Tesis

Faktor-Faktor Hemodinamik yang Memengaruhi Penyapihan Ventilator pada Anak Sakit Kritis = Hemodynamic Factors Affecting Ventilator Weaning in Critically Ill Children.

Latar Belakang Kegagalan penyapihan ventilator pada pasien anak di unit perawatan intensif dapat memperpanjang lama perawatan, meningkatkan risiko komplikasi, serta menambah beban biaya. Berbagai penyebab kegagalan telah diklasifikasikan dalam pendekatan ABCDE (Airway, Brain, Cardiac, Diaphragm, Endocrine). Namun, hingga kini belum ada data komprehensif yang mengevaluasi peran parameter hemodinamik seperti VIS, ScVO₂, LVEF, SMII, PKR, dan dP/dt dalam memprediksi keberhasilan penyapihan pada populasi pediatrik. Metode Penelitian ini merupakan studi observasional prospektif terhadap 82 pasien anak yang menjalani ventilasi mekanik di PICU RSUPN Dr. Cipto Mangunkusumo selama Maret– Juli 2025. Penilaian parameter hemodinamik dilakukan secara serial pada fase baseline, awal dan akhir ERT/SBT, serta pasca-ekstubasi, menggunakan ekokardiografi, USCOM®, dan USCOM BP+®. Subjek dikelompokkan berdasarkan keberhasilan penyapihan dan dianalisis secara bivariat, multivariat, ROC, dan pembuatan sistem skoring. Hasil Dari 82 pasien, 72 (87,8%) berhasil dan 10 (12,2%) gagal ekstubasi. Tidak terdapat perbedaan bermakna pada perubahan nilai ScVO₂, LVEF, SMII, PKR, dan dP/dt dari baseline ke akhir ERT/SBT. Pada analisis nilai baseline, LVEF dan dP/dt berbeda secara bermakna antara kelompok berhasil dan gagal (p = 0,039 dan p = 0,024), serta memiliki akurasi prediksi yang baik dengan AUC masing-masing 0,719 dan 0,721. Sistem skoring sederhana berbasis kedua parameter ini menghasilkan AUC 0,806 (IK 95%: 0,693–0,918; p = 0,002) dengan kalibrasi baik (uji Hosmer–Lemeshow p = 0,165). VIS score tidak dianalisis lebih lanjut karena jumlah subjek yang mendapat inotrop sangat sedikit. Simpulan Nilai LVEF dan dP/dt baseline dapat dijadikan prediktor keberhasilan penyapihan ventilator pada pasien pediatrik, terutama jika dikombinasikan dalam sistem skoring sederhana. Parameter lain seperti ScVO₂, SMII, dan PKR menunjukkan tren perubahan fisiologis yang relevan, namun tidak memiliki signifikansi statistik sebagai prediktor tunggal.
Kata kunci: dP/dt, hemodinamik, LVEF, penyapihan ventilator mekanis, PKR, SMII, ScVO2, VIS score


Background Weaning failure from mechanical ventilation in pediatric intensive care units (PICU) can prolong hospital stay, increase the risk of complications, and elevate healthcare costs. The causes of weaning failure are classified within the ABCDE approach (Airway, Brain, Cardiac, Diaphragm, Endocrine). To date, there is limited data evaluating hemodynamic parameters such as VIS, ScVO₂, LVEF, SMII, PKR, and dP/dt as predictors of successful weaning in the pediatric population. Methods This prospective observational study involved 82 mechanically ventilated pediatric patients admitted to the PICU of Dr. Cipto Mangunkusumo National Referral Hospital from March to July 2025. Hemodynamic assessments were performed at four phases: baseline, start and end of ERT/SBT, and post-extubation, using echocardiography, USCOM®, and USCOM BP+®. Patients were grouped based on weaning outcomes, and data were analyzed using bivariate, multivariate, ROC curve analysis, and scoring system development. Results Among the 82 patients, 72 (87.8%) were successfully extubated, while 10 (12.2%) experienced weaning failure. There were no statistically significant differences in the changes of ScVO₂, LVEF, SMII, PKR, and dP/dt from baseline to the end of ERT/SBT between the two groups. However, baseline values of LVEF and dP/dt showed significant differences between success and failure groups (p = 0.039 and p = 0.024, respectively), and demonstrated good predictive accuracy with AUC values of 0.719 and 0.721. A simplified scoring system based on these two parameters yielded an AUC of 0.806 (95% CI: 0.693–0.918; p = 0.002) and good calibration (Hosmer–Lemeshow test, p = 0.165). VIS score was not further analyzed due to the low number of patients receiving vasoactive support. Conclusion Baseline LVEF and dP/dt values may serve as useful predictors for successful ventilator weaning in pediatric patients, especially when combined into a simple scoring model. Other parameters such as ScVO₂, SMII, and PKR showed physiologically relevant trends but lacked statistical significance as independent predictors.
Keywords: dP/dt, hemodynamic, LVEF, PKR, SMII, ScVO2, ventilator weaning, VIS score