianosis

11Diagnosis

Suspect pneumonia if:

New or progressive infiltrate seen on chest x-ray AND signs/symptoms of systemic infection

Lower respiratory tract sampling

Bronchoalveolar lavage or protected specimen brush

Culture specimen

12Dd/

In children, bronchiolitis, croup or laryngotracheobronchitis, epiglottitis, asthma, reactive airway disease, respiratory distress syndrome, and foreign bodies should be considered.

Treatment Treat hypoxemia/provide oxygen

Empiric antibiotic selection depends on setting/patient characteristics

No clear guidelines on which regimen is best

If nosocomial, more virulent bacteria s/b targeted

CA:

clindamycin, metronidazole

OR

β-lactam/ β-lactamase inhibitor

HA:

GNB coverage + clindamycin, metronidazole +/- vancomycin

13

14Monitoring Response to Therapy

Vitals

Tmax, HR

WBC

Should be trending down

Chest X R

Should see improvement

Oxygenation

Kadar O2 darah meningkat

hould be able to ↓ supportive oxygenation

15KOMPLIKASI DAN MORTALITAS

Gagal nafas akut.

Mortalitas pneumoni aspirasi

komuniti 5 % , nosokomial 20 %.

16PROGNOSIS

Jika tidak ada komplikasi maka angka mortalitas peneumonitis 5%, sedangkan pada aspirasi massif dengan atau tanpa sindrom Mendelson mencapai 70%.