Tatalaksana Pasien Obesity Hypoventilation Syndrome di Intensive Care Unit (ICU)

Yunita Susanto Putri, Ardi Zulfariansyah

Abstract


Obesity Hypoventilation Syndrome (OHS) seringkali tidak disadari sehingga terlambat ditatalaksana. Pasien OHS dengan gagal napas memiliki angka mortalitas yang cukup tinggi dan memerlukan waktu perawatan yang lama. Kasus ini dilaporkan untuk mengkaji tatalaksana pada pasien OHS di ICU. Seorang wanita berusia 67 tahun dirawat di RS Santosa Kopo Bandung pada bulan April 2018 dengan diagnosis awal obesitas kelas III (BMI 46), hypertensive heart disease (HHD) dan gagal jantung kongestif. Satu hari perawatan di ruangan biasa, kesadaran pasien menjadi somnolen dengan sesak napas yang semakin hebat. Hasil pemeriksaan analisis gas darah arteri didapatkan pH 7,18 dan pCO2 118 mmHg, kemudian dilakukan pemasangan pipa endotrakeal, ventilasi mekanik dan pasien dipindahkan ke Intensive Care Unit (ICU). Pasien dirawat di ICU selama 28 hari kemudian dilakukan trakeostomi dan pulang ke rumah dengan melanjutkan topangan ventilasi mekanik dengan mode continuous positive airway pressure (CPAP). Terdapat beberapa modalitas terapi di ICU yang dapat meningkatkan ventilasi pada pasien OHS yang mengalami gagal napas hiperkapnia kronik eksaserbasi akut, yaitu non invasive positive pressure ventilation (NPPV), intubasi endotrakea dengan ventilasi mekanik invasif dan trakeostomi dengan atau tanpa ventilasi mekanik. Semakin cepat diagnosis OHS ditegakkan disertai dengan tatalaksana yang sesuai akan memberikan keluaran pasien yang baik pula.

Kata kunci: Gagal napas, ICU, obesitas, obesity hypoventilation syndrome

Management of Obesity Hypoventilation Syndrome in the Intensive CareUnit (ICU)

Most OHS cases are late to be diagnosed. Patients with OHS and respiratory failure, have a high mortality rate and can cause prolonged length of stay. This case report is aimed to review the management OHS patient in the ICU. A 67 year old woman was hospitalized in Santosa Kopo Hospital in April 2018 with obesity class III (BMI 46), hypertensive heart disease), and congestive heart failure. The Patient was hospitalized in a regular ward, for one day than she became somnolence with shortness of breath. Blood gas analysis showed pH 7.18 and pCO2 118, then patient was intubated and connected to the ventilator and transferred to ICU. Patient was treated for 28 days in the ICU, had tracheostomy and continued home care with CPAP ventilator. There are several therapeutic modalities in the ICU that can improve ventilation in OHS patients who experience acute on chronic hypercapnia respiratory failure including non-invasive positive pressure ventilation (NPPV), endotracheal intubation with invasive mechanical ventilation and tracheostomy with or without mechanical ventilation. The faster the diagnosis of OHS accompanied with appropriate management will provide good outcome.

Key words: ICU, obesity, obesity hypoventilation syndrome, respiratory failure


Keywords


Gagal napas, ICU, obesitas, obesity hypoventilation syndrome

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