Faktor risiko kejadian unplanned extubation pada pasien anak di pediatric intensive care unit: Sebuah tinjauan sistematis
DOI: https://doi.org/10.33024/hjk.v19i10.1939
Faktor Risiko Pasien Anak Pediatric Intensive Care Unit Unplanned Extubation
Abstract
Background: Introduction: Unplanned extubation (UE) is a common adverse event in the Pediatric Intensive Care Unit (PICU) and can lead to clinical deterioration, increased morbidity, and decreased quality of care. Despite various preventative measures, UE remains a challenge in pediatric intensive care.
Purpose: To synthesize current evidence on risk factors associated with unplanned extubation in pediatric patients to support the development of effective, evidence-based prevention strategies.
Method: A systematic literature search was conducted in Scopus, ProQuest, and PubMed databases for observational studies published in the past 15 years following PRISMA guidelines. The methodological quality of included studies was assessed using the Newcastle–Ottawa Scale (NOS). Narrative synthesis was used to summarize and integrate the study findings.
Results: Eleven observational studies met the inclusion criteria, with eight studies demonstrating a low risk of bias. The most consistent risk factors associated with UE were inadequate sedation and patient agitation. Other important risk factors include suboptimal endotracheal tube (ETT) fixation, high nurse-to-patient ratios, night shift care, and limited nursing experience. The relationship between patient age and UE risk has shown varying results across studies.
Conclusion: The incidence of unplanned extubation in pediatric patients in the PICU is multifactorial and influenced by patient factors, clinical conditions, the care environment, and equipment and procedures. Modifiable factors, such as sedation management, standardization of ETT fixation, and optimization of nursing resources, are the most potential targets for intervention. UE significantly impacts the quality of care, particularly the quality of nursing care, due to variations in the preventive interventions implemented. Therefore, implementing a best-practice-based prevention bundle is crucial to reducing UE rates in the PICU.
Keywords: Pediatric Intensive Care Unit; Pediatric Patients; Risk Factors; Unplanned Extubation.
Pendahuluan: Unplanned extubation (UE) merupakan kejadian tidak diinginkan yang sering terjadi di Pediatric Intensive Care Unit (PICU) dan dapat menyebabkan penurunan kondisi klinis pasien, peningkatan morbiditas, serta penurunan mutu pelayanan. Meskipun berbagai upaya pencegahan telah dilakukan, kejadian UE masih menjadi tantangan dalam perawatan intensif anak.
Tujuan: Untuk mensintesis bukti terkini mengenai faktor-faktor risiko yang berhubungan dengan kejadian unplanned extubation pada pasien anak guna mendukung pengembangan strategi pencegahan yang efektif dan berbasis bukti.
Metode: Pencarian literatur sistematis dilakukan pada basis data Scopus, ProQuest, dan PubMed terhadap studi observasional yang dipublikasikan dalam 15 tahun terakhir dengan mengikuti pedoman PRISMA. Kualitas metodologis studi yang diinklusi dinilai menggunakan Newcastle–Ottawa Scale (NOS). Sintesis naratif digunakan untuk merangkum dan mengintegrasikan temuan penelitian.
Hasil: Sebanyak 11 studi observasional memenuhi kriteria inklusi, dengan 8 studi menunjukkan risiko bias yang rendah. Faktor risiko yang paling konsisten terkait dengan kejadian UE adalah sedasi yang tidak adekuat dan agitasi pasien. Faktor risiko penting lainnya meliputi fiksasi endotracheal tube (ETT) yang tidak optimal, rasio perawat–pasien yang tinggi, perawatan pada shift malam, serta pengalaman perawat yang terbatas. Hubungan antara usia pasien dan risiko UE menunjukkan hasil yang bervariasi antar penelitian.
Simpulan: Kejadian unplanned extubation pada pasien anak di PICU bersifat multifaktorial dan dipengaruhi oleh faktor pasien, kondisi klinis, lingkungan perawatan, serta aspek alat dan prosedur. Faktor-faktor yang dapat dimodifikasi, seperti manajemen sedasi, standarisasi fiksasi ETT, dan optimalisasi sumber daya keperawatan, merupakan target intervensi yang paling potensial. Kejadian UE berdampak signifikan terhadap mutu pelayanan, khususnya mutu asuhan keperawatan, akibat variasi intervensi pencegahan yang diterapkan. Oleh karena itu, implementasi bundle pencegahan berbasis praktik terbaik sangat penting untuk menurunkan angka kejadian UE di PICU.
Kata Kunci: Faktor Risiko; Pasien Anak; Pediatric Intensive Care Unit; Unplanned Extubation.
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