Korelasi antara Lama Pintas Jantung Paru dan Lama Bantuan Ventilasi Mekanis pada Pasien Pascabedah Pintas Arteri Koroner di Unit Perawatan Intensif Jantung Rumah Sakit Dr. Hasan Sadikin Bandung
Abstract
Pintas jantung paru (PJP) diperlukan untuk sebagian besar prosedur bedah pintas arteri koroner (BPAK). Fungsi paru dan oksigenasi menurun sekitar 2–90% pada pasien pascabedah jantung dengan PJP. Ketergantungan terhadap ventilator setelah BPAK secara signifikan berhubungan dengan morbiditas dan mortalitas. Tujuan penelitian ini adalah mengorelasikan waktu PJP dengan lama bantuan ventilasi mekanis pada pasien BPAK. Penelitian ini merupakan analisis kohort retorospektif pada 43 pasien yang menjalani BPAK dengan PJP yang dirawat di Unit Perawatan Intensif Jantung Rumah Sakit Dr. Hasan Sadikin Bandung pada bulan Januari 2014 sampai Juni 2015. Lama PJP dibagi menjadi ≤90 menit dan >90. Lama bantuan ventilasi mekanis terbagi menjadi ≤12 jam dan >12 jam. Parameter yang dicatat pada penelitian ini adalah usia, berat badan, tinggi badan, indeks massa tubuh, lama PJP, waktu klem aorta, dan lama bantuan ventilasi mekanis. Analisis stastistik menggunakan uji korelasi Lambda, signifikan jika nilai p<0,05. Penelitian ini menunjukkan korelasi yang cukup kuat antara waktu PJP dan lama bantuan ventilasi mekanis setelah BPAK dengan korelasi positif (0,545) dan signifikan (p<0,05). Simpulan penelitian ini adalah semakin lama waktu PJP berkorelasi dengan memanjangnya lama bantuan ventilasi mekanis.
Kata kunci: Bedah pintas arteri koroner, pintas jantung paru, ventilasi mekanis
Correlation between Cardiopulmonary Bypass Time and Duration of Mechanical Ventilation after Coronary Artery Bypass Graft at Cardiac Intensive Care Unit of Dr. Hasan Sadikin General Hospital Bandung
Cardiopulmonary bypass (CPB) is necessary for majority of procedures in coronary artery bypass grafting (CABG) surgery. Lung function and oxygenation are impaired in 20% to 90% of CPB cardiac surgery patients. Ventilator dependency following CABG is often associated with significant morbidity and mortality. This study aims to correlate the CPB time and duration of mechanical ventilation after coronary artery bypass graft. This was a retrospective analysis cohort study on 43 consecutive patients undergoing CABG on CPB who admitted to cardiac intensive care unit between January 2014 and June 2015 in Dr. Hasan Sadikin General Hospital Bandung. The CPB time divided into <90 minutes and ≥90 minutes. Duration of mechanical ventilation was defined as ≤12 hours and ≥12 hours ventilation. Parameters recorded in this study were age, weight, height, body mass index, CPB time, aortic cross-clamp time and duration of mechanical ventilation. Statistical analysis was performed using Lambda correlation, significanti if p value <0.05. This study showed moderate correlation between CPB time and duration of mechanical ventilation after CABG surgery with a positive (0.545) and significant correlation (p<0.05). Conclusion of this research is longer CPB timed correlated with prolonged mechanical ventilation
Key words: Cardiopulmonary bypass time, coronary artery bypass grafting, mechanical ventilation
Keywords
Full Text:
PDFReferences
Nozawa E, Azeka E, Ignêz ZM, Feltrim Z, Auler JO. Factors associated with failure of weaning from long-term mechanical ventilation after cardiac surgery. Int Heart J. 2005;46(5):819–31.
Faritous. ZS, Aghdaie N, Tazdanian F, Azarfarin R, Dabbagh A. Perioperatif risk factors for prolonged mechanical ventilation and tracheostomy in women undergoing coronary artery bypass graft with cardiopulmonary bypass. Saudi J Anaesth. 2011;5(2):167–9.
Rezaianzadeh A, Maghsoudi B, Tabatabaee T, Keshavarzi S, Bagheri Z, dkk. Factors associated with extubation time in coronary artery bypass grafting patients. Peer J. 2015;3:1–11.
Piotto RF, Ferreira RB, Colosimo FC, Silva GS, Sousa AG, Braile DM. Independent predictors of prolonged mechanical ventilation after coronary artery bypass surgery. Rev Bras Cir Cardiovasc. 2012;27(4):520–8.
Thomas LH, Yared JP, Adi A. Postoperatif respiratori care. Dalam: Kaplan JA, Reich D, Savino JS, penyunting. Kaplan’s cardiac anesthesia. Edisi ke-6. Missouri: Elsevier Saunders; 2011. hlm. 1046–60.
Rodrigues CD, Oliveira RA, Soares OM, Figueiredo LC, Sebastião Araújo, Dragosavac D. Lung injury and mechanical ventilation in cardiac surgery: a review. Rev Bras Cir Cardiovasc. 2010;22:4.
Grocott HP, Smith MS, Mangano CT. Cardiopulmonary bypass management and organ protection. Dalam: Kaplan JA, Reich D, Savino JS, penyunting. Kaplan’s cardiac anesthesia. Edisi ke-6. Missouri: Elsevier Saunders; 2011. hlm. 862–4.
Natarajan K, Patil S, Lesley N, Ninan B. Predictors of prolonged mechanical ventilation after on-pump coronary artery bypass grafting. Ann Card Anaesth. 2006;9:31–6.
Piotto RF, Maia LN, Machado MN, Orrico SP. Effects of the use of mechanical ventilation weaning protocol in the coronary care unit: randomized study. Rev Bras Cir Cardiovasc. 2011;26(2):213–21.
Tobias JD. Is there an optimal mode of ventilation following cardiac surgery? Saudi J Anesth. 2011;5(2):121–2.
Totonchi Z, Baazm F, Chitsazan M, Seifi S, Chitsazan MN. Predictors of prolonged mechanical ventilation after open heart surgery. J Cardiovasc Thorac Res. 2014;6(4):211–6.
London MJ, Shroyer AL, Coll JR, MaWhinney S, Fullerton DA, Hammermeister KE. et al. Early extubation following cardiac surgery in a veterans population. Anesthesiology. 1998;88:1447–58.
Arom KV, Emery RW, Petersen RJ, Schwartz M. Cost-effectiveness and predictors of early extubation. Ann Thorac Surg. 1995;60(1):127-32.
Cislaghi F, Condemi AM, Corona A. Predictors of prolonged mechanical ventilation in a cohort of 3,269 CABG patients. Minerva Anestesiol. 2007;73:615–21.
Imura H, Caputo M, Lim K, Ochi M, Suleiman S, Shimizu K, dkk. Pulmonary injury after cardiopulmonary bypass: Beneficial effects of low-frequency mechanical ventilation. J Thorac Cardiovasc Surg. 2009;137:1530–7.
Clark SC. Lung injury after cardiopulmonary bypass. Perfusion. 2006;21:225–8.
Jansen NJ, van OW, van VM, et al. The role of different types of corticosteroids on the inflammatory mediators in cardiopulmonary bypass. Eur J Cardiothorac Surg 1991;5:211–217.
Moitra VK, Sladen RN. Cardiopulmonary bypass and the lung. Dalam: Gravlee GP, Davis RF, Stammers AH, Ungerleider RM, penyunting. Cardiopulmonary bypass: principles and practice. Edisi ke-3. Philadelphia: Lippincott Williams & Wilkins; 2008. hlm. 311–20.
Steidl S. the adverse effects of the cardiopulmonary bypass machine. Liberty University. 2011;1(1):1–35.
Tönz M, Mihaljevic T, von Segesser LK, Fehr J, Schmid ER, Turina MI. Acute lung injury during cardiopulmonary bypass: are the neutrophils responsible?. Chest. 1995; 108:1551–6.
Katseni K, Chalkias A, Kotsis T, Dafnios N, Arapoglou V, Kaparos G, dkk. The effect of perioperatif ischemia and reperfusion on multiorgan dysfunction following abdominal aortic aneurysm repair. Biomed Res Int. 2015;2015:1–11.
Karalapillai D, Story D, Hart GK, Bailey M, Pilcher D, Cooper DJ, dkk. Postoperatif hypothermia and patient outcomes after elective cardiac surgery. Anaesthetists. 2013;68(6):605–11.
DOI: https://doi.org/10.15851/jap.v5n2.1106
Article Metrics
Abstract view : 690 timesPDF - 1354 times
This Journal indexed by
JAP is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
View My Stats