Indeks Distensibilitas Vena Jugularis Interna sebagai Prediktor Fluid Responsiveness Pada Pasien dengan Ventilasi Mekanik di ICU RSUP Dr Sardjito

Zulfakhri, dr. Calcarina Fitriani RW, Sp.An-TI, Subsp.T.I(K).; DR. dr. Sudadi, SpAnTI, Subsp.N. An (K), Subsp. An. R (K)

2025 | Tesis-Subspesialis | SUBSPESIALIS ANESTESIOLOGI DAN TERAPI INTENSIF

Latar Belakang: Penilaian fluid responsiveness pada pasien ventilasi mekanik di ICU seringkali memerlukan metode invasif. Meskipun Passive Leg Raising (PLR) dapat mensimulasikan pemberian cairan, akurasi prediksi responsivitas cairan tetap membutuhkan parameter non-invasif yang valid.

Tujuan: Mengevaluasi performa Indeks Distensibilitas Vena Jugularis Interna (IJV-DI) sebagai prediktor non-invasif fluid responsiveness pada pasien ventilasi mekanik di ICU RSUP DR.SARDJITO.

Metode: Studi observasional prospektif cross-sectional di ICU RSUP Dr. Sardjito (Januari–Juni 2024) dengan sampel 52 pasien. IJV-DI diukur menggunakan ultrasonografi, dan stroke volume (SV) dinilai dengan electrical cardiometry (ICON) sebelum dan 2 menit pasca-PLR. Kriteria responder: peningkatan SV ?10% pasca-PLR. Analisis statistik meliputi ROC curve, uji korelasi Pearson, dan regresi logistik.

Hasil: IJV-DI menunjukkan akurasi diagnostik moderat (AUC 0,811; 95% CI  0,665–0,956). Cut-off optimal 49,5% (sensitivitas 96,7%, spesifisitas 72,7%) untuk skrining awal. Korelasi signifikan antara IJV-DI dengan ?SV pasca-PLR (r=0,422; p=0,002). Performa lebih baik pada subgrup sepsis (AUC 0,711 vs. 0,289 pada non- sepsis).

Kesimpulan: Indeks Distensibilitas Vena Jugularis Interna (IJV-DI) dapat digunakan sebagai prediktor fluid responsiveness pada pasien dengan ventilasi mekanik di ICU RSUP DR SARDJITO.

Background: Assessing fluid responsiveness in mechanically ventilated ICU patients often requires invasive methods. Although PLR can simulate fluid administration, a validated non-invasive predictor is still needed.

Objective: To evaluate the diagnostic performance of the Internal Jugular Vein Distensibility Index (IJV-DI) as a non-invasive predictor of fluid responsiveness in mechanically ventilated ICU patients Dr. Sardjito General Hospital.

Methods: A prospective observational cross-sectional study was conducted in the ICU of RSUP Dr. Sardjito (January–June 2024) with 52 patients. IJV-DI was measured via ultrasonography, and stroke volume (SV) was assessed using electrical cardiometry (ICON) before and 2 minutes after PLR. Fluid responsiveness was defined as a ?10% increase in SV post-PLR. Statistical analysis included ROC curve, Pearson correlation, and logistic regression.

Results: IJV-DI showed moderate diagnostic accuracy (AUC 0.811; 95% CI 0.665–0.956). Optimal cut-offs 49.5% (sensitivity 96.7%, specificity 72.7%) for initial screening. Significant correlation between IJV-DI and ?SV post-PLR (r=0.422; p=0.002). Better performance in sepsis subgroup (AUC 0.711 vs. 0.,289 in non- sepsis).

Conclusion: The Internal Jugular Vein Distensibility Index (IJV-DI) can be used as a predictor of fluid responsiveness in mechanically ventilated patients in the ICU of Dr. Sardjito General Hospital.

Kata Kunci : indeks distensibilitas vena jugularis interna, fluid responsiveness, passive leg raising, stroke volume.