Tesis

Penggunaan Electrical Impedance Tomography sebagai Panduan Perubahan PEEP pada Pasien Model Hipertensi Intra-Abdomen dalam Mencegah Cedera Epitel Paru: Kajian terhadap Distribusi Ventilasi Paru dan Kadar Penanda RAGE = Electrical Impedance Tomography as a Guide to PEEP Changes in Intra-Abdominal Hypertension Model Patients in Determining Pulmonary Epithelial Injury: Study of Lung Ventilation Distribution and RAGE Marker Levels.

Latar Belakang Hipertensi intra-abdomen sering dialami pasien kritis. Kondisi ini akan memengaruhi distribusi ventilasi paru. Manajemen ventilasi mekanis, seperti penggunaan PEEP yang tidak tepat dapat mengakibatkan cedera epitel paru yang ditandai dengan peningkatan penanda RAGE. Belum tersedia bukti di RSCM mengetahui pengaruh pengaturan PEEP terhadap distribusi ventilasi di paru dan cedera epitel paru yang ditandai perubahan kadar RAGE. Distribusi ventilasi paru memerlukan penggunaan EIT, namun penggunaan metode ini pada pasien perawatan ICU dapat terkendala waktu dan ketersediaan alat, sehingga digunakan model hipertensi intra-abdomen pada pasien yang menjalani bedah laparoskopik. Metode Penelitian kohort prospektifdengan metode non probability sampling pada semua pasien laparoskopi ginekologi selama bulan September 2023 hingga Februari 2024 di Unit Pelayanan Bedah Terpadu RSUPN Dr. Cipto Mangunkusumo Jakarta. Pasien diberikan manajemen ventilasi sesuai protokol penelitian dengan memberikan PEEP 5-8-11-14 cmH2O pasca insuflasi gas CO2. Distribusi udara diamati melalui alat EIT dan dicatat parameter numeriknya serta dilakukan pengambilan sampel RAGE melalui bilasan bronkus pada waktu sebelum insuflasi, setelah manajemen ventilasi dan 2 jam pascamanajemen ventilasi. Hasil Secara statistik hanya parameter ∆TIV-ROI yang memiliki kemaknaan (p < 0.001). Gambaran distribusi udara paru ∆TIV-ROI memiliki perbedaan bermakna selama perubahan perlakuan; ∆EELI-G dapat membuktikan pemberian PEEP 5cmH2O dapat menjaga FRC lebih baik dibanding sebelum manajemen ventilasi dan dibandingkan pemberian PEEP 8, 11 dan 14; ∆EELI-ROI dapat membuktikan bahwa pemberian PEEP dapat menjaga distribusi udara lebih baik di regio paru dependen hingga PEEP 14, dan regio paru non-dependen hingga PEEP 11; ∆CR-ROI regio dependen dibandingkan regio non-dependen dapat menunjukkan perubahan fisiologi paru bahwa komplains paru regio dependen semakin baik dengan penambahan PEEP hingga 14 dan paru regio non-dependen hanya sampai PEEP 11; kadar RAGE tidak mengalami peningkatan selama melebihi rentang kadar normal selama perubahan perlakuan yang diamati. Simpulan Alat EIT dapat membantu melihat distribusi udara paru selama pemberian manajemen ventilasi pasien model hipertensi intra-abdomen sehingga tidak menyebabkan cedera pada paru.
Kata Kunci EIT, ∆TIV-ROI, ∆EELI-G, ∆EELI-ROI, ∆CR-ROI, distribusi udara paru, laparoskopi, hipertensi intra-abdomen


Background Intra-abdominal hypertension is often experienced by critical patients. This condition will affect the distribution of lung ventilation. Mechanical ventilation management, such as inappropriate use of PEEP can result in lung epithelial injury characterized by increased RAGE markers. There is no evidence available at RSCM regarding the effect of PEEP settings on the distribution of ventilation in the lungs and lung epithelial injury as indicated by changes in RAGE levels. Distribution of lung ventilation requires the use of EIT, however the use of this method in ICU care patients can be limited by time and equipment availability, so the intra-abdominal hypertension model is used in patients undergoing laparoscopic surgery. Method This study is a prospective cohort study using a non-probability sampling method on all gynecological laparoscopy patients during September 2023 to February 2024 at the Integrated Surgical Services Unit, RSUPN Dr. Cipto Mangunkusumo Jakarta. Patients were given ventilation management according to the research protocol by providing PEEP 5-8-11-14 cmH2O after insufflation of CO2 gas. Air distribution was observed using the EIT device and the numerical parameters were recorded and RAGE samples were taken via bronchial lavage before insufflation, after ventilation management and 2 hours after ventilation management. Result After the analysis was conducted, ∆TIV-ROI parameter was found to have statistical significance (p < 0.001). The ∆TIV-ROI lung air distribution features had significant differences during treatment changes; ∆EELI-G data demonstrated that FRC was more maintained than before ventilation management with PEEP 5 cmH2O compared to giving PEEP 8, 11 and 14; ∆EELI-ROI proved that giving PEEP can maintain better air distribution in dependent lung regions up to PEEP 14, and non-dependent lung regions up to PEEP 11; ∆CR-ROI of the dependent region compared to the non-dependent region can indicate changes in lung physiology that the dependent region's lung complaints improve with the addition ofPEEP up to 14 and the non-dependent region's lung complaints only up to PEEP 11; RAGE levels did not increase as long as they exceeded the normal range during the observed treatment changes. Conclusion The EIT device can help see the distribution of lung air during ventilation management for patients with intra-abdominal hypertension so that it does not cause injury to the lungs.
Keywords EIT, ∆TIV-ROI, ∆EELI-G, ∆EELI-ROI, ∆CR-ROI, lung air distribution, laparoscopy, intra-abdominal hypertension