Yusuf, Muhammad Farlyzhar and dr. Arie Zainul Fatoni,, Sp.An, KIC and dr. Rudy Vitraludyono,, Sp.An., KAP (2022) Analisis Hubungan Parameter Ventilator Mekanik dengan Tingkat Mortalitas Pasien COVID-19 di Intensive Care Unit (ICU) Rumah Sakit Umum Daerah Dr. Saiful Anwar (RSSA) Periode Januari-Desember 2021. Magister thesis, Universitas Brawijaya.
Abstract
Latar belakang: Penggunaan ventilator pada pasien COVID-19 memiliki pengaruh terhadap mortalitas pada pasien COVID-19 yang dirawat di ICU. Hal ini dikarenakan penggunaan ventilator merupakan gambaran yang dapat dimanipulasi terkait terjadinya patologi pada paru. Kondisi parameter ventilator yang berpengaruh adalah PEEP, P/F rasio, dan komplians. Pengaturan ventilator yang baik berdasarkan stratifikasi risiko yang tepat dapat meningkatkan keberhasilan terapi pada pasien kritis yang dirawat di ICU sebagai pengaturan standar dan prediktor prognosis. Tujuan: Untuk mengetahui hubungan antara parameter ventilator mekanik dengan mortalitas pasien COVID-19 yang dirawat di ruang ICU RSUD Dr. Saiful Anwar. Metode: Penelitian ini bersifat observasional analitik, kohort retrospektif. Diambil sampel pasien COVID-19 yang dirawat di ICU RSSA mulai dari bulan Januari 2021 sampai dengan Desember 2021 dengan sumber data dari rekam medis. Analisis statistik dilakukan dengan menggunakan Statistical Package for Social Science (SPSS). Normalitas data diuji dengan uji T tidak berpasangan. Uji Chi-square akan digunakan untuk membandingkan hubungan antara masing-masing kelompok. Hasil: Didapatkan 171 subyek setelah melalui proses inklusi dan eksklusi dengan angka mortalitas sebesar 69,6%. Didapatkan penggunaan non-invasive ventilation (NIV) sebanyak 36 orang (21,1%) sedangkan yang menggunakan ventilator invasif sebanyak 135 orang (78,9%). Dari hasil analisis statistik didapatkan bahwa tidak terdapat perbedaaan rata-rata yang signifikan pada parameter ventilator mekanik (Invasif dan Non Invasif) pada PEEP (0,246), P/F rasio (p=0,065) dan komplians paru (p=0,058) antara pasien terdiagnosis positif Covid-19 derajat kritis yang hidup dan meninggal. Sedangkan pada hasil parameter ventilator mekanik invasif terdapat perbedaaan rata-rata yang signifikan pada komplians paru (p=0,028) antara kelompok hidup dan meninggal dari pasien terdiagnosis positif Covid-19 derajat kritis. Pasien hidup memiliki rata-rata komplians lebih besar dibandingkan pasien yang meninggal (25,2 vs 22,1. P=0,028). Sedangkan pada pasien yang menggunakan ventilator non-invasif (NIV) didapatkan bahwa tidak terdapat perbedaaan rata-rata yang signifikan pada parameter ventilator PEEP (0,599), P/F rasio (p=0,299), dan komplians paru (p=0,501). Analisis hubungan tipe COVIDARDS menunjukkan pasien terdiagnosis positif Covid-19 derajat kritis yang menjalani menjalani perawatan di Intensive Care Unit incovit RSU Dr. Saiful Anwar yang memiliki tipe Covid-ARDS tipe H berhubungan dengan mortalitas lebih tinggi (p=0,010). Kesimpulan : Komplians paru berasosiasi dengang tingkat mortalitas yang lebih tinggi pada pasien yang menggunakan ventilator mekanik invasif, dan didapatkan profil Covid ARDS tipe H berasosiasi dengan tingkat mortalitas yang lebih tinggi, namun tidak didapatkan perbedaan rata-rata pada PEEP, P/F rasio, dan komplians paru pasien Covid-19 hidup dan meninggal yang menggunakan ventilator mekanik (Invasif dan Non invasif).
English Abstract
Background: The use of ventilators in COVID-19 patients has an influence on mortality in COVID-19 patients treated in the ICU. This is because the use of a ventilator is a picture that can be manipulated related to the occurrence of pathology in the lungs. Conditions that affect the ventilator parameters are PEEP, P/F ratio, and compliance. A good ventilator setting based on appropriate risk stratification can increase the success of therapy in critically ill patients treated in the ICU as a standard setting and predictor of prognosis. Objective: To determine the association between mechanical ventilator parameters and the mortality of the COVID-19 patient treated in the ICU of Dr. Saiful Anwar Hospital. Methods: This research is analytical observational with a retrospective cohort study. Samples were taken from COVID-19 patients who were treated at the ICU RSSA from January 2021 to December 2021 with data sources from medical records. Statistical analysis was performed using the Statistical Package for Social Science (SPSS). Data normality was tested by unpaired t test. Chi-square test will be used to compare the relationship between each group. Results: There were 171 subjects through the inclusion and exclusion process with a mortality rate of 69.6%. There were 36 people using non-invasive ventilation (NIV) (21.1%) while 135 people using an invasive ventilator (78.9%). From the results of statistical analysis, it was found that there was no significant mean difference in mechanical ventilator parameters (Invasive and Non-Invasive) in PEEP (0.246), P/F ratio (p=0.065) and lung compliance (p=0.058) between patients who confirmed positive for Covid-19 in critical degrees living and dead patient. Meanwhile, from the results of the invasive mechanical ventilator parameters, there was a significant average difference in lung compliance (p = 0.028) between the living and dead groups of patients diagnosed with critically confirmed positive for COVID-19. Living patients had a greater mean compliance than deceased patients (25.2 vs 22.1. P=0.028). Meanwhile, in patients using noninvasive ventilators (NIV) it was found that there was no significant difference in the mean of ventilator parameters PEEP (0.599), P/F ratio (p=0.299), and lung compliance (p=0.501). The analysis of the relationship between the types of COVID-ARDS showed that patients diagnosed as positive for critically ill Covid-19 were undergoing treatment at the Incovit Intensive Care Unit at RSU Dr. Saiful Anwar who had Covid-ARDS type H was associated with higher mortality (p=0.010). Conclusion: Pulmonary compliance was associated with a higher mortality rate in patients using invasive mechanical ventilators, and the Covid ARDS type H profile was associated with a higher mortality rate, but there was no difference in mean PEEP, P/F ratio, and lung compliance of living and dead Covid-19 patients who use mechanical ventilators (Invasive and Non-invasive).
Other obstract
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| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | 0422060169 |
| Uncontrolled Keywords: | COVID-19, Ventilator Mekanik, Severitas, Mortalitas |
| Subjects: | 600 Technology (Applied sciences) > 617 Surgery, regional medicine, dentistry, ophthalmology, otology, audiology > 617.9 Operative surgery and special fields of surgery > 617.96 Anesthesiology |
| Divisions: | Profesi Kedokteran > Spesialis Anestesiologi dan Terapi Intensif, Fakultas Kedokteran |
| Depositing User: | Endang Susworini |
| Date Deposited: | 08 May 2023 07:02 |
| Last Modified: | 08 May 2023 07:02 |
| URI: | http://repository.ub.ac.id/id/eprint/198944 |
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