Efek perbedaan Volume Tidal Ventilasi Mekanik Selama Operasi terhadap Rasio PaO2/FiO2 Pascakraniotomi Elektif

Dita Aditianingsih, Rudyanto Sedono, Yoshua Baktiar

Abstract


Latar Belakang: Kraniotomi elektif memiliki insidens komplikasi paru pascaoperasi (25%) dan mortalitas (10%) yang tinggi; insiden ini lebih rendah pada pemakaian volume tidal rendah sebagai teknik proteksi paru. Penelitian ini meneliti efek volume tidal 6 mL/kg dan 10 mL/kg terhadap rasio PaO2/FiO2(sebagai parameter keparahan cedera paru) pascaoperasi pada kraniotomi elektif.
Subjek dan Metode: Setelah mendapat izin Komite Etik FKUI/Rumah Sakit Cipto Mangukusumo dan konsen pasien, dilakukan uji klinis acak pada 52 pasien kraniotomi elektif yang dirandomisasi ke dalam 2 kelompok: ventilasi mekanik selama operasi dengan volume tidal 6 mL/kg (VT–6) atau 10 mL/kg (VT–10), lalu dilakukan analisis gas darah.
Hasil: Rasio PaO2/FiO2 kelompok VT-6 dan VT–10 secara berurutan: pada 1 jam pascainduksi 413,7 ± 113,4 mmHg dan 401,5 ± 106,3 mmHg (p>0.05); pada akhir operasi, 466,6 ± 94,6 mmHg dan 471,1 ± 89,0 mmHg (p>0.05), pada 24 jam pascainduksi, 418,8 ± 108,8 mmHg dan 448,5 ± 119,6 mmHg (p>0.05); pada 48 jam pascainduksi, 414,9 ± 88,1 mmHg dan 402,5 ± 100,7 mmHg (p>0.05 ). Tidak ada perbedaan signifikan insiden mortalitas dan komplikasi paru dan ekstraparu diantara dua kelompok.
Simpulan: Tidak ada perbedaan signifikan antara volume tidal 6 ml/kg dan 10 ml/kg terhadap ratio PaO2/FiO2 pada pasien kraniotomi elektif.

The Effect of Different Tidal Volume against Postoperative PaO2/FiO2 Ratio in Elective Craniotomy Patients


Background: Elective craniotomy is associated with a high incidence of postoperative pulmonary complications/PPC (25%) and mortality (10%); in which these incidence went down with the administration of low tidal volume. This study investigated the effect of low tidal volume in intraoperative PaO2/FiO2 ratio in elective craniotomy patients.

Subject and Methods: After approval from Ethics Committee Faculty of Medicine Universitas Indonesia, Ciptomangunkusumo Hospital and consent from patients,a randomized controlled trialwas done to 52 elective craniotomy patients. Subjects were ventilated with tidal volume 6 mL/kg (VT–6) or 10 mL/kg (VT–10) intraoperatively, then blood gas analyses wereperformed.
Results: PaO2/FiO2 ratio of VT–6 and VT–10 respectively: at 1 hour postinduction, 413.7 ± 113.4 mmHg and 401.5 ± 106.3 mmHg (p>0.05); at end of surgery, 466.6 ± 94.6 mmHg and 471.1 ± 89.0 mmHg (p>0.05); at 24 hours postinduction, 418.8 ± 108.8 and 448.5± 119.6 mmHg (p>0.05); at 48 hours postinduction, 414.9 ± 88.1 mmHg and 402.5 ± 100.7 mmHg (p>0.05). There were no significant differences on mortality, lung and extralung complications observed between both groups
Conclusions: There were no significant difference between tidal volume 6 ml/kg and 10 ml/kg against intraoperative PaO2/FiO2 ratio in elective craniotomy patients.

 


Keywords


volume tidal; rasio PaO2/FiO2; kraniotomi elektif; komplikasi paru pascaoperasi; neuroanestesia; tidal volume; PaO2/FiO2 ratio; lective craniotomy; postoperative pulmonary complications; neuroanesthesia

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DOI: https://doi.org/10.24244/jni.vol5i3.77

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