Akutni respiratorni distresni sindrom u poslijeoperacijskom razdoblju

master's thesis

• Title (english): Postoperative acute respiratory distress syndrome
• Author: Sunčica Belošević
• Mentor: Daniela Bandić Pavlović (mentor)
• Committee member: Mladen Perić (predsjednik povjerenstva)
• Committee member: DINKO TONKOVIĆ (član povjerenstva)
• Committee member: Daniela Bandić Pavlović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Intensive Care

Abstract

Akutni respiratorni distresni sindrom je hitno medicinsko stanje obilježeno akutnom respiratornom nemoći koja je od svojeg prvog opisa 1967. godine nosila smrtnost iznad 50%. Danas se prosječno javlja između 1,5 i 79 novih slučajeva na 100,000 stanovnika godišnje s incidencijom u poslijeoperacijskom razdoblju koja varira između 4,1 i 80% ovisno o vrsti operacije. Smrtnost je 27% za blagi, 32% za umjereni i 45% za teški oblik akutnog respiratornog distresnog sindroma. Najčešći uzroci su sepsa, pneumonija i trauma, ali se javlja i kao komplikacija operacija, češće kardijalnih i torakalnih. Osnovna patofiziologija je povećanje plućne permeabilnosti i razvoj plućnog edema. S obzirom na to da nema jedinstvenog testa ili metode za dokazivanje ili isključenje dijagnoze, velike su varijacije u incidenciji, a zbog toga i u liječenju. Klinička slika je jednaka kod de novo i poslijeoperacijskog ARDS-a, a očituje se u prvih tjedan dana nakon ozljede ili operacije u obliku progresivne dispneje, tahipneje, hipoksemije i cijanoze. Na rendgenskim snimkama nalaze se difuzni alveolarni infiltrati. Težina stanja određena je omjerom arterijskog parcijalnog tlaka kisika i frakcije udahnutog kisika. Liječenje se zasniva na mehaničkoj ventilaciji s nižim volumenima protoka i pozitivnim tlakom na kraju ekspirija, periodičko okretanje u pronacijski položaj te liječenje osnovnog stanja. Dodatno se mogu koristiti anestetici, sedativi i neuromuskularni blokatori.

Abstract (english)

Acute respiratory distress syndrome is an emergency medical condition characterized by acute respiratory failure that had a mortality rate over 50% since it has been described for the first time in 1967. Today, the annual incidence is between 1.5 and 79 new cases per 100,000 in the general population and postoperative incidence varies between 4,1 and 80% depending on the type of the surgery. The mortality rate for the mild ARDS is 27%, 32% for the moderate type and 45% for severe ARDS. The most common causes are: sepsis, pneumonia, and trauma, but there have been occurrences of ARDS as part of postoperative complications, more often cardial and toracal. The pathophysiology includes an increase in pulmonary permeability and the development of a pulmonary edema. Given that there is no single test or method to diagnose or exclude this diagnosis, there are large variations in incidence, and, subsequently, in treatment. The signs begin within the first week after an injury or an surgery as a progressive dyspnea, tachypnea, hypoxemia and cyanosis. Chest radiographic findings show diffuse alveolar damage. The ratio of arterial oxygen partial pressure to the fractional inspired oxygen determine the severity of the condition. The treatment is based on mechanical ventilation with lower flow rates and a positive end-expiration pressure, periodic repositioning into the prone position and treating the underlaying cause. Anesthetics, sedatives and neuromuscular blockers may also be used.

• Keywords: ARDS; poslijeoperativno; operacija
• Keywords (english): ARDS; postoperative; surgery
• Language: croatian
• URN:NBN: urn:nbn:hr:105:952195
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-12-18 14:56:46