Penggunaan Ventilatory Ratio dan Alveolar Dead Space Fraction sebagai Prediktor Mortalitas pada Pasien COVID-19 dengan Acute Respiratory Distress Syndrome

Muh Kemal Putra, Arie Utariani, Bambang Pujo Semedi, Christrijogo Soemartono Waloejo, Hardiono Hardiono

Abstract


Pada pasien COVID-19 dengan ARDS terjadi gangguan oksigenasi dan ventilasi. Menurut kriteria Berlin ARDS, oksigenasi diukur dengan PaO2/FiO2, namun tidak mengukur ventilasi alveolar yang diukur dengan dead space yang dapat terjadi akibat kondisi, seperti kerusakan endotel, mikrotrombus, dan penggunaan ventilator yang berlebih. Tujuan penelitian ini menganalisis penggunaan ventilatory ratio (VR) dan dead space fraction (Vd/Vt) sebagai prediktor mortalitas pasien COVID-19 ARDS. Penelitian ini adalah analitik kohort retrospektif. Data dikumpulkan dari rekam medik pasien COVID-19 yang dirawat di RIK RSUD Dr. Soetomo periode Juni–September 2020 dengan teknik total sampling terhadap subjek yang memenuhi kriteria inklusi dan tidak termasuk eksklusi. Data yang dikumpulkan adalah nilai VR dan Vd/Vt (diambil dari data laboratorium), kondisi klinis pasien dan pengaturan ventilator 24 jam pertama setelah terintubasi. Penelitian ini didapatkan 77 dari 80 subjek yang memenuhi kriteria. Nilai VR berhubungan dengan mortalitas secara signifikan dengan nilai p 0,001; cut off 1,84; sensitivitas 84,2%; spesifisitas 85%; RR 30,22; CI 95%: 7,31–124,89. Vd/Vt dan mortalitas menunjukkan hubungan yang signifikan terhadap mortalitas dengan nilai p 0.001. Uji analisis Spearman VR dengan Vd/Vt didapatkan hasil korelasi yang kuat dengan koefisien korelasi 0,704 dan p 0,001. Simpulan, nilai VR dan Vd/Vt dapat digunakan sebagai prediktor mortalitas pasien COVID-19 dengan ARDS dan keduanya mempunyai korelasi yang kuat. VR dapat menggantikan Vd/Vt.

Use of Ventilatory Ratio and Alveolar Dead Space Fraction as Predictorz of Mortality in Covid-19 Patients with Acute Respiratory Distress Syndrome

COVID-19 with ARDS experience impaired oxygenation and ventilation. In Berlin ARDS criteria, oxygenation is measured by PaO2 /FiO2, but does not measure alveolar ventilation, which is measured through the dead space produced in this conditions, such as endothelial damage, microthrombus, and excessive use of entilator. The purpose of this study was to analyze the use of ventilatory ratio (VR) and dead space fraction (Vd/Vt) as predictors of mortality in patients with COVID-19 ARDS. This study was a retrospective cohort analytic study one medical records of COVID-19 patients treated in an inpatient unit of a referral hospital in Indonesia. The ethical clearance was obtained from the Health Research Ethics Committee of Dr. Soetomo Hospital, Indonesia. Data were collected through total sampling of medical records that met the inclusion and exclusion criteria. The VR and Vd/Vt scores were collected from the laboratory data, patient clinical condition, and ventilator setting 24 hours after intubation. Of all medical records screened, 77 out of 80 samples met the criteria. VR was significantly associated with mortality with a p value of 0.001 (cut-off point:1.84, sensitivity: 84.2%, specificity: 85%, RR: 30.22, and 95%, CI: 7.31–124.89). Similarly, Vd/Vt and mortality showed a significant relationship with mortality with a p value of 0.001 (cut-off: 0.25, sensitivity: 85%, specificity: 86%, RR: 34.71, 95% CI: 8.24–146.05). The Spearman analysis test between VR and Vd/Vt showed a strong correlation with a correlation coefficient of 0,704 and p 0,001. Thus, VR and Vd/Vt can be used as predictors of mortality in COVID-19 patients with ARDS and because both have a strong correlation. VR can also substitute Vd/Vt.


Keywords


ARDS, COVID-19, dead space fraction, mortalitas, ventilatory ratio

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DOI: https://doi.org/10.15851/jap.v9n1.2274

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