Perbandingan Teknik Ekstubasi Metode Tekanan Positif dan Metode Suctioning Terhadap Selisih P/F Ratio pada Pasien SICU RSUP Dr. Sardjito

Muhammad Syarif Nurdianto, dr. Calcarina Fitriani R. W., Sp.An-TI, Subsp.T.I.(K) ; dr. Bowo Adiyanto, M.Sc., Sp.An-TI, Subsp.T.I.(K)

2026 | Tesis-Spesialis | S2 Anestesiologi

Latar Belakang: Ekstubasi endotrakeal di ICU merupakan prosedur rutin dengan risiko komplikasi seperti aspirasi, atelektasis, dan gangguan oksigenasi. Metode suctioning dan tekanan positif sering digunakan, namun perbandingan keamanannya pada pasien SICU masih terbatas.

Tujuan: Membandingkan teknik ekstubasi tekanan positif dengan suctioning terhadap perubahan P/F ratio dan komplikasi pasca-ekstubasi pada pasien SICU.

Metode: Studi quasi-eksperimental pretest-posttest pada 109 pasien dewasa di SICU RSUP Dr. Sardjito (tekanan positif n=54; suctioning n=55) yang memenuhi kriteria inklusi. Intervensi berupa ekstubasi tekanan positif (PS 15 cmH?O, PEEP 10 cmH?O) dibandingkan suctioning. Outcome utama adalah selisih P/F ratio, dan sekunder adalah komplikasi hingga 48 jam. Analisis menggunakan independent t-test (p<0>

Hasil: Karakteristik subjek pada kedua kelompok relatif sebanding, dengan rerata usia sekitar 50 tahun (49,76 ± 16,23 vs 50 ± 15,32 tahun; p=0,937), distribusi usia dewasa dan lansia yang homogen (p=0,772), serta tidak terdapat perbedaan signifikan jenis kelamin (p=0,293). Nilai PaO? pre-ekstubasi juga relatif sebanding antara kelompok tekanan positif dan suctioning (179,04 ± 53,67 vs 160,43 ± 53,07 mmHg; p=0,072). Namun, terdapat perbedaan signifikan pada jenis operasi (p=0,009). Tidak terdapat perbedaan signifikan selisih P/F ratio antara kelompok tekanan positif (116,78 ± 119,55 mmHg) dan suctioning (76,35 ± 128,30 mmHg; p=0,092), meskipun kelompok tekanan positif menunjukkan peningkatan lebih besar (pre: 360,63 ± 107,49 vs post: 477,41 ± 154,65; suctioning pre: 329,7 ± 110,17 vs post: 406,04 ± 154,17). Vital sign stabil tanpa perbedaan signifikan (misalnya sistolik pre p=0,141). Komplikasi rendah secara keseluruhan (0% vs 5,5%; p=0,243); desaturasi 0% vs 3,6% (p=0,495), reintubasi 0% vs 1,8% (p=1,000), tanpa aspirasi atau takipnea.

Kesimpulan: Terdapat kecenderungan peningkatan selisih P/F ratio yang lebih baik pada teknik ekstubasi metode tekanan positif dibandingkan metode suctioning pada pasien SICU RSUP Dr. Sardjito, namun perbedaan tersebut tidak bermakna secara statistik sehingga kedua metode menunjukkan efektivitas yang relatif sebanding dalam mempertahankan oksigenasi pasca ekstubasi.

Background: Endotracheal extubation in the ICU is a routine procedure associated with complications such as aspiration, atelectasis, and impaired oxygenation. Suctioning and positive-pressure methods are commonly used; however, data comparing their safety in SICU patients remain limited.

Objective: To compare the positive-pressure extubation technique with the suctioning method regarding changes in P/F ratio and post-extubation complications in SICU patients.

Methods: A quasi-experimental pretest-posttest study was conducted on 109 adult patients in the SICU of RSUP Dr. Sardjito (positive-pressure group n=54; suctioning group n=55) who met the inclusion criteria. The intervention consisted of positive-pressure extubation (PS 15 cmH?O, PEEP 10 cmH?O) compared with suctioning. The primary outcome was the difference in P/F ratio, while secondary outcomes included complications within 48 hours. Data were analyzed using the independent t-test (p<0>

Results: Subject characteristics in both groups were relatively comparable, with a mean age of approximately 50 years (49.76 ± 16.23 vs 50 ± 15.32 years; p=0.937), homogeneous distribution of adult and elderly patients (p=0.772), and no significant difference in sex distribution (p=0.293). Pre-extubation PaO? values were also relatively comparable between the positive-pressure and suctioning groups (179.04 ± 53.67 vs 160.43 ± 53.07 mmHg; p=0.072). However, there was a significant difference in the type of surgery performed (p=0.009). No significant difference was found in the change of P/F ratio between the positive-pressure group (116.78 ± 119.55 mmHg) and the suctioning group (76.35 ± 128.30 mmHg; p=0.092), although the positive-pressure group demonstrated a greater increase (pre: 360.63 ± 107.49 vs post: 477.41 ± 154.65; suctioning pre: 329.7 ± 110.17 vs post: 406.04 ± 154.17). Vital signs remained stable without significant differences (e.g., pre-extubation systolic blood pressure p=0.141). Overall complications were low (0% vs 5.5%; p=0.243), including desaturation (0% vs 3.6%; p=0.495), reintubation (0% vs 1.8%; p=1.000), with no aspiration or tachypnea observed.

Conclusion: There was a tendency toward a greater improvement in P/F ratio with the positive-pressure extubation technique compared with the suctioning method in SICU patients at RSUP Dr. Sardjito; however, the difference was not statistically significant, indicating that both methods demonstrated relatively comparable effectiveness in maintaining post-extubation oxygenation.

Kata Kunci : ekstubasi, tekanan positif, metode suctioning, P/F ratio