PERBANDINGAN ANTARA NILAI INDEKS VARIASI GELOMBANG PLETHYSMOGRAPHY DENGAN NILAI VARIASI TEKANAN PULSASI ARTERI PADA PASIEN DENGAN VENTILASI TEKANAN POSITIF DI ICU RSUP DR. SARDJITO

Background: Pulse pressure variations (PPV) provide a good assessment of fluid status but require the
installation of arterial line with high cost, difficult installation, and the risk of complications in the form of
tissue death as well as infection. Meanwhile, the plethysmography variation index which has similarities to
the pulse pressure variation that arises due to arteriolar pulses and is influenced by the breathing cycle, but
is non-invasive, easy to apply, cheaper material, and without the risk of tissue death or infection.
Methods: This study uses a prospective observational study design. We measured pulse pressure variation
and plethysmography variability index (PVi) in 22 patients mechanically ventilated with preexisting radial
artery catheter in intensive care unit (ICU). PPV was obtained by installing radial arterial line connected
to Mostcare®. PVi was obtained by installing an oximetry probe on fourth finger and connected to the
Masimo® monitor. We compared PPV and PVi using Mann-whitney test and looked for correlations with
the spearman coefficient.
Result: Twenty-two patients (SAPS II = 1.74 (0.4-75) had PPV values of 11.7 (7.03) and PVi 13.29 (7.76)
different but were not statistically significant p = 0.405 (p> 0.05). There was a moderate correlation between
PPV and PVi (r = 0.55). Four of the 22 patients receiving noreepinephiren (dose = 0.125 mcg / kg / min (0.1-
0.15)) showed no correlation between PPV and PVi (r = 0.40 p = 0.60). Conclusion: There was no significant difference between the value of the pulse pressure variation and
the plethysmography variability index (PVi). There was a moderate correlation between the pulse pressure
variation with the plethysmography variability index. There was no correlation between PVi and PPV in
patients receiving norepinephrine.

Latar belakang: Variasi tekanan pulsasi memberi penilaian status cairan yang baik namun membutuhkan
pemasangan jalur arteri dengan biaya mahal, sulit dalam pemasangan, dan resiko komplikasi berupa
kematian jaringan juga infeksi. Sementara itu, indeks variasi plethysmography yang memiliki kemiripan
dengan variasi tekanan pulsasi yaitu muncul akibat denyut arteriol dan dipengaruhi oleh siklus pernapasan,
namun bersifat tidak-invasif, mudah diterapkan, bahan lebih murah, dan tanpa resiko kematian jaringan
maupun infeksi.
Metode: Penelitian ini menggunakan rancangan studi observasional prospektif. Kami mengukur variasi
tekanan pulsasi (VTP) dan indeks variasi plethysmography (IVP) pada 22 pasien terpasang mesin ventilasi di
ICU. VTP diperoleh dengan memasang jalur arteri yang terhubung dengan Mostcare®. IVP diperoleh dengan
memasang probe terhubung dengan Masimo®. pada terpasang mesin ventilasi. Kami membandingkan VTP
dan IVP menggunakan mann whitney dan mencari korelasi dengan koefisien spearman.
Hasil: Dua puluh dua pasien (SAPS II =1,74 (0,4-75)) memiliki nilai VTP 11,7 (7,03) dan IVP 13,29 (7,76)
berbeda tetapi tidak bermakna secara statistik p=0,405 (p>0,05). Terdapat korelasi sedang antara VTP dan
IVP (r=0,55). Empat dari 22 pasien menerima noreepinephiren (dosis = 0,125 mcg/kgbb/menit (0,1-0,15)
memperlihatkan tidak adanya korelasi antara VTP dan IVP (r=0,40 p=0,60).
Kesimpulan: Tidak terdapat perbedaan yang signifikan antara antara nilai variasi tekanan pulsasi (VTP)
dengan indeks variasi plethysmography (IVP). Terdapat korelasi sedang antara antara nilai variasi tekanan
pulsasi (VTP) dengan indeks variasi plethysmography (IVP). Tidak terdapat korelasi antara nilai IVP dan VTP
pada pasien menerima norepinephrine.

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