GANGGUAN VENTILASI

Muhammad Zulkarnain Bus

Ventilasi : peristiwa masuk dan

keluarnya udara ke dalam paru
Difusi

: perpindahan O2 darah alveoli ke

dalam darah dan CO2 dari darah
ke alveoli

Perfusi

: distribusi darah ke dalam

paru

Zona Respirasi

Bronkiolus Respiratorius &

Aveoli

Anatomy of the
Respiratory Zone

Anatomy of the
Respiratory Zone

Anatomy of the
Respiratory Zone

Anatomy of the
Respiratory Zone

Blood Supply to the

Lungs

Chest Wall and Pleural Sac

Role of Pressure in
Pulmonary Ventilation
Air moves in and out of lungs by bulk flow
Pressure gradient drives flow
Air moves from high to low pressure
Inspirationpressure in lungs less than
atmosphere
Expirationpressure in lungs greater than
atmosphere

Pulmonary Pressures

Muscles of Breathing

Zona konduksi / ruang rugi anatomis :

Trakea ~ bronkiolus terminalis
Bagian saluran napas tempat aliran
udara dari luar ke dalam paru
Zona respirasi :
Bronkiolus respiratori ~ alveolus
Berfungsi untuk proses pertukaran
gas (difusi)

Minute Ventilation
Total volume of air entering and leaving
respiratory system each minute
Minute ventilation = VT x RR
Normal respiration rate = 12 breaths/min
Normal VT = 500 mL
Normal minute ventilation =
500 mL x 12 breaths/min = 6000 mL/min

Dead Space and

Ventilation
Conducting
zone
(anatomical
dead space)

Fresh air
Old air

Alveolus

Expiration

(c)

Inspiration

(a)

CO2

O2

Exchange with blood

(b)

Alveolar Ventilation
Volume of air reaching the gas exchange
areas per minute
Alveolar ventilation =
(VT x RR) (DSV x RR)

Normal = 4200 mL/min

(500 mL/br x 12 br/min) (150 mL/br X 12
br/min)

Pulmonary volumes and

capacities

Pulmonary volumes (by using spirometer):

1) Tidal volume is the volume of air inspired or expired with
each normal breath = 500ml in young adult man.

2) Inspiratory reserve volume is the extra volume of air

that can be inspired over and beyond the normal tidal volume
= 3000ml.

3) Expiratory reserve volume is the extra amount of air

that can be expired by forceful expiration after the end of a
normal tidal expiration ~ 1100ml.

4) Residual volume is the extra volume of air that still

remain in the lungs after the most forceful expiration ~
1200ml.

The pulmonary
capacities
Comprises more than one volume:
1) Inspiratory capacity is the volume of air inspired by a maximal
inspiratory effort after normal expiration = 3500ml = inspiratory reserve
volume + tidal volume.
2) The functional residual capacity is the volume of air remaining in the
lungs after normal expiration = 2300ml = expiratory reserve volume +
residual volume.
3) The vital capacity is the volume of air expired by a maximal expiratory
effort after maximal inspiration ~ 4600ml = inspiratory reserve volume +
tidal volume + expiratory reserve volume.
4) Total lung capacity is the maximum volume of air that can be
accommodated in the lungs ~ 5800ml = vital capacity + residual
volume.
5) Minute respiratory volume is the volume of air breathed in or out of the
lungs each minute = respiratory rate x tidal volume = 12 X 500ml =
6000ml/min.
All lung volume and capacity are about 20 to 25% less in women than in men
and are greater in athletic persons than in small and asthenic persons.

Pulmonary Function
Tests:
Forced Vital Capacity
(FVC)
Maximum volume inhale followed
by exhale as fast as possible
Low FVC indicates restrictive
pulmonary disease

Pulmonary Function Tests:

Forced Expiratory Volume
(FEV)
Percentage of FVC that can be exhaled
within certain time frame
FEV1 = percent of FVC that can be
exhaled within 1 second
Normal FEV1 = 80%
If FVC = 4000 ml, should expire 3200 ml in 1
sec
FEV1 < 80% indicates obstructive pulmonary
disease

Forced capacity (FVC &

FEV1)
Normal

( N ) FEV 1
( N ) VC

Obstructive ( N ) FEV 1
or ( N ) VC
Restrictive

( N ) FEV 1
or ( N ) VC

Respiratory Rate and

Ventilation

Gangguan pada faal paru :

A. Gangguan ventilasi
B. Gangguan difusi
C. Gangguan perfusi

A. Gangguan ventilasi
Restriksi
Obstruksi

Measurement
Tidal volume
(VT)
Inspiratory
reserve volume
(IRV)
Expiratory
reserve volume
(ERV)
Residual volume
(RV)
Total lung
capacity (TLC)
Functional
residual

Definition
Each normal breath

Average Adult
Values ( m L )
500

Maximal additional volume

that can be inspired above
VT
Maximal volume that can be
expired below VT

3000

Volume remaining after

maximal exhalation
RV+ERV+VT+IRV

1200

RV + ERV

2300

1100

5800

Restriksi : gangguan pengemban

paru oleh sebab apapun
Semua volume statis paru mengecil :
KV, KPT, VR, VCE, KRF
VEP1 / KVP masih diatas 75%
Gambaran flow volum loop = N
(ukuran lebih kecil)

Obstruksi : gangguan saluran napa

baik struktural / fungsion
yang menimbulkan
perlambatan arus respira
Beberapa volume meningkat yaitu VR & KPT
KV dapat turun atau normal
VEP1 / KVP < 75%

Kelainan restriksi
Parameter = KV
KV 80 - 120% nilai prediksi = N
KV < 80% nilai prediksi = restriksi
KV > 120% = hiperinflasi

1. Kelainan parenkim paru :

Tumor paru
Pneumonia
Abses paru
Edema paru
Atelektasis
Fibrosis paru :
~ TB
~ Penyakit paru fibrosis
~ Pneumokoniosis : asbestosis, silikosis
~ Penyakit kolagen : RA, LE, sarkoidosis
~ Penyakit interstisial paru

2. Kelainan pleura :

Efusi pleura
Pneumotoraks
Pleuritis sicca / schwarte
Tumor pleura

3 Kelainan dinding dada / tulang :

Patah iga
Obesitas
Pektus ekskavatus
Skoliosis
Khiposis
Gibbus

Kelainan obstruksi
~
~
~
2. Ekstra luminer : ~
1. Intra luminer :

tumor paru
sumbatan oleh sekret
benda asing
tumor yang menekan
bronkus
~ jaringan peyanggah
kurang (emfisema)
3. Penebalan mukosa (hiperplasia &
hipertrofi) : bronkitis kronik