Tesis

Korelasi Antara Tekanan Intraabdomen dengan Urine Output pada Resusitasi Cairan Luka Bakar = Correlation Between Intra-abdominal Pressure and Urine Output in Fluid Resuscitation for Burn Injury.

Pendahuluan: Luka bakar merupakan suatu kondisi kegawatdaruratan medis yang membutuhkan tata laksana komprehensif sesuai dengan etiologi dan derajat keparahan. Terapi resusitasi cairan pada luka bakar sangat penting untuk mencegah atau mengatasi syok hipovolemik. Prinsip resusitasi luka bakar adalah memberikan cairan yang tidak terlalu banyak untuk mencapai target resusitasi tetapi mencapai tingkat optimal agar perfusi organ tercukupi. Ekstravasasi cairan resusitasi dalam jumlah besar ke dalam dinding usus dapat menyebabkan edema masif dan peningkatan tekanan intraabdomen (TIA). TIA yang meningkat dan menetap akan menyebabkan hipertensi intraabdomen (HIA) dan sindrom kompartemen abdomen (SKA). Saat ini, formula Parkland masih menjadi terapi resusitasi cairan standar dan menggunakan hasil pengukuran urine output (UO) sebagai parameter kecukupan resusitasi pada pasien luka bakar. Metode: Subjek dalam penelitian ini adalah pasien luka bakar yang mendapatkan resusitasi cairan di ULB RSCM dan memenuhi kriteria inklusi dan eksklusi. Penelitian ini menggunakan desain studi cross sectional untuk mengetahui korelasi antara TIA dan UO dan bersumber dari data primer. Pengambilan data dilakukan selama fase resusitasi cairan 24 jam pertama. Pengukuran TIA dilakukan setiap 6 jam, sedangkan pengukuran UO dilakukan setiap 1 jam. Hasil: 12 pasien terinklusi dalam penelitian ini. Korelasi antara TIA dan UO 6 jam pertama bernilai lemah positif (r =0,225), pada 6 jam kedua korelasi lemah negatif (r = - 0,226), pada 6 jam ketiga korelasi sedang negatif (r = -0,524), pada 6 jam keempat tidak terdapat korelasi (r = -0,120), pada korelasi secara keseluruhan selama 24 jam didapatkan korelasi lemah negatif (r = -0,208) tanpa adanya signifikansi secara keseluruhan (p > 0,05). Lebih lanjut, ditemukan korelasi antara %TBSA dengan jumlah cairan resusitasi selama 24 jam tergolong sangat kuat (r = 0,890) dan signifikan, korelasi antara %TBSA dengan rerata TIA selama 24 jam tergolong lemah positif (r = 0,226, p > 0,05), dan korelasi antara jumlah cairan resusitasi dan TIA rerata tergolong sedang positif (r = 0,467, p > 0.05). Kesimpulan: Tidak terdapat korelasi secara signifikan (p > 0.05) antara tekanan intraabdomen terhadap urine output pada pasien luka bakar selama fase 24 jam resusitasi cairan pertama di ULB RSCM.
Kata kunci: tekanan intraabdomen, urine output, resusitasi cairan, luka bakar


Introduction: Burns are a medical emergency that require comprehensive management according to the etiology and degree of severity. Fluid resuscitation therapy for burns is very important to prevent or treat hypovolemic shock. The principle of burn wound resuscitation is to provide fluids that are not too much to achieve the resuscitation target but reach optimal levels so that organ perfusion is adequate. Extravasation of large amounts of resuscitation fluid into the intestinal wall can cause massive edema and increased intra-abdominal pressure (IAP). Increasing and persistent IAP will cause intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Currently, the Parkland formula is still the standard fluid resuscitation therapy and use urine output (UO) measurements as a parameter for the adequacy of resuscitation in burn patients. Methods: Subjects in this study were burn patients who received fluid resuscitation at ULB RSCM and met the inclusion and exclusion criteria. This research uses a crosssectional study design to determine the correlation between TIA and UO and is sourced from primary data. Data collection was carried out during the first 24 hours of fluid resuscitation phase. IAP measurements are carried out every 6 hours, while UO measurements are carried out every 1 hour. Results: 12 patients were included in this study. The correlation between IAP and UO in the first 6 hours was weakly positive (r = 0.225), in the second 6 hours the correlation was weakly negative (r = -0.226), in the third 6 hours the correlation was moderately negative (r = -0.524), in the fourth 6 hours it was not there is a correlation (r = -0.120), in the overall correlation for 24 hours there is a weak negative correlation (r = -0.208) with no overall significance (p > 0.05). Furthermore, it was found that the correlation between %TBSA and the amount of resuscitation fluid for 24 hours was classified as very strong (r = 0.890) and significant, the correlation between %TBSA and average IAP for 24 hours was classified as weakly positive (r = 0.226, p > 0.05), and the correlation between the amount of resuscitation fluid and average IAP was moderately positive (r = 0.467, p > 0.05). Conclusion: There is no significant correlation (p > 0.05) between intra-abdominal pressure and urine output in burn patients during the first 24hour phase of fluid resuscitation at ULB RSCM.
Keywords: intra-abdominal pressure, urine output, fluid resuscitation, burns