Tesis

Pengaruh Tindakan Bronchial Toilet Dalam 48 Jam Pertama Pada Pasien Pneumonia Dengan ARDS yang Terventilasi Mekanik Invasif Terhadap Keberhasilan Ekstubasi Di RSUPN DR. Cipto Mangunkusumo = The Effect of Bronchial Toilet in the First 48 Hours in Patients with Pneumonia and ARDS Under Invasive Mechanical Ventilation on Extubation Success at Dr. Cipto Mangunkusumo National Hospital.

Latar Belakang: Pneumonia berat dengan sindrom gangguan pernapasan akut (ARDS) sering memerlukan terapi ventilasi mekanik invasif. Peningkatan sekresi jalan napas dan gangguan refleks batuk dapat menurunkan keberhasilan ekstubasi. Bronchial toilet bertujuan untuk eliminasi sekresi dan memperbaiki patensi jalan napas, namun bukti mengenai pengaruh onset tindakan ini terhadap keberhasilan ekstubasi masih terbatas. Tujuan: Menilai pengaruh waktu bronchial toilet dan keberhasilan ekstubasi pada pasien dewasa dengan pneumonia dan ARDS. Metode: Studi quasi eksperimental ini dilakukan di ICU RS Nasional Dr. Cipto Mangunkusumo periode bulan November-Desember 2025. Pasien pneumonia dan ARDS usia dewasa dengan terapi ventilasi mekanik invasifdikelompokkan menjadi onset ≤48 jam dan >48 jam. Outcome utama adalah keberhasilan ekstubasi. Analisis dilakukan secara deskriptif, analitik dengan uji Chi square and multivariat dengan regresi logistik. Hasil: Karakteristik dasar 63 pasien kelompok ≤48 jam dan 58 pasien pada kelompok >48 jam relatif sebanding. Median durasi intubasi lebih singkat pada kelompok ≤48 jam (9 vs 12 hari; p=0,487). Keberhasilan ekstubasi lebih tinggi pada kelompok ≤48 jam (56,9% vs 47,6%), tetapi tidak signifikan (p=0,307; RR 1,122; IK95% 0,565–2,227). Analisis multivariat menunjukkan derajat ARDS, lama intubasi, dan klasifikasi pneumonia berhubungan signifikan dengan keberhasilan ekstubasi (p < 0.05). Simpulan: Tindakan bronchial toilet dalam 48 jam pertama tidak meningkatkan keberhasilan ekstubasi secara signifikan pada pasien pneumonia dengan ARDS, sementara derajat ARDS, lama intubasi, dan klasifikasi pneumonia merupakan faktor-faktor yang mempengaruhi keberhasilan ekstubasi. Studi prospektif dengan sampel lebih besar diperlukan untuk mengonfirmasi manfaat klinisnya.
Kata kunci: pneumonia berat; sindrom gangguan pernapasan akut; bronchial toilet; bronkoskopi; ekstubasi; ventilasi mekanik


Background: Severe pneumonia with acute respiratory distress syndrome (ARDS) often requires invasive mechanical ventilation. Increased airway secretions and impaired cough reflex can decrease extubation success. Bronchial toilet aims to eliminate secretions and improve airway patency, but evidence regarding the effect of bronchial toilet onset on extubation success is limited. Objective: To assess the effect of bronchial toilet timing on extubation success in adult patients with pneumonia and ARDS. Methods: This quasi-experimental study was conducted in the ICU of Dr. Cipto Mangunkusumo National Hospital from November to December 2025. Adult patients with pneumonia and ARDS receiving invasive mechanical ventilation were categorized into those with onset ≤48 hours and those with onset >48 hours. The primary outcome was extubation success. Analysis was descriptive, analytical using the Chi-square test, and multivariate analysis using logistic regression. Results: The baseline characteristics of the 63 patients in the ≤48-hour group and the 58 patients in the >48-hour group were relatively comparable. The median duration of intubation was shorter in the ≤48-hour group (9 vs. 12 days; p=0.487). Extubation success was higher in the ≤48-hour group (56.9% vs. 47.6%), but not significantly (p=0.307; RR 1.122; 95% CI 0.565–2.227). Multivariate analysis showed that ARDS severity, intubation duration, and pneumonia classification were significantly associated with extubation success (p < 0.05). Conclusion: Bronchial toilet within the first 48 hours did not significantly improve extubation success in patients with pneumonia with ARDS, while ARDS severity, intubation duration, and pneumonia classification were factors that influenced extubation success. Prospective studies with larger sample sizes are needed to confirm its clinical benefit.
Keywords: severe pneumonia; acute respiratory distress syndrome; bronchial toilet; bronchoscopy; extubation; mechanical ventilation