Faktor Prediktor Kejadian Ventilator Associated Pneumonia (VAP) Di Neonatal Intensive Care Unit (NICU)

RR Wening Gelar P, dr. Rina Triasih Med(Paed), PhD, Sp.A(K.; dr. Setya Wandita, M.Kes, Sp.A(K)

2023 | Tesis | MAGISTER ILMU KEDOKTERAN KLINIS

Latar belakang Ventilator Associated Pneumonia (VAP) merupakan masalah pada neonatus yang memerlukan bantuan ventilasi mekanik, di mana banyak faktor prediktor untuk terjadinya hal ini. Penelitian ini bertujuan untuk mengetahui faktor prediktor terjadinya VAP pada neonatus yang dirawat di NICU. Metode Studi kohort prospektif dilakukan di NICU RSUP Dr. Sardjito Yogyakarta dari 8 November 2022 sampai 28 Februari 2023. Subjek yang dimasukkan dalam penelitian ini adalah neonatus berumur 0-28 hari yang membutuhkan bantuan ventilasi mekanik lebih dari 48 jam. Subjek dikeluarkan dari penelitian bila ada kelainan bawaan anatomi saluran napas, terdiagnosis VAP sebelumnya, atau meninggal kurang dari 48 jam sejak diberi bantuan ventilasi mekanik. Subjek yang dimasukkan dalam penelitian diikuti sampai terdiagnosis VAP atau ekstubasi. Diagnosis VAP sesuai dengan kriteria diagnosis CDC tahun 2014. Faktor prediktor yang diteliti adalah sepsis, penggunaan Umbilical Vein Catheter (UVC), pemberian Total Parenteral Nutrition (TPN), pemberian surfaktan, tindakan reintubasi dan lamanya penggunaan ventilasi mekanik. Data yang terkumpul dianalisis menggunakan analisis bivariat (Fisher Exact test) dan multivariat (regresi logistik). Hasil Penelitian Selama penelitian didapatkan 393 subejk di mana 70 subjek diantaranya memerlukan bantuan ventilasi mekanik lebih dari 48 jam. Satu 1 subjek dieksklusi karena telah terdiagnosis VAP sebelumya. Pada 69 subjek penelitian didapatkan 28 (40,5%) mengalami VAP. Analisis bivariat menunjukan usia kehamilan <37minggu (RR= 2,91 95%CI 1,98-5,95) dan penggunaan ventilasi mekanik 5 hari (RR=1,7, 95% CI 1,13-2,58) merupakan predictor terjadinya VAP. Pada analisis multivariat usia kehamilan <37minggu (p=0,004 RR 5,08 IK95% 1,68-15,37) dan penggunaan ventilasi mekanik 5 hari (p=0,035 RR 3,28 IK95% 1,09-9,89) terbukti sebagai faktor prediktor terjadinya VAP. Kesimpulan Usia kehamilan <37 minggu dan pemakaian ventilasi mekanik 5 hari merupakan faktor prediktor terjadinya VAP.

Background Ventilator-Associated Pneumonia (VAP) is a problem in neonates who require mechanical ventilation support, and there are many predictor factors for this occurrence. This study aims to determine the predictor factors for the occurrence of VAP in neonates who are treated in the NICU. Methods The prospective cohort study was conducted at the NICU Dr. Sardjito Yogyakarta from 8 November 2022 to 28 February 2023. Subjects included in this study were neonates aged 0-28 days who needed mechanical ventilation for more than 48 hours. Subjects were excluded from the study if there were congenital abnormalities of the airway anatomy if previously diagnosed with VAP or died less than 48 hours after being given mechanical ventilation. Subjects included in the study were followed until VAP was diagnosed or extubated. The diagnosis of VAP was per the 2014 CDC diagnostic criteria.The predictor factors studied were sepsis, use of Umbilical Vein Catheter (UVC), Total Parenteral Nutrition (TPN) administration, administration of surfactants, reintubation measures, and length of use of mechanical ventilation. The collected data were analyzed using bivariate analysis (Fisher Exact test) and multivariate (logistic regression). Result During the study, 393 subjects were found, of which 70 required mechanical ventilation for more than 48 hours. One subject was excluded because they had been previously diagnosed with VAP. Of the 69 study subjects, 28 (40.5%) experienced VAP. Bivariate analysis showed gestational age <37 weeks (RR= 2.91 95% CI 1.98-5.95) and use of mechanical ventilation 5 days (RR=1.7, 95% CI 1.13-2.58) were predictors of VAP. In multivariate analysis of gestational age <37 weeks (p=0.004 RR 5.08 95% CI 1.68-15.37) and the use of mechanical ventilation 5 days (p=0.035 RR 3.28 95% CI 1.09-9.89) proved to be a predictor factor for the occurrence of VAP. Conclusions Gestational age <37 weeks and use of echanical ventilation for 5 days are predictors of VAP.

Kata Kunci : Ventilator Associated Pneumonia, neonatus, faktor prediktor, NICU,Ventilator-Associated Pneumonia, neonates, predictor factors