Tesis

Hubungan Lingkar Betis dengan Keberhasilan Ekstubasi Pasien Dewasa di Ruang Rawat Intensif = Association Between Calf Circumference and Successful Extubation ofAdult Patients in the Intensive Care Unit.

Latar belakang: Pasien sakit kritis pengguna ventilasi mekanis mengalami hiperkatabolisme dan peningkatan laju atrofi otot yang dapat memengaruhi keberhasilan penyapihan dan ekstubasi. Pemeriksaan massa otot dengan alat tervalidasi terbatas karena instabilitas klinis, kesulitan transfer pasien, beban biaya, dll. Lingkar betis (LB) berkorelasi dengan hasil pemeriksaan massa otot tervalidasi, sederhana, cepat, dan efisien. Studi ini bertujuan mengetahui hubungan lingkar betis saat admisi ICU sebagai pemeriksaan massa otot dengan keberhasilan ekstubasi pasien dewasa sakit kritis. Metode: Studi kohort prospektif melibatkan 65 subjek berusia 18−70 tahun, pengguna ventilasi mekanis invasif di RSUPN dr. Cipto Mangunkusumo dan RS Universitas Indonesia. Pemantauan sejak awal admisi ICU hingga pasien ekstubasi atau hingga maksimal 14 hari pasca intubasi. Hasil: Subjek penelitian didominasi laki-laki (67,7%), rerata usia 48,2 ± 13,8 tahun, dan memiliki rerata indeks massa tubuh 23,77 ± 6,30 kg/m2. Sebagian besar pasien bedah (81,5%) dan memiliki komorbiditas (81,5%). Durasi intubasi pada median 43 jam (12-401 jam). Rerata LB awal admisi 32,8 ± 3,4 cm dan LB akhir 32,1 ± 3,6 cm, terdapat beda rerata -0,68 cm (p < 0,001). Tidak ditemukan hubungan LB awal dengan keberhasilan ekstubasi (RR 1,23; IK 95%: 0,89−1,69, p = 0,199). Kesimpulan: Lingkar betis awal sebagai pemeriksaan pengganti untuk massa otot bukan merupakan salah satu prediktor keberhasilan ekstubasi pasien. Akan tetapi, analisis tambahan menemukan ada perbedaan rerata yang bermakna pada LB awal dan LB akhir yang diukur. Perubahan LB juga didapatkan perbedaan nilai bermakna antara kelompok yang berhasil ekstubasi dibandingkan kelompok yang sulit ekstubasi.
Kata kunci: antropometri; lingkar betis; ekstubasi; massa otot


Background: Critically ill patients on mechanical ventilation experience hypercatabolism and increased rates of muscle wasting, affecting the success of weaning and extubation. Muscle mass examination with validated tools is still limited due to patients’s clinical instability, transfer difficulty, cost burden, etc. Calf circumference (CC) correlates with validated muscle mass examination results, is simple, fast, and efficient. This study aims to determine the relationship between initial calf circumference at ICU admission as a surrogate measure for muscle mass and successful extubation of critically ill adult patients. Methods: The prospective cohort study involving 65 subjects aged 18−70 years, users ofinvasive mechanical ventilation at Dr. Hospital. Cipto Mangunkusumo and University of Indonesia Hospital. Monitoring from the start of ICU admission until the patient is extubated or up to a maximum of 14 days after intubation. Results: The subjects were predominantly male (67,7%), mean age 48,2 ± 13,8 years, and had mean BMI of 23,77 ± 6.3 kg/m2. Most subjects are surgical pastients (81,5%) and had comorbidities (81,5%). The median duration of intubation was 43 hours (12−401 hours). Mean initial CC at admission was 32,8 ± 3,4 cm and mean final CC was 32,1 ± 3,6 cm, there was a mean difference of -0,68 cm (p < 0,001). There was no association between initial CC at ICU admission and successful extubation (RR 1,23; CI 95%: 0,89−1,69, p = 0,199). Conclusion: Initial calf circumference as a surrogate measure for muscle mass is not a predictor of successful extubation. However, additional analysis found that there was a significant mean difference in the measured initial and final CC. There was also a significant difference in CC changes between the successful extubation group compared to the difficult extubation group.
Keywords: anthropometry; calf circumference; extubation; muscle mass