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Tatalaksana ICU pada Pasien Pasca Laminektomi Servikal dengan Kesulitan Weaning dan Ekstubasi

1Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan, Universitas Gadjah Mada/RSUP Dr. Sardjito, Yogyakarta, Indonesia

2Departemen Anestesi dan Perawatan Intensif Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan, Universitas Gadjah Mada/RSUP Dr. Sardjito, Yogyakarta, Indonesia

3Departemen Anestesi dan Perawatan Intensif, Fakultas Kedokteran, Universitas Diponegoro/RSUP Dr. Kariadi, Semarang, Indonesia

Received: 21 May 2023; Published: 31 Jul 2023.

Citation Format:
Abstract

Latar Belakang: Salah satu penyebab kesulitan weaning adalah gangguan neuromuskuler seperti polineuropati, miopati, dan spinal cord injury (SCI) segmen servikal di atas C5. Angka kegagalan ekstubasi berkisar pada 10-20% dari keseluruhan kasus intensive care unit (ICU) dengan angka kematian 25-50%. Ventilasi mekanik jangka panjang seringkali diperlukan pada pasien dengan cedera medula spinalis segmen di atas C5.

Kasus: Kami laporkan 2 pasien; seorang laki-laki 22 tahun dengan diagnosis tetraparese spastik dengan lesi transversal total medula spinalis C5 et causa spinal cord injury, dan pada pasien kedua seorang laki-laki 34 tahun dengan diagnosis tetraplegia akut et causa canal stenosis servikal setinggi C1-3 et causa massa ekstradura et causa squamous cell carcinoma. Kedua pasien juga didiagnosis mengalami kejadian ventilator associated pneumonia (VAP), pasca prosedur pembedahan laminektomi. Penatalaksanaan berupa terapi antibiotik empiris dan de-eskalasi.

Pembahasan: Sebagian besar gangguan neuromuskular yang mempersulit weaning diperoleh selama perawatan pasien di ICU. Fungsi sistem pernapasan pada pasien dengan cedera medula spinalis servikal memerlukan perhatian khusus, khususnya segmen level tinggi oleh karena keterlibatan saraf frenikus. Trakeostomi direkomendasikan dilakukan lebih awal setelah intubasi untuk menyederhanakan weaning. Komplikasi pascaoperasi harus diatasi agar tidak memperburuk luaran pasien.

Kesimpulan: Kriteria weaning dan ekstubasi pada gangguan neuromuskuler dapat berbeda antar referensi, namun secara umum melibatkan vital capacity (VC), respiratory rate (RR), minute ventilation, PaO2, FiO2, PaCO2, rapid shallow breathing index, positive end-expiratory pressure (PEEP), dan kondisi klinis pasien. Selama weaning, bantuan ventilasi dilepas untuk sementara dan diselingi dengan periode istirahat.

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Keywords: ekstubasi; laminektomi; servikal; unit perawatan intensif; weaning
Funding: Universitas Diponegoro

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