Tesis

Perbedaan Perubahan Kadar Creatinine Height Index Terhadap Keberhasilan Penyapihan Ventilator Pada Pasien dengan Prolonged Mechanical Ventilation = Comparison of Creatinine Height Index Level Changes in Predicting Ventilator Weaning Outcomes of Patients with Prolonged Mechanical Ventilation.

Latar Belakang: Ventilasi mekanik merupakan salah satu prosedur yang sering digunakan dalam penatalaksanaan pasien sakit kritis yang mengalami gagal napas. Penggunaan ventilator jangka panjang (Prolonged Mechanical Ventilation, PMV) meningkatkan morbiditas dan mortalitas. Salah satu faktor risiko yang berperan dalam terjadinya PMV adalah malnutrisi dan sarkopenia, yang ditandai dengan hilangnya massa dan fungsi otot. Di satu sisi, sakit kritis sendiri ditandai dengan hipermetabolisme dan peningkatan katabolisme protein otot itu sendiri. Pemantauan massa otot di perawatan intensif menjadi penting, namun belum ada metode pengukuran yang cukup praktis dalam menggambarkan massa otot tubuh. Creatinine Height Index dapat menjadi salah satu penanda massa otot tubuh sehingga diperkirakan terdapat perbedaan perubahan Creatinine Height Index terhadap keberhasilan penyapihan pada pasien dengan penggunaan ventilator jangka panjang. Metode: Penelitian ini merupakan studi prospektif observasional pada pasien sakit dengan PMV di RSUPN dr. Cipto Mangunkusumo dan RS Universitas Indonesia. Dilakukan pengukuran Creatinine Height Index (CHI) pada 72 jam pertama pemakaian intubasi dan diulang pada saat pasien ekstubasi atau maksimal hari ke- 14 penggunaan ventilator. Hasil Creatinine Height Index akan dilihat berdasarkan keberhasilan penyapihan. Karakteristik subjek lainnya meliputi usia, jenis kelamin, riwayat asupan bahan makanan sumber kreatin, aktivitas fisik pra admisi, imbang cairan kumulatif, asupan energi dan protein selama perawatan di ICU. Hasil: Terdapat 27 subjek dengan rerata usia 46 tahun dan mayoritas laki-laki (67%). Nilai CHI awal dan akhir tidak berbeda pada kelompok yang berhasil maupun yang gagal menyapih (p = 0,466 dan p = 0,494), namun nilai perubahan CHI berbeda bermakna secara statistik pada mereka yang mengalami berhasil menyapih dan gagal menyapih (p = 0,009). Kelompok yang gagal menyapih mengalami penurunan nilai CHI sebesar 3,9 (-18,3;23,7)%. Kesimpulan: Tidak terdapat perbedaan bermakna pada nilai CHI awal maupun akhir pada kelompok yang berhasil dan gagal menyapih. Terdapat perbedaan bermakna secara statistik pada perubahan nilai CHI pada kelompok yang berhasil dan gagal menyapih. Kelompok yang gagal menyapih mengalami penurunan nilai CHI, sementara kelompok yang berhasil menyapih tidak mengalami hal tersebut.
Kata kunci: Creatinine Height Index, Prolonged Mechanical Ventilation, Sakit Kritis


Background: Mechanical ventilation is one of the procedures that frequently used in the management of critically ill patients experiencing respiratory failure. Prolonged mechanical ventilation increases morbidity and mortality. One of the risk factors contributing to prolonged mechanical ventilation (PMV) is malnutrition and sarcopenia, characterized by loss of muscle mass and its function. On one hand, critical illness itself is marked by hypermetabolism and increased muscle protein catabolism. Monitoring muscle mass in intensive care is essential, but there is currently no practical method for describing whole-body muscle mass. Creatinine Height Index could serve as an indicator of body muscle mass, suggesting potential differences between Creatinine Height Index level changes and successful weaning in patients with prolonged mechanical ventilation. Methods: This study is a prospective observational study conducted on critically ill patients with prolonged mechanical ventilation (PMV) at RSUPN dr. Cipto Mangunkusumo and RS Universitas Indonesia. Creatinine Height Index (CHI) was measured within the first 72 hours of intubation and repeated upon extubation or by day 14 of ventilation. CHI results were then categorized based on weaning success. Other subject characteristics included age, gender, history of dietary creatine intake, pre-admission physical activity, cumulative fluid balance, energy intake, and protein intake during ICU hospitalization. Results: There were 27 subjects with a mean age of 46 years, predominantly male (67%). Initial and final CHI values did not differ between the successful and failed weaning groups (p = 0.466 and p = 0.494, respectively), but there was a statistically significant difference in the change in CHI values between those who successfully weaned and those failed (p = 0.009). The failed weaning group experienced a decrease in CHI values by 3.9 (-18.3; 23.7)%. Conclusion: There was no significant difference in initial or final CHI values between the groups that successfully weaned and those who failed. However, there was a statistically significant difference in the CHI values alteration between those groups. The failed weaning group experienced a decrease in CHI values, while the successful weaning group did not.
Keywords: Creatinine Height Index, Prolonged Mechanical Ventilation, Critically Ill