Tesis

Ketepatan Metode Velosimetri Elektrik Dibandingkan DenganEkokardiografi Dalam Menilai Fluid Responsiveness: Kajian Terhadap Variasi Isi Sekuncup dan Perubahan Isi Sekuncup Pasca-Fuid Challenge = The Accuracy of Electrical Velocimetry Compared to Echocardiography in Assessing Fluid Responsiveness: A study of stroke volume variation and Changes in Stroke Volume Post- Fluid Challenge.

Latar Belakang : Fluid responsiveness penting diketahui untuk optimalisasi preload jantung sehingga kondisi hipovolemia maupun hipervolemia yang meningkatkan morbiditas dan mortalitas pasien dapat dicegah. Pengukuran variasi isi sekuncup menggunakan velosimetri elektrik untuk menilai fluid responsiveness bersifat mudah, murah, non invasif, continous yang menarik untuk dimanfaatkan, namun belum banyak diteliti. Penelitian ini bertujuan untuk mengetahui ketepatan metode velosimetri elektrik dibandingkan dengan ekokardiografi pasca- fluid challenge dalam menilai fluid responsiveness. Metode : Penelitian ini merupakan uji diagnostik untuk mengetahui ketepatan penilaian fluid responsiveness menggunakan variasi isi sekuncup velosimetri elektrik dengan desain potong lintang pada pasien yang menjalani operasi terencana di Unit Pelayanan Bedah Terpadu pada bulan Juli - September 2018. Didapatkan 109 subjek yang memenuhi kriteria penerimaan dan bersedia menandatangani informed consent penelitian. Dilakukan penilaian variasi isi sekuncup dengan velosimetri elektrik oleh peserta PPDS Anestesiologi dan Terapi Intensif dan dibandingkan dengan pemeriksaan ekokardiografi perubahan isi sekuncup sebelum dan sesudah fluid challenge oleh satu orang operator. Analisis data dilakukan dengan uji diagnostik. Hasil : Penilaian berdasarkan metode velosimetri elektrik didapatkan 47,7% pasien tergolong fluid responsiveness positif. Penilaian berdasarkan ekokardiografi didapatkan 26,6% pasien tergolong fluid responsiveness positif. Didapatkan hasil sensitivitas metode velosimetri elektrik menggunakan variasi isi sekuncup dalam menilai fluid responsiveness adalah 51,7% dengan spesifisitas 53,8%. Nilai prediksi positif dari velosimetri elektrik adalah 28,9% dan nilai prediksi negatif adalah 75,4%. Simpulan : Metode velosimetri elektrik dengan memanfaatkan nilai variasi isi sekuncup memiliki ketepatan yang tidak sama baik dengan ekokardiografi pascafluid challenge dalam menilai fluid responsiveness
Kata kunci : Ekokardiografi; fluid responsiveness; variasi isi sekuncup; velosimetri elektrik


Background : Fluid responsiveness is important to optimize the preload of the
heart so that hypovolemia or hypervolemia that increase patient morbidity can be
prevented. Electrical velocimetry is a noninvasive cardiac output monitor, can
measure stroke volume variation that can be used to assess fluid responsiveness.
Measuring the stroke volume variation using electrical velocimetry to assess fluid
responsiveness is easy, inexpensive, but has not been widely studied. This study
aims to determine the accuracy of the electrical velocimetry method compared to
echocardiography in assessing fluid responsiveness.
Methods : This is a cross sectional study of fluid responsiveness assessment
using electrical velocimetry measurement of stroke volume variation in patients
undergone elective surgery in the Surgical Unit in July - September 2018. There
were 109 subjects who met inclusion criteria. Electrical velocimetry measurement
was carried out by anesthesiologist residents and compared with
echocardiographic examination by an operator. Data analysis was carried out by
diagnostic tests.
Results : Assessment based on the electric velosimetry method found 47.7% of
patients were fluid responsiveness. Assessment based on echocardiography found
26.6% of patients were fluid responsiveness. Sensitivity of the electrical
velocimetry using stroke volume variation in assessing fluid responsiveness was 51.7% with a specificity of 53.8%. The positive predictive value of electric velosimetry is 28.9% and the negative predictive value is 75.4% Conclusion : Fluid responsiveness assessment by electrical velocimetry using stroke volume variation has lower accuracy in comparison to post- fluid challenge stroke volume changes measurement by echocardiography.
Keywords : Echocardiografi; electrical velocimetry; fluid responsiveness; stroke volume variation