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Early Percutaneous Dilatational Tracheostomy pada Pasien COVID-19 dengan Gagal Napas: Laporan Kasus

*Ahmad Feza Fadhlurrahman  -  Departemen Anestesiologi dan Terapi Intensif; Fakultas Kedokteran; Universitas Brawijaya/RSUD Dr. Saiful Anwar; Malang, Indonesia
Rudy Vitraludyono  -  Departemen Anestesiologi dan Terapi Intensif; Fakultas Kedokteran; Universitas Brawijaya/RSUD Dr. Saiful Anwar; Malang, Indonesia
Taufiq Agus Siswagama  -  Departemen Anestesiologi dan Terapi Intensif; Fakultas Kedokteran; Universitas Brawijaya/RSUD Dr. Saiful Anwar; Malang, Indonesia
Arie Zainul Fatoni  -  Departemen Anestesiologi dan Terapi Intensif; Fakultas Kedokteran; Universitas Brawijaya/RSUD Dr. Saiful Anwar; Malang, Indonesia

Citation Format:
Abstract

Latar belakang: Pasien kritis dengan infeksi coronavirus disease 2019 (COVID-19) memiliki kecenderungan untuk perawatan ventilasi mekanik dalam waktu yang lama. Perawatan dengan translaryngeal intubasi dalam waktu lama beserta penggunaan sedasi dan tindakan lainnya di intensive care unit (ICU) dapat memunculkan beberapa komplikasi lebih lanjut.

Kasus: Pasien perempuan pascaoperasi sectio caesaria dengan gagal napas akibat infeksi COVID-19.  Pasien mendapat support high flow nasal canule (HFNC) di awal perawatan di ICU. 4 hari perawatan, kondisi distress napas pasien memberat dan dilakukan intubasi translaryngeal. Dari evaluasi kondisi pasien selama 4 hari perawatan dengan ventilasi mekanik, tim ICU memutuskan melakukan tracheostomy melalui pendekatan dilatasi perkutan. Prosedur dilakukan di ruang bertekanan negatif dengan penggunaan alat pelindung diri (APD) level 3. Kondisi pasien berangsur mengalami perbaikan selama 7 hari perawatan dengan tracheostomy. Support ventilasi yang minimal, kebutuhan fraksi oksigen yg menurun dan perbaikan kondisi umum menjadi pertimbangan dilakukan dekanulasi. 3 hari pasca dekanulasi pasien dipindah rawat ke ruangan dengan kondisi stabil.

Selama perawatan di ICU, pasien mendapat standar terapi berupa antiviral, antibiotik, antikoagulan, analgesik, steroid, dan obat penunjang lainnya.

Pembahasan: Tindakan tracheostomy berhubungan dengan insiden pneumonia yang lebih rendah, penurunan penggunaan obat sedasi dan percepatan masa lepas rawat dari ventilasi mekanik. Early tracheostomy dilakukan sebelum hari ke-10 intubasi. Teknik dilatasi perkutan memiliki kelebihan atas efektifitas dan efisiensi biaya dan alat pendukung. Tindakan percutaneous dilatational tracheostomy (PDT) pada pasien COVID-19 harus dilakukan dengan proteksi tenaga medis yang optimal.

Kesimpulan: Early tracheostomy dapat dipertimbangkan dalam tatalaksana pasien kritis COVID-19. Penilaian kondisi klinis pasien dan proteksi tenaga medis merupakan faktor utama menentukan tindakan early tracheostomy pada pasien COVID-19.

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Keywords: ARDS; COVID-19; dilatasi perkutan; gagal napas; tracheostomy

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