Faktor risiko kejadian Pneumonia terkait ventilator (Ventilator-Associated Pneumonia) pasca pembedahan di ICU RS Dr. Sardjito Yogyakarta :: Suatu analisis faktor resiko

MANDANG, Jeni Sarah, dr. Pandit Sarosa, SpAn.K

2006 | Tesis | PPDS I Anestesiologi dan Reanimasi

Latar belakang : Pneumonia sebagai infeksi nosokomial saluran napas bawah menempati urutan ke 2 setelah infeksi saluran kemih. Pneumonia terkait ventilator atau ventilator-associated pneumonia (VAP) merupakan pneumonia nosokomial pada pasien-pasien dengan bantuan ventilasi mekanik selama lebih dari 48 jam, merupakan penyulit pada perawatan pasien di ICU sehingga memperpanjang lama tinggal dan meningkatkan morbiditas. Kejadian VAP pada penderita pasca pembedahan mempunyai risiko lebih tinggi dibandingkan penderita non pembedahan. Insidens VAP bervariasi pada unit yang berbeda sehingga berperanan dalam pengendalian faktor risiko. Tujuan : Mengetahui dan menghitung nilai Odds Ratio faktor risiko host, faktor risiko terapi dan faktor risiko kontrol infeksi, serta faktor risiko yang berperan terhadap terjadinya kejadian VAP pada penderita pasca pembedahan di ICU RS Dr.Sardjito Yogyakarta Desain : Retrospektive matched case control study Ruang Lingkup : Penderita pasca pembedahan laki-laki dan wanita yang dirawat di ICU RS.Dr.Sardjito Yogjakarta selama 48-96 jam Data penderita pasca pembedahan diperoleh dari instalasi catatan medik serta sistem pencatatan dan pelaporan ICU pada periode 1 Januari 2004 sampai 31 Juni 2006. Subyek : Sebanyak 25 penderita kelompok kasus dan 25 penderita kelompok kontrol dengan pencocokan dalam hal jenis kelamin dan umur yang dikelompokkan pada setiap 10 tahun periode usia. Hasil Penelitian : Pada analisis multivariat diperoleh nilai Odds Ratio pada variabel bebas berikut : asidosis metabolik OR=120,67 (95% CI 3,57- 4078,66) p=0,008; profilaksis stress ulcer OR=54,59 (95% CI 2,46-1213,22) p=0,011; pemberian enteral feeding OR=30,74 (95% CI 2,00-471,77) p=0,014; syok OR=12,48 (95% CI 1,24- 125,53) p=0,032; gangguan kesadaran OR=6,82 (95% CI 1,09- 49,60) p=0,054. Kesimpulan : Faktor risiko host berupa kondisi asidosis metabolik, syok, gangguan kesadaran; faktor risiko terapi berupa profilaksis stress ulcer dan pemberian enteral feeding, sebagai faktor risiko terjadinya VAP pasca pembedahan di ICU RS Dr.Sarjito Yogjakarta periode 1 Januari 2004 sampai 31 Juni 2006 dan faktor risiko host yang berpotensi terhadap terjadinya VAP pasca pembedahan diantara faktor risiko terapi dan faktor risiko kontrol infeksi

Background : Pneumonia as nosocomial infection at lower respiratory tract considered as the second higher nosocomial infection after urinary tract infection. Ventilator-associated pneumonia (VAP) is nosocomial pneumonia in patients with support mechanical ventilation more than 48 hours, which increases the difficulties of treatment during in ICU care. This case could prolong length stay and increases the morbidity rate. Post surgery VAP cases have higher risk compared non surgery patients. The incidence of VAP is varies in different units which related to manage risk factors. Objective : to determine Odds Ratio value for host risk factors, therapy risk factors, infection control risk factors and dominant risk factors associated with development of VAP for post surgery patients at the department of ICU Dr.Sardjito general hospital, Yogjakarta. Design : Retrospektive matched case control study Setting : Male and female post surgery patiens threated at the ICU Dr.Sardjito general hospital Yogjakarta for 48-96 hours in duration. The post surgery patients data are taken from the medical record department as well as record system and ICU reports at the period of 1 January 2004 until 31 June 2006. Subjects : We took 25 patients as cases group and 25 pateints as controls group, we matched them into sex and age groupping in 10 years age period. Results : From the multivariate analysis we found the Odds Ratio of these independent variable as follows: metabolic acidosis OR=120,67 (97% CI 3,57-4078,66) p=0,008; stress ulcer prophylaxis OR=54,59 (95% CI 2,46-1213,22) p=0,011; enteral feeding OR=30,74 (95% CI 2,00-471,77) p=0,014; shock OR=12,48 (95% CI 1,24-125,53) p=0,032; conciousness disorder OR=6,82 (95% CI 1,09-49,60) p=0,054. Conclusion : Host risk factors such as metabolic acidosis, shock, conciuosness disorder; therapy risk factors such as stress ulcer prophylaxis and enteral feeding, as risk factors associated to development VAP post surgery patients in ICU Dr.Sardjito general hospital Yogjakarta at the period 1 January 2004 until 31 June 2006 and host risk factors act as potential risk factors associated to development VAP at post surgery among therapy risk factors and infection control risk factors

Kata Kunci : Pneumonia,Ventilator,Pembedahan