DAFTAR ISI

ABSTRAK ...................................................................................................... ii

ABSTRACT .................................................................................................... iii

KATA PENGANTAR ..................................................................................... iv

DAFTAR TABEL ........................................................................................... xiii

DAFTAR GAMBAR ....................................................................................... xiv

DAFTAR SINGKATAN ................................................................................. xvi

BAB I PENDAHULUAN ................................................................................ 1

1.1 Latar Belakang ............................................................................................ 1

1.2 Rumusan Masalah ....................................................................................... 7

1.3 Tujuan Penelitian ........................................................................................ 7

1.4 Kegunaan Penelitian .................................................................................. 8

1.4.1 Kegunaan Praktis ............................................................................. 8

1.4.2 Kegunaan Akademis ........................................................................ 8

BAB II KAJIAN PUSTAKA DAN KERANGKA PEMIKIRAN ............. 9

2.1 Kajian Pustaka ........................................................................................... 9

2.1.1 COVID-19 ....................................................................................... 9

2.1.1.1 Definisi .................................................................................. 9

2.1.1.2 Epidemiologi ......................................................................... 10

2.1.1.3 Etiologi .................................................................................. 11

2.1.1.4 Patogenesis ............................................................................ 12

2.1.1.5 Manifestasi Klinis ................................................................. 18

2.1.2 Tatalaksana Oksigenasi Pada COVID-19 ....................................... 19

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 2.1.2.1 High-Flow Nasal Cannula dan Ventilasi Non-invasif.......... 20

2.1.2.2 Ventilasi Mekanik Invasif ..................................................... 20

2.1.3 Lung-protective strategy .................................................................. 21

2.1.4 Hiperkapnia ..................................................................................... 22

2.1.4.1 Penyebab Hiperkapnia .......................................................... 27

2.1.4.2 Klasifikasi Hiperkapnia ........................................................ 27

2.1.4.3 Efek Fisiologis Hiperkapnia ................................................. 28

2.1.4.4 Efek Hiperkapnia pada ARDS .............................................. 31

2.1.4.5 Hiperkapnia pada pasien COVID-19 .................................... 32

2.1.4.6 Penanganan Hiperkapnia ...................................................... 36

2.2 Kerangka pemikiran ................................................................................... 38

2.3 Premis dan Hipotesis.................................................................................. 43

2.3.1 Premis .............................................................................................. 43

2.3.1 Hipotesis .......................................................................................... 44

BAB III SUBJEK DAN METODE PENELITIAN ..................................... 45

3.1 Subjek Penelitian ....................................................................................... 45

3.1.1 Pemilihan Subjek ............................................................................. 45

3.1.1.1 Kriteria Inklusi ...................................................................... 45

3.1.1.2 Kriteria Eksklusi ................................................................... 45

3.1.1.3 Penentuan Besar Sampel ....................................................... 46

3.2 Metode Penelitian ...................................................................................... 47

3.2.1 Rancangan Penelitian ...................................................................... 47

3.2.2 Definisi Konsepsional dan Operasional Penelitian ......................... 47

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 3.2.2.1 Definisi Konsepsional Penelitian .......................................... 47

3.2.2.2 Definisi Operasional Penelitian ............................................ 48

3.2.3 Cara Kerja dan Teknik Pengumpulan Data ................................... 49

3.2.4 Analisis Data .................................................................................. 49

3.2.5 Tempat dan Waktu Penelitian ........................................................ 52

3.2.5.1 Tempat penelitian ................................................................ 52

3.2.5.2 Waktu Penelitian ................................................................. 52

3.2.6 Aspek Etik Penelitian ................................................................... 52

BAB IV HASIL PENELITIAN DAN PEMBAHASAN ............................. 54

4.1 Hasil Penelitian .......................................................................................... 54

4.1.1 Karakteristik Subjek Penelitian ....................................................... 54

4.1.2 Hubungan Hiperkapnia Dengan Mortalitas Pasien COVID-19 ...... 56

4.1.3 Hubungan Klasifikasi PaCO2 dengan Mortalitas Pasien COVID-19 57

4.1.4 Hubungan kadar PaCO2 48 jam dengan Mortalitas Hari ke-7 ........ 59

4.1.5 Hubungan Faktor Komorbid dengan Hiperkapnia pada Pasien dengan

Mortalitas Hari ke-7 ........................................................................ 61

4.1.6 Hubungan Nilai Pemeriksaan Penunjang dengan Mortalitas

Hari ke-7 .......................................................................................... 62

4.2 Uji Hipotesis .............................................................................................. 63

4.3 Pembahasan ................................................................................................ 64

4.3.1 Karakteristik Pasien Penelitian ........................................................ 64

4.3.2 Hiperkapnia dan Mortalitas Pasien COVID-19 ............................... 68

4.3.3 Temuan Tambahan Penelitian ......................................................... 71

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4.4 Keterbatasan Penelitian ................................................................................... 75

BAB V SIMPULAN DAN SARAN .............................................................. 76

5.1 Simpulan .................................................................................................... 76

5.1.1 Simpulan Umum.............................................................................. 76

5.1.2 Simpulan Khusus ............................................................................. 76

5.2 Saran .......................................................................................................... 77

5.2.1 Saran Akademis ............................................................................... 77

5.2.2 Saran Praktis .................................................................................... 77

DAFTAR PUSTAKA ..................................................................................... 78

LAMPIRAN.................................................................................................... 83

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 DAFTAR TABEL

Tabel 3.1 Definisi operasional penelitian ........................................................ 48

Tabel 4.1 Karakteristik Pasien ......................................................................... 55

Tabel 4.2 Hubungan Hiperkapnia Dengan Mortalitas Hari ke-7 ..................... 56

Tabel 4.3 Hubungan Hiperkapnia Dengan Mortalitas Hari ke-28 ................... 57

Tabel 4.4 Hubungan Klasifikasi PaCO2 dengan Mortalitas Hari ke-7 ............ 58

Tabel 4.5 Hubungan Klasifikasi PaCO2 dengan Mortalitas Hari ke-28 .......... 59

Tabel 4.6 Hubungan kadar PaCO2 48 jam perawatan dengan Mortalitas

Hari ke-7 .......................................................................................... 60

Tabel 4.7 Hubungan Faktor Komorbid dengan Hiperkapnia pada Kelompok

Pasien dengan Mortalitas Hari ke-7 ................................................ 62

Tabel 4.8 Perbandingan Nilai Pemeriksaan Penunjang dengan Mortalitas

Hari ke-7 .......................................................................................... 63

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 DAFTAR GAMBAR

Gambar 2.1 Struktur Coronavirus .................................................................... 12

Gambar 2.2 Immunopatogenesis pada COVID-19 .......................................... 16

Gambar 2.3 Patofisiologi pada COVID-19 ...................................................... 17

Gambar 2.4 Protokol Terapi Oksigen dan Ventilasi ARDS COVID-19 ......... 19

Gambar 2.5 Efek Fisiologis dari Hiperkapnia ................................................. 31

Gambar 2.6 Skema kerangka berfikir .............................................................. 42

Gambar 3.1 Alur Penelitian ............................................................................. 53

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 DAFTAR LAMPIRAN

Lampiran 1. Surat Persetujuan Etik (Ethical Approval) dari Komite Etik

Penelitian Kesehatan RSUP Dr. Hasan Sadikin Bandung .......... 83

Lampiran 2. Surat Izin Penelitian .................................................................... 84

Lampiran 3. Data Subjek Penelitian ................................................................ 86

Lampiran 4. SPSS ............................................................................................ 92

Lampiran 5. Daftar Riwayat Hidup.................................................................. 107

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 DAFTAR SINGKATAN

ACP : Acute Cor Pulmonale

ALI : Acute Lung Injury

ARDS : Acute Respiratory Distress Syndrome

ASA : American Society of Anesthesiologists

CARDS : COVID-19 dengan ARDS

CDC : Centers for Disease Control and Prevention

CFR : Case Fatality Rate

CO2 : Karbon dioksida

COVID-19 : Coronavirus Disease 2019

ICU : Intensive care unit

KKMMD : Kedaruratan Kesehatan Masyarakat yang Meresahkan Dunia

LPV : Lung-protective ventilation

MERS : Middle East Respiratory Syndrome

mPAP : Mean Pulmonary Arterial Pressure

PA : Pulmonary Artery

PaCO2 : Tekanan parsial karbon dioksida arteri

PCO2 : Tekanan parsial karbon dioksida

PEEP : Positive End Expiratory Pressure

PHEIC : Public Health Emergency of International Concern

Ppao : Pulmonary artery occlusion pressure

PVR : Pulmonary Vascular Resistance

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RSUP : Rumah Sakit Umum Pusat

RV : Right Ventricle

SARS : Severe Acute Respiratory Syndrome

SARS-CoV-2 : Severe Acute Respiratory Syndrome Coronavirus 2

SVR : Systemic Vascular Resistance

TEE : Transesophageal Echocardiography

VCO2 : Carbon Dioxide Output

WHO : World Health Organization

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