Role of SMART PULMO in Respiratory Failure Interpretation
Respiratory failure can be classified into hypoxaemic and hypercapnic types, each requiring specific management based on the underlying pathophysiology. The SMART PULMO tool aids in interpreting respiratory failure by utilizing formulas and algorithms, providing valuable insights into acid-base disorders. Developed by a team of researchers and programmers, this tool offers a comprehensive approach to understanding and managing respiratory failure in critical care patients.
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Presentation Transcript
Peran SMART PULMO untuk Interpretasi Gagal Napas dan Gangguan Asam Basa Peneliti: Siswanto, Reviono, Jatu Aphridasari, Arifin Programmer: Soesapto Joeni Hantoro Sebelas Maret Acid base and Respiratory failure interpretation Tool- PULMOnology
Respiratory failure interpretation Acid base disorders interpretation 1. Based on Henderson-Hasselbalch approach 2. Based on combined method of Henderson-Hasselbalch, BE, and Stewart 1
RESPIRATORY FAILURE TYPE occurs when disease processes impair oxygen transfer, leading to insufficient oxygen levels in the blood. Hypoxaemic (type I) occurs when inadequate alveolar ventilation (V A) leads to the failure to clear carbon dioxide. Hypercapnic (type II) Hypoxemia and Condition hypoxemic and hypercapnia occurs coexist. hypercapnia (type II) 2
DETECT TYPE OF RESPIRATORY FAILURE: IMPORTANT TO MANAGEMENT Pathophysiology Central nervous system Pheriperal nervous sytem and chest wall airway alveoli Hypoxemic or hypercapnia Acute or chronic Hypoxemic: alveolar hypoventilation, ventilation perfusion mismatch, shunt, and diffusion limitation Hypercapnia: ventilatory failure (drive failure, pump failure) Respiratory failure type Causes/Abnormalities 3
IMPORTANT RESPIRATORY FORMULAS Hypoxemic respiratory failure Hypercapnia respiratory failure Alveolar oxygen pressure (PAO2)= (713xFiO2)-(PaCO2x1,25) Alveolar-arterial oxygen gradient (AaDO2)= PAO2-PaO2 Hypoxemic score/ PF ratio (HS) = PaO2/FiO2 FiO2 correction/needed = (PAO2 target+(1,25xPaCO2)):713 PAO2= PIO2 (PaCO2/R)= (713xFiO2)-(PaCO2x1,25) AaDO2= PAO2-PaO2 PaCO2 = (V CO2x k)/V A V E = V A + V D 4
DEVELOPMENT PROCESS FOR RESPIRATORY FAILURE INTERPRETATION Diagnotic criteria Computer programme Formulas Algorithm 5
INTRODUCTION Acid base complex disorders is common in critical respiratory illness patients Electrolite imbalance, malnutrition, low intake fluid Hypoalbumine, unmeasured anion (ec lactate) Interpretation method combining Henderson-Hasselbalch, base excess (BE), and Stewart approaches is needed to detect type of acid base disorders to predict its etiologies 6
DEVELOPMENT PROCESS FOR ACID BASE DISORDERS INTERPRETATION BASED ON HENDERSON-HASSELBALCH APPROACH Interpretation algorithm by Park SH et al. (2011) Computer programme 7
DEVELOPMENT PROCESS FOR ACID BASE DISORDERS INTERPRETATION BASED ON COMBINED METHOD OF HENDERSON-HASSELBALCH, BE, DAN STEWART Computer programme Reliability test Improvement app Steps Algorithm Android app 8
STUDY RELIABILITY OF AUTOMATIC INTERPRETATION COMBINING HENDERSON-HASSELBALCH, BASE EXCESS, AND STEWART APPROACHES TO DETECT ACID BASE DISORDER IN PNEUMONIA* SISWANTO, REVIONO, JATU APHRIDASARI, ARIFIN *WAS PRESENTED IN NATIONAL CONGRES OF PDPI MEDAN 2017 9
RESULT Tabel 1. Acid base disorders in pneumonia patients with qSOFA 2. to detect hidden acid base disorders 10
Tabel 2. Kappa Cohen agreement test for respiratory acid base disorders. 11
Tabel 2. Kappa Cohen agreement test for metabolic acid base disorders. 12
STUDY INTERPRETATION COMPARISON OF ACID-BASE DISTURBANCE BETWEEN COMBINATION METHOD (HENDERSON-HASSELBACH, BASE EXCESS, AND STEWART) AND HENDERSON-HASSELBACH S METHOD IN RESPIRATORY FAILURE PATIENT AT DR. MOEWARDI HOSPITAL, SURAKARTA* DIAN APRILIANA, REVIONO, JATU APHRIDASARI, YUSUP SUBAGIO SUTANTO, SISWANTO *WAS PRESENTED IN PIPKRA UNIVERSITAS INDONESIA JAKARTA 2018 13
RESULT Table 2. Interpretation comparison of respiratory acid base disorder between combination method and Henderson-Hasselbach s method in respiratory failure patient. Respiratoric acidosis Respiratoric alkalosis Normal P 56 (28 %) 129 (64,5 %) 15 (7,4 %) 0,000 Combination method 29 (14,5 %) 63 (31,5 %) 108 (54 %) Henderson- Hasselbach s method 14
RESULT Table 3. Interpretation comparison of metabolic acid base disorder of combination method and Henderson-Hasselbach s method in respiratory failure patient. p Metabolic acidosis Metabolic alkalosis Metabolic acidosis and alkalosis Normal 0,000 Combination 26 (13 %) 117 (58 %) 20 (10 %) 37 (18,5 %) Methode 0 (0 %) Henderson- 15 (7,5 %) 92 (46 %) 93 (46,5 %) Hasselbach s method 15
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