PERBANDINGAN KEGAGALAN PENYAPIHAN VENTILASI MEKANIK ANTARA T-PIECE DAN CPAP

Background : Weaning from mechanical ventilation procedure is often done in the ICU. There are several ways that can be used for the weaning process, including the T-piece and CPAP. The purpose of this study is to compare the mechanical ventilation weaning failure between T-piece and CPAP.
Methods : This study was an open randomized controlled clinical trials. Subjects were adult patients in ICU Dr Sardjito Hospital, planned to be weaned and meet the criteria for weaning from mechanical ventilation. All patients or family signed informed consent. Exclusion criteria were refusal to participate and patients with tracheostomy. Drop out criteria were unable to apply research procedure, withdrawal of consent after randomization and autoextubation. Subject sampling was conducted in consecutive sampling and block randomly. The patients were divided into two groups, group T (T-piece with O2 supply 4L/minutes) and group C (CPAP with PEEP 5cmH2O and FiO2 ≤ 0,4), evaluated for 2 hours to determine whether the patient feasible for extubation. When the patient was considered feasible for extubation, the extubation was performed. Otherwise patients returned to the previous mode and re-evaluated. Mechanical ventilation weaning was determined to be successfull when the patient did not reintubated within the rst 24 hours after extubation. If the patient showed any signs of respiratory failure within 24 hours, then the patient was intubated and connected to a ventilator.
Results : There were very signi cant differences (p <0.01) for weaning failure in patients with T-piece. Weaning failure observed in patients with T-piece was 33,3% while for CPAP 0% (p = 0.007).

Latar Belakang : Tindakan penyapihan dari ventilasi mekanis merupakan hal yang cukup sering dikerjakan di unit perawatan intensif (ICU). Ada beberapa cara yang bisa digunakan untuk proses penyapihan tersebut, di antaranya T-piece dan CPAP. Tujuan penelitian ini membandingkan kegagalan penyapihan ventilasi mekanik antara T-piece dan CPAP.

Metode : Rancangan penelitian ini adalah uji klinis terbuka acak terkontrol desain paralel. Subyek penelitian adalah pasien dewasa yang dirawat di ICU RSUP Dr Sardjito yang direncanakan untuk dilakukan penyapihan dan memenuhi kriteria penyapihan. Semua subyek/keluarga telah menandatangani informed consent. Kriteria eksklusi dalam penelitian ini adalah pasien menolak untuk berpartisipasi dan pasien dengan trakheostomi. Kriteria drop out jika tidak mengikuti prosedur cara kerja, menarik diri dari keikutsertaan setelah dilakukan randomisasi dan autoekstubasi. Pemilihan sampel dilakukan secara consecutive sampling dan block random. Subyek penelitian dibagi menjadi dua kelompok, kelompok T dengan T-piece O2 4L/menit dan kelompok C dengan CPAP, PEEP≤ 5cmH20 dan FiO2≤ 0,4. Dilakukan evaluasi selama 2 jam untuk menentukan apakah pasien layak ekstubasi atau tidak. Jika pasien dinilai layak ekstubasi maka ekstubasi dilakukan, sedangkan pasien yang tidak memenuhi kriteria ekstubasi maka dikembalikan ke mode ventilator semula dan dievaluasi ulang. Penyapihan ventilasi mekanik dikatakan sukses bila pasien tidak diintubasi ulang dalam 24 jam pertama pasca ekstubasi. Jika toleransi selama 24 jam tersebut kondisi pasien menunjukkan adanya tanda-tanda gagal nafas maka pasien diintubasi dan dihubungkan ke ventilator.

Hasil : Terdapat perbedaan sangat bermakna (p<0,01) untuk kegagalan penyapihan pada pasien dengan T-piece. Kegagalan penyapihan pada pasien dengan T-piece 33,3% sedangkan untuk pasien CPAP 0% (p=0,007).
Simpulan : Metode CPAP memberikan jumlah kegagalan penyapihan yang lebih rendah dibandingkan T-piece (0% vs 33,3%; p=0,007; p<0,01).

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