Diagnosis dan Tatalaksana ARDS

Ramacandra Rakhmatullah, Reza Widianto Sudjud

Abstract


Acute Respiratory Distress Syndrome (ARDS) mempengaruhi sekitar 200.000 pasien setiap tahunnyadi Amerika Serikat, mengakibatkan hampir 75.000 kematian. Angka mortalitas yang cukup tinggi menunjukkan bahwa ARDS kurang terdiagnosis sehingga mengalami penundaan terapi. Tinjauan pustaka ini disusun untuk memahami diagnosis ARDS berikut perkembangan atalaksananya.
Penegakan diagnosis disesuaikan dengan konsensus definisi ARDS Berlin 2012. Penerapan definisi Berlin pada beberapa negara berkembang yang memiliki keterbatasan fasilitas menyebabkan ARDS kurang terdiagnosis. Alternatif penegakan diagnosis muncul dari studi Kigali yang menggabungkan definisi American-European Consensus Conference (AECC) 1994 dan definisi Berlin 2012. Fokus utama penegakan diagnosis tetap pada empat gejala klinis yaitu onset gagal nafas yang berhubungan dengan perburukan klinis pasien, edema paru selain karena sebab hidrostatik, temuan foto toraks, dan tingkat hipoksemia. Terapi utama dari ARDS adalah mengatasi hipoksemia diikuti dengan identifikasi dan terapi penyebab ARDS. Terapi hipoksemia menggunakan prinsip lung protective strategy untuk mencegah VILI (Ventilator Induced Lung Injury). Terapi selanjutnya bersifat suportif dan farmakologis yang bertujuan untuk meningkatkan pengiriman oksigen dan menurunkan konsumsi oksigen. Terapi cairan konservatif juga penting dilaksanakan untuk mencegah keseimbangan cairan positif. Kecepatan dalam menegakkan diagnosis dan ketepatan memberikan terapi sangat mempengaruhi outcome dan prognosis.
Penelitian lebih lanjut tentang ARDS masih diperlukan.


Kata kunci: ARDS; diagnosis; terapi


Diagnosis and Management of ARDS

Acute respiratory distress syndrome (ARDS) affects approximately 200.000 patients each year in the UnitedStates, resulting in nearly 75.000 deaths annually. Despite the high mortality rate, ARDS was often underdiagnosed
resulting in delay of therapy. This review describes the diagnosis of ARDS and management advances. The diagnosis of ARDS follows the 2012 Berlin definition of ARDS. The Berlin definition is not suitable in developing countries where resources are limited. An alternative definition for ARDS emerged from the Kigali study that combined the AECC definition (1994) and the Berlin definition (2012). There are four main clinical features for diagnosing ARDS, the onset of respiratory failure in relation to the inciting event, non-hydrostatic origin of pulmonary edema, chest radiograph findings, and degree of hypoxemia. The main therapy of ARDS is to overcome hypoxemia followed by the identification and treatment of the underlying cause. Hypoxemia therapy uses lung protective strategy to prevent VILI. Further therapy includes supportive and pharmacologic therapy that focused on increasing oxygen delivery and decreasing oxygen consumption. A conservative fluid therapy is also important to prevent positive fluid balance. Early diagnosis and therapy greatly influence the outcome and prognosis of ARDS. Further studies of ARDS are still needed.


Key words: ARDS, diagnosis, therapy


Keywords


ARDS; diagnosis; terapi

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