Tesis

Efikasi dan Keamanan High Flow Nasal Cannula dibandingkan dengan Nasal Continuous Positive Airway Pressure terhadap Angka Kegagalan Terapi Pascaekstubasi pada Bayi Prematur = Efficacy and Safety of High Flow Nasal Cannula (HFNC) and Nasal Continuous Positive Airway Pressure (nCPAP) on Therapy Failure post-extubation in Preterm Neonates.

Latar belakang: Nasal continuous positive airway pressure (nCPAP) merupakan alat bantu napas noninvasif pilihan pertama pascaekstubasi untuk bayi prematur. Saat ini High flow nasal cannula (HFNC) digunakan sebagai alternatif lain yang sama efektif nya seperti nCPAP. Tujuan: Untuk mengetahui efikasi, keamanan dan angka kegagalan terapi penggunaan HFNC dibandingkan nCPAP pascaekstubasi pada bayi prematur. Metode: Uji klinis acak terkontrol tidak tersamar tunggal dilakukan Februari-Juni 2024 di Divisi Neonatologi Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia, RS Cipto Mangunkusumo Jakarta. Kriteria inklusi adalah bayi usia gestasi antara 28 minggu sampai 36 minggu 6 hari yang terintubasi dan menggunakan ventilasi mekanik. Randomisasi dilakukan pada 42 subjek yang dibagi menjadi dua kelompok (nCPAP vs HFNC). Hasil: Tidak terdapat perbedaan bermakna (p=0,747) kegagalan terapi dalam waktu < 1 jam (23,8% vs 33,3%) dan 1 -24 jam (42,9% vs 33,3%). Tidak terdapat perbedaan nilai pCO2 pada analisis gas darah (p=0,683), kejadian trauma hidung (p=0,317), dan skor nyeri (p=0,795) yang menggunakan ventilasi noninvasif HFNC dan nCPAP. Meskipun tidak terdapat perbedaan bermakna kejadian distensi abdomen (p=0,197) pada kedua kelompok, namun HFNC memiliki angka penurunan kejadian distensi abdomen yang lebih besar dibandingkan nCPAP. Simpulan: Tidak ada perbedaan kegagalan terapi pemakaian HFNC dibanding nCPAP pascaekstubasi pada bayi prematur. Angka kejadian distensi abdomen didapati lebih kecil pada pemakaian HFNC.
Kata Kunci: High flow nasal canula, nasal continuous positive airway pressure, ekstubasi, prematur


Background: Nasal continuous positive airway pressure (nCPAP) is the primary noninvasive respiratory support choice after extubation for neonates. Hence, High Flow Nasal Cannula (HFNC) has use as effective as nCPAP. Objective: To determine the efficacy, safety, and therapy failure rates of HFNC and nCPAP post-extubation in preterm neonates. Methods: A single-blind randomized controlled clinical trial was conducted from February-June 2024 in the Neonatology Division of the Department of Pediatrics, RS Cipto Mangunkusumo Jakarta. The inclusion criteria were preterm (28 weeks to 36 weeks 6 days) with mechanical ventilation. Randomization was performed on 42 subjects, divided into two groups (nCPAP vs HFNC) Results: There was no significant difference (p=0,747) in the proportion of therapy failure, within < 1 hour (23,8% vs 33,3%) and 1 -24 hours (42,9% vs 33,3%). There was no difference in the proportion of pCO2 values in blood gas analysis (p=0.683), nasal trauma (p=0.317), and pain scores (p = 0.795) between HFNC and nCPAP. Although there was no significant difference in abdominal distension rate (p=0.197) between the two groups, HFNC had a greater reduction in abdominal distension than nCPAP. Conclusion: There was no difference in the proportion of therapy failure between HFNC and nCPAP use post-extubation in preterm. The incidence of abdominal distension was found lower with HFNC.
Keywords: High flow nasal canula, nasal continuous positive airway pressure, extubation, premature