Daftar Pustaka

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PENINGKATAN FUNGSI VENTILASI OKSIGENASI PARU \line\tab \up0 \expndtw-
5\charscalex100 PADA KLIEN PASCA VENTILASI MEKANIK \line \tab \up0 \expndtw-
5\charscalex100 DENGAN \ul0\nosupersub\cf5\f6\fs28 DEEP BREATHING EXERCISE
\par\pard\ql \li3974\sb243\sl-253\slmult0 \up0 \expndtw-4\charscalex100
\ul0\nosupersub\cf6\f7\fs24 Priyanto\ul0\super\cf7\f8\fs21\ul0\super\cf7\f8\fs20 1,
2*\ul0\nosupersub\cf6\f7\fs24 , Dewi
Irawaty\ul0\super\cf7\f8\fs21\ul0\super\cf7\f8\fs20 3\ul0\nosupersub\cf6\f7\fs24 ,
Luknis Sabri\ul0\super\cf7\f8\fs21\ul0\super\cf7\f8\fs20 4 \par\pard\ql
\li2145\sb206\sl-230\slmult0 \up0 \expndtw-2\charscalex100
\ul0\nosupersub\cf8\f9\fs20 1. Program Studi Ilmu Keperawatan STIKES Ngudi Waluyo
Ungaran, Semarang 50513, Indonesia \par\pard\ql \li2212\sb1\sl-193\slmult0 \up0
\expndtw-2\charscalex100 2. Program Magister Fakultas Ilmu Keperawatan Universitas
Indonesia, Depok 16424, Indonesia \par\pard\ql \li2966\sb8\sl-193\slmult0 \up0
\expndtw-2\charscalex100 3. Fakultas Ilmu Keperawatan Universitas Indonesia, Depok
16424, Indonesia \par\pard\ql \li2798\sb8\sl-193\slmult0 \up0 \expndtw-
3\charscalex100 4. Fakultas Kesehatan Masyarakat Universitas Indonesia, Depok
16424, Indonesia \par\pard\ql \li4588\sb0\sl-240\slmult0
\par\pard\ql\li4588\sb29\sl-240\slmult0 \up0 \expndtw-4\charscalex100
\ul0\nosupersub\cf9\f10\fs20 *Email: priyanto_araaf@yahoo.co.id \par\pard\ql
\li5769\sb0\sl-230\slmult0 \par\pard\ql\li5769\sb0\sl-230\slmult0
\par\pard\ql\li5769\sb29\sl-230\slmult0 \up0 \expndtw-3\charscalex100
\ul0\nosupersub\cf10\f11\fs20 Abstrak \par\pard\qj \li1080\ri761\sb195\sl-
200\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf9\f10\fs20 Deep
breathing exercise\ul0\nosupersub\cf8\f9\fs20 (DBE) merupakan latihan aktifitas
paru dengan teknik nafas dalam dan batuk efektif untuk meningkat-\line \up0
\expndtw0\charscalex102 kan ventilasi oksigenasi. Tujuan penelitian untuk
mengidentifikasi pengaruh DBE terhadap fungsi ventilasi oksigenasi \line \up0
\expndtw-1\charscalex100 (VO) paru pada klien paska ventilasi mekanik. Penelitian
ini menggunakan kuasi\ul0\nosupersub\cf9\f10\fs20 \ul0\nosupersub\cf8\f9\fs20
eksperimen \ul0\nosupersub\cf9\f10\fs20
nonequivalent\ul0\nosupersub\cf8\f9\fs20 \ul0\nosupersub\cf9\f10\fs20 control
group \line \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf8\f9\fs20
yang\ul0\nosupersub\cf9\f10\fs20 \ul0\nosupersub\cf8\f9\fs20 melibatkan 26
responden untuk kelompok intervensi dan kontrol yang diseleksi dengan metode
\ul0\nosupersub\cf9\f10\fs20 consecutive sampling\ul0\nosupersub\cf8\f9\fs20 .
\line \up0 \expndtw-1\charscalex100 Kelompok intervensi melakukan DBE selama lima
hari. Instrumen yang digunakan \ul0\nosupersub\cf9\f10\fs20 bedside
monitor\ul0\nosupersub\cf8\f9\fs20 , \ul0\nosupersub\cf9\f10\fs20 peak
flowmeter,\ul0\nosupersub\cf8\f9\fs20 dan \line \up0 \expndtw-2\charscalex100
\ul0\nosupersub\cf9\f10\fs20 pulse oximetry\ul0\nosupersub\cf8\f9\fs20 . Penelitian
dilaksanakan di ICU rumah sakit di wilayah Semarang. Hasil penelitian menunjukkan
ada perbeda-\line \up0 \expndtw0\charscalex100 an bermakna fungsi VO paru setelah
melakukan DBE pada hari ke-4 dan 5 (p= 0,018, p= 0,004, \u945?= 0,05). Penelitian
ini \line \up0 \expndtw0\charscalex105 merekomendasikan penerapan DBE dalam praktik
keperawatan kritis untuk meningkatkan pelayanan keperawatan. \line \up0 \expndtw-
2\charscalex100 Profesionalisme keperawatan ditunjukkan melalui intervensi
keperawatan yang bersifat mandiri terutama pada penanganan \line \up0 \expndtw-
3\charscalex100 klien \ul0\nosupersub\cf9\f10\fs20 post\ul0\nosupersub\cf8\f9\fs20
ventilasi mekanik. \par\pard\ql \li1080\sb176\sl-230\slmult0 \up0 \expndtw-
2\charscalex100 \ul0\nosupersub\cf10\f11\fs20 Kata kunci:
\ul0\nosupersub\cf9\f10\fs20 deep breathing exercise \ul0\nosupersub\cf8\f9\fs20
(DBE), fungsi ventilasi oksigenasi (VO) paru, \ul0\nosupersub\cf9\f10\fs20
post\ul0\nosupersub\cf8\f9\fs20 ventilasi mekanik \par\pard\ql \li5774\sb170\sl-
230\slmult0 \up0 \expndtw-4\charscalex100 \ul0\nosupersub\cf11\f12\fs20 Abstract
\par\pard\qj \li1080\ri761\sb195\sl-200\slmult0 \up0 \expndtw-2\charscalex100
\ul0\nosupersub\cf9\f10\fs20 Deep breathing exercise (DBE) is pulmonary activities
with deep breath technique and effective cough to restore oxygenation \up0
\expndtw0\charscalex100 ventilation. The purpose of research was to identify the
influence of deep breathing exercises on ventilation oxygenation \up0 \expndtw-
2\charscalex100 pulmonary function on client with post mechanical ventilation. This
research used quasy experiment nonequivalent\ul0\nosupersub\cf8\f9\fs20
\ul0\nosupersub\cf9\f10\fs20 control \up0 \expndtw0\charscalex100 group, involving
26 respondents for each intervention and control group who selected by consecutive
sampling method. \up0 \expndtw-2\charscalex100 Bedside monitor, peak flow meter,
pulse oximetry were instrument used. The research was conducted on ICU of hospital
in \up0 \expndtw-3\charscalex100 Semarang district. The results showed significant
difference ventilation oxygenation (VO) pulmonary function after conduc\up0
\expndtw-4\charscalex100 ting deep breathing exercise (DBE) on day 4 and 5
(p=0,018, p=0,004, \u945?= 0,05). Recommendations of this study as a reference \up0
\expndtw-3\charscalex100 to improve the standard of nursing care through the
application of DBE in the practice of critical care nursing. Implications \up0
\expndtw-3\charscalex100 for service quality improvement through an independent
professional nursing care. \par\pard\ql \li1080\sb176\sl-230\slmult0 \up0 \expndtw-
3\charscalex100 \ul0\nosupersub\cf11\f12\fs20 Keywords:
\ul0\nosupersub\cf9\f10\fs20 deep breathing exercises (DBE), ventilation
oxygenation (VO) pulmonary function, post mechanical
ventilation\par\pard\sect\sectd\sbknone\cols2\colno1\colw6247\colsr160\colno2\colw5
693\colsr160\ql \li1080\sb0\sl-322\slmult0 \par\pard\ql \li1080\sb0\sl-
322\slmult0 \par\pard\ql \li1080\sb165\sl-322\slmult0 \up0 \expndtw-3\charscalex100
\ul0\nosupersub\cf1\f2\fs28 Pendahuluan\par\pard\qj \li1080\ri323\sb131\sl-
280\slmult0 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf2\f3\fs24 Kegagalan
pernapasan merupakan indikasi yang \line \up0 \expndtw0\charscalex105 paling umum
untuk dirawat di unit perawatan \line \up0 \expndtw-1\charscalex100
intensif\ul0\nosupersub\cf3\f4\fs24 \ul0\nosupersub\cf2\f3\fs24 (ICU) rumah sakit.
Kegagalan pernapas-\line \up0 \expndtw0\charscalex107 an merupakan kondisi
ketidakmampuan paru \line \up0 \expndtw0\charscalex108 menjaga keseimbangan atau
\ul0\nosupersub\cf3\f4\fs24 homeostatis\ul0\nosupersub\cf2\f3\fs24
O\ul0\sub\cf4\f5\fs21 2 \line \up0 \expndtw0\charscalex105
\ul0\nosupersub\cf2\f3\fs24 dan CO\ul0\sub\cf4\f5\fs21 2\ul0\nosupersub\cf2\f3\fs24
di dalam tubuh serta ketidakmampu-\line \up0 \expndtw0\charscalex104 an paru
menyediakan O\ul0\sub\cf4\f5\fs21 2\ul0\nosupersub\cf2\f3\fs24 yang cukup atau
me-\line \up0 \expndtw0\charscalex106 ngurangi tumpukan CO\ul0\sub\cf4\f5\fs21
2\ul0\nosupersub\cf2\f3\fs24 di dalam tubuh. Me-\line \up0 \expndtw-
4\charscalex100 nurut Ignatavicius dan Workman (2006), kegagal-\line \up0
\expndtw0\charscalex107 an pernapasan lanjut dapat didefinisikan
se-\par\pard\column \ql \li6407\sb0\sl-276\slmult0 \par\pard\ql \li6407\sb0\sl-
276\slmult0 \par\pard\ql \li6407\sb0\sl-276\slmult0 \par\pard\ql \li21\sb92\sl-
276\slmult0 \up0 \expndtw0\charscalex107 bagai kegagalan ventilasi dan atau
kegagalan\par\pard\ql \li21\sb2\sl-276\slmult0 \up0 \expndtw-3\charscalex100
oksigenasi karena berbagai faktor penyebab.\par\pard\qj \li6407\sb0\sl-
279\slmult0 \par\pard\qj \li21\ri839\sb5\sl-279\slmult0 \up0
\expndtw0\charscalex106 Pemberian bantuan pernapasan dengan pe-\line \up0
\expndtw0\charscalex106 masangan ventilasi mekanik dapat membantu \up0
\expndtw0\charscalex105 ventilasi paru untuk meningkatkan oksigenasi \up0 \expndtw-
4\charscalex100 dan mencegah kerusakan paru. Menurut Smeltzer, \up0
\expndtw0\charscalex107 et al. \up0 \expndtw0\charscalex103 (2008) bantuan tersebut
dilakukan untuk\par\pard\qj \li21\ri844\sb5\sl-278\slmult0 \up0 \expndtw-
2\charscalex100 memenuhi kebutuhan oksigen, mengurangi kerja \up0
\expndtw0\charscalex107 pernapasan, dan meningkatkan oksigenasi ke \up0 \expndtw-
3\charscalex100 jaringan atau mengoreksi asidosis pernapasan.
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\ul0\nosupersub\cf12\f13\fs16 Jurnal Keperawatan Indonesia, Volume 14, No. 1, Maret
2011; hal 23 -
30\par\pard\sect\sectd\sbknone\cols2\colno1\colw6247\colsr160\colno2\colw5693\colsr
160\ql \li1080\sb0\sl-276\slmult0 \par\pard\ql \li1080\sb226\sl-276\slmult0 \up0
\expndtw0\charscalex104 \ul0\nosupersub\cf2\f3\fs24 Penggunaan ventilasi mekanik
menurut survai\par\pard\qj \li1080\ri325\sb0\sl-280\slmult0 \up0
\expndtw0\charscalex102 multinasional terhadap 5000 klien di Eropa di-\line
\up0 \expndtw0\charscalex107 gunakan pada kasus gagal nafas akut (69%), \up0
\expndtw-3\charscalex100 koma (17%), gagal nafas kronis (13%) dan gang-\line
\up0 \expndtw0\charscalex100 guan neuromuskuler (2%) (Rodriquez, Dojat, & \up0
\expndtw0\charscalex107 Brochard, 2005). Bantuan pernapasan harus \up0
\expndtw0\charscalex104 diberikan secara adekuat sesuai indikasi untuk \up0
\expndtw0\charscalex106 mencegah kelemahan otot pernapasan karena \up0 \expndtw-
3\charscalex100 diistirahatkan (Smeltzer et al, 2008).\par\pard\qj \li1080\sb0\sl-
\expndtw0\charscalex105 Penyapihan (\ul0\nosupersub\cf3\f4\fs24
weaning\ul0\nosupersub\cf2\f3\fs24 ) ventilasi mekanik di-\line \up0
\expndtw0\charscalex108 lakukan jika sudah ada kemampuan bernafas \up0 \expndtw-
3\charscalex100 spontan. Hal ini menjadi salah satu alasan dilaku-\line \up0
\expndtw-2\charscalex100 kannya perbaikan fungsi pernapasan (Rodriquez, \up0
\expndtw0\charscalex101 Dojat, & Brochard, 2005). Upaya tersebut di-\line
\up0 \expndtw0\charscalex100 lakukan dengan latihan pernapasan untuk mem-\line \up0
\expndtw0\charscalex108 perbaiki fungsi ventilasi dan oksigenasi paru \up0
\expndtw-4\charscalex100 (Ignatavicius & Workman, 2006).\par\pard\qj
\li1080\sb0\sl-280\slmult0 \par\pard\qj \li1080\ri325\sb32\sl-280\slmult0 \up0
\expndtw0\charscalex105 Beberapa jenis latihan pernapasan yang dapat \line \up0
\expndtw0\charscalex104 dianjurkan untuk pemulihan paru adalah
\ul0\nosupersub\cf3\f4\fs24 Deep \line \up0 \expndtw0\charscalex106 breathing
exercises \ul0\nosupersub\cf2\f3\fs24 (DBE ), \ul0\nosupersub\cf3\f4\fs24
diaphragmatic \line \up0 \expndtw-6\charscalex100
exercise\ul0\nosupersub\cf2\f3\fs24 , tehnik \ul0\nosupersub\cf3\f4\fs24 pursed lip
breathing\ul0\nosupersub\cf2\f3\fs24 , dan \ul0\nosupersub\cf3\f4\fs24 incentive
\line \up0 \expndtw0\charscalex100 spirometer\ul0\nosupersub\cf2\f3\fs24
(Smeltzer, et al, 2008). Westerdahl, \line \up0 \expndtw0\charscalex103 et al
\up0 \expndtw0\charscalex107 (2005) meneliti klien yang melakukan\par\pard\qj
\li1080\ri322\sb0\sl-280\slmult0 \up0 \expndtw-2\charscalex100 DBE sebanyak 30
kali/ jam ketika terjaga setelah \line \up0 \expndtw0\charscalex102 1 (satu) jam
paska ekstubasi post CABG, pada \line \up0 \expndtw0\charscalex105 hari keempat
menunjukkan jumlah \ul0\nosupersub\cf3\f4\fs24 atelektasis \line \up0 \expndtw-
6\charscalex100 \ul0\nosupersub\cf2\f3\fs24 lebih kecil dan terjadi peningkatan
fungsi ventilasi.\par\pard\qj \li1080\sb0\sl-279\slmult0 \par\pard\qj
\li1080\ri317\sb31\sl-279\slmult0 \up0 \expndtw-6\charscalex100
DBE\ul0\nosupersub\cf3\f4\fs24 \ul0\nosupersub\cf2\f3\fs24 terdiri atas 10 kali
napas dalam, dibagi dalam \up0 \expndtw0\charscalex102 3 (tiga) stase selama
setengah jam dengan jeda \up0 \expndtw0\charscalex105 batuk efektif untuk
memobilisasi sekresi. Bila \up0 \expndtw0\charscalex101 mungkin klien melakukan
latihan dengan posisi \up0 \expndtw-6\charscalex100 duduk. Menurut Ignatavicius dan
Workman (2006) \up0 \expndtw-4\charscalex100 setelah ekstubasi
\ul0\nosupersub\cf3\f4\fs24 weaning\ul0\nosupersub\cf2\f3\fs24 , klien dianjurkan
untuk \up0 \expndtw-5\charscalex100 segera berlatih nafas dalam (DBE) setiap
setengah \up0 \expndtw-3\charscalex100 jam dan berlatih duduk
\ul0\nosupersub\cf3\f4\fs24 semifowler\ul0\nosupersub\cf2\f3\fs24 .\par\pard\qj
\expndtw-3\charscalex100 Peran perawat ICU diantaranya memantau keluh-\line \up0
\expndtw-5\charscalex100 an sesak nafas, kemampuan ekspansi dada, jumlah \line \up0
\expndtw0\charscalex103 pernapasan, mengamati keteraturan dan karak-\line \up0
\expndtw0\charscalex102 teristik pernapasan serta oksigenasi ke jaringan \line \up0
\expndtw-2\charscalex100 (Ignatavicius & Workman, 2006). Tugas penting \line
\up0 \expndtw-5\charscalex100 lainnya penanganan \ul0\nosupersub\cf3\f4\fs24
emergency\ul0\nosupersub\cf2\f3\fs24 , monitoring fungsi \line \up0
\expndtw0\charscalex102 pernapasan melalui observasi fisik dan
\ul0\nosupersub\cf3\f4\fs24 bedside\par\pard\column \ql \li6407\sb0\sl-
276\slmult0 \par\pard\ql \li21\sb226\sl-276\slmult0 \up0 \expndtw0\charscalex109
monitor\ul0\nosupersub\cf2\f3\fs24 , edukasi serta pengawasan
terhadap\par\pard\ql \li21\sb2\sl-276\slmult0 \up0 \expndtw-3\charscalex100
perbaikan fungsi ventilasi paru.\par\pard\qj \li6407\sb0\sl-279\slmult0
\par\pard\qj \li21\ri837\sb5\sl-279\slmult0 \up0 \expndtw0\charscalex108 DBE
merupakan upaya yang dianggap dapat \line \up0 \expndtw0\charscalex104 meningkatkan
fungsi paru khususnya ventilasi \line \up0 \expndtw0\charscalex102 oksigenasi, dan
mencegah kegagalan pernapas-\line \up0 \expndtw0\charscalex107 an berulang serta
risiko \ul0\nosupersub\cf3\f4\fs24 atelektasis\ul0\nosupersub\cf2\f3\fs24 paru
post \line \up0 \expndtw-4\charscalex100 ventilasi mekanik. Tujuan penelitian untuk
meng-\line \up0 \expndtw0\charscalex108 identifikasi pengaruh DBE terhadap
fungsi \line \up0 \expndtw0\charscalex100 ventilasi oksigenasi (VO) paru pada klien
paska \line \up0 \expndtw-3\charscalex100 ventilasi mekanik\par\pard\ql
\li6407\sb0\sl-322\slmult0 \par\pard\ql \li21\sb70\sl-322\slmult0 \up0 \expndtw-
3\charscalex100 \ul0\nosupersub\cf1\f2\fs28 Metode\par\pard\qj
\li21\ri835\sb193\sl-280\slmult0 \up0 \expndtw0\charscalex100
\ul0\nosupersub\cf2\f3\fs24 Penelitian kuasi eksperimen dengan pendekatan \line
\up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf3\f4\fs24 non
equivalent\ul0\nosupersub\cf2\f3\fs24 \ul0\nosupersub\cf3\f4\fs24 control
group\ul0\nosupersub\cf2\f3\fs24 ini menggunakan \line \up0 \expndtw-
6\charscalex100 kelompok intervensi dan kontrol. Kedua kelompok \line \up0
\expndtw0\charscalex110 memperoleh perawatan dan tindakan medik \line \up0
\expndtw0\charscalex101 sesuai prosedur RS. Intervensi dalam penelitian \line
\up0 \expndtw0\charscalex110 ini adalah penggunaan DBE modifikasi dari \line
\up0 \expndtw0\charscalex107 Westerdahl, et al. (2005), Ignatavicius dan
\line \up0 \expndtw0\charscalex105 Workman (2006), dan Anne, Pippin, dan Hill
\line \up0 \expndtw0\charscalex107 (2009). DBE\ul0\nosupersub\cf3\f4\fs24
\ul0\nosupersub\cf2\f3\fs24 meliputi 30 kali latihan nafas \line \up0 \expndtw-
2\charscalex100 dalam selama 30 menit dengan diselingi istirahat \line \up0
\expndtw0\charscalex100 30 menit, sebanyak 6 kali sehari pada siang hari \line \up0
\expndtw-3\charscalex100 selama lima hari.\par\pard\qj \li6407\sb0\sl-
\expndtw0\charscalex106 Penelitian ini dilaksanakan selama delapan di \line \up0
\expndtw0\charscalex100 ICU beberapa rumah sakit di Semarang. Sampel \line \up0
\expndtw0\charscalex101 penelitian menggunakan jumlah minimal peng-\line \up0
\expndtw0\charscalex112 hitungan rumus uji beda dua proporsi yaitu \line \up0
\expndtw-5\charscalex100 sebanyak 26 responden (masing-masing kelompok \line
\up0 \expndtw0\charscalex102 13 orang) dengan teknik \ul0\nosupersub\cf3\f4\fs24
consecutive sampling. \line \up0 \expndtw0\charscalex100
\ul0\nosupersub\cf2\f3\fs24 Penentuan kelompok dengan \ul0\nosupersub\cf3\f4\fs24
systematic random \line \up0 \expndtw-3\charscalex100 sampling.\par\pard\qj
\expndtw0\charscalex107 \ul0\nosupersub\cf2\f3\fs24 Kriteria inklusi responden:
usia dewasa, post \line \up0 \expndtw0\charscalex106 ventilasi mekanik paska
ekstubasi 1 jam, ada \line \up0 \expndtw0\charscalex105 riwayat kegagalan
pernapasan, dapat bernafas \line \up0 \expndtw0\charscalex100 spontan, bersedia
menjadi responden dan meng-\line \up0 \expndtw-2\charscalex100 erti instruksi.
Kriteria eksklusi meliputi: keadaan \line \up0 \expndtw-5\charscalex100 umum sangat
lemah/ \ul0\nosupersub\cf3\f4\fs24 bedrest \ul0\nosupersub\cf2\f3\fs24 total; ada
nyeri berat; \line \up0 \expndtw0\charscalex105 mendapat terapi obat depresan
susunan syaraf \line \up0 \expndtw-3\charscalex100 pusat; ada trakeostomi; ada
riwayat pembedahan, \line \up0 \expndtw0\charscalex107 dan ada riwayat ventilasi
mekanik program \line \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf3\f4\fs24
maintenance\ul0\nosupersub\cf2\f3\fs24 .
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450014514500145145007ffd9}}}}}\pard\sb0\sl-240{\bkmkstart Pg3}{\bkmkend
Pg3}\par\pard\sect\sectd\sbknone\cols2\colno1\colw10711\colsr160\colno2\colw1229\co
lsr160\ql \li1089\sb0\sl-184\slmult0 \par\pard\ql \li1089\sb0\sl-184\slmult0
\par\pard\ql \li1089\sb0\sl-184\slmult0 \par\pard\ql \li1089\sb0\sl-184\slmult0
\par\pard\ql \li1089\sb15\sl-184\slmult0 \up0 \expndtw0\charscalex100
\ul0\nosupersub\cf12\f13\fs16 Peningkatan fungsi ventilasi oksigenasi paru melalui
deep breathing excercise (Priyanto, Dewi Irawaty, Luknis Sabri)\par\pard\column \ql
\li10871\sb0\sl-276\slmult0 \par\pard\ql \li10871\sb0\sl-276\slmult0
\ul0\nosupersub\cf2\f3\fs24
\expndtw-4\charscalex100 Fungsi Ventilasi Oksigen (VO) paru
diidentifikasi\par\pard\qj \li1080\ri323\sb0\sl-280\slmult0 \up0 \expndtw-
2\charscalex100 melalui pola pernapasan, kapasitas vital paru dan \up0
\expndtw0\charscalex107 saturasi oksigen. Instrumen penelitian meng-\line \up0
\expndtw0\charscalex110 gunakan \ul0\nosupersub\cf3\f4\fs24 bed side
monitor\ul0\nosupersub\cf2\f3\fs24 , \ul0\nosupersub\cf3\f4\fs24 peak flow
meter, \up0 \expndtw-4\charscalex100 \ul0\nosupersub\cf2\f3\fs24
dan\ul0\nosupersub\cf3\f4\fs24 pulse oximetry\ul0\nosupersub\cf2\f3\fs24
.\par\pard\qj \li1080\sb0\sl-279\slmult0 \par\pard\qj \li1080\ri321\sb60\sl-
279\slmult0 \up0 \expndtw0\charscalex107 Analisis data menggunakan uji
\ul0\nosupersub\cf3\f4\fs24 Wilcoxon \ul0\nosupersub\cf2\f3\fs24 dan \up0 \expndtw-
2\charscalex100 \ul0\nosupersub\cf3\f4\fs24 Mann-Whitney\ul0\nosupersub\cf2\f3\fs24
untuk mengidentifikasi ada tidak-\line \up0 \expndtw0\charscalex101 nya perbedaan
fungsi ventilasi oksigenasi paru. \up0 \expndtw-3\charscalex100
\ul0\nosupersub\cf3\f4\fs24 Spearman correlation \ul0\nosupersub\cf2\f3\fs24
dan\ul0\nosupersub\cf3\f4\fs24 Fisher exact test\ul0\nosupersub\cf2\f3\fs24 untuk
\up0 \expndtw-3\charscalex100 mengidentifikasi faktor perancu.\par\pard\ql
\li1080\sb0\sl-322\slmult0 \par\pard\ql \li1080\sb141\sl-322\slmult0 \up0 \expndtw-
2\charscalex100 \ul0\nosupersub\cf1\f2\fs28 Hasil\par\pard\ql \li1080\sb196\sl-
276\slmult0 \up0 \expndtw-4\charscalex100 \ul0\nosupersub\cf6\f7\fs24 Fungsi
Ventilasi Oksigenasi Paru\par\pard\qj \li1080\ri318\sb164\sl-279\slmult0 \up0
\expndtw0\charscalex107 \ul0\nosupersub\cf2\f3\fs24 Ada peningkatan rerata fungsi
ventilasi oksi-\line \up0 \expndtw0\charscalex100 genasi (VO) paru hari ke-2, 3, 4,
dan 5 pada ke-\line \up0 \expndtw0\charscalex106 dua kelompok dengan peningkatan
kelompok \line \up0 \expndtw-2\charscalex100 intervensi lebih tinggi. Pada kelompok
intervensi \line \up0 \expndtw-1\charscalex100 mulai hari ke-3 fungsi ventilasi
oksigenasi (VO) \line \up0 \expndtw0\charscalex104 paru baik (mean > 9,15),
sedangkan pada ke-\line \up0 \expndtw-1\charscalex100 lompok kontrol sampai hari
ke-5 fungsi ventilasi \line \up0 \expndtw-3\charscalex100 oksigenasi (VO) paru
kurang baik (mean < 9).\par\pard\column \ql \li6407\sb0\sl-276\slmult0 \par\pard\ql
\li21\sb207\sl-276\slmult0 \up0 \expndtw-1\charscalex100 Ada perbedaan bermakna
antara fungsi VO paru\par\pard\qj \li21\ri841\sb0\sl-280\slmult0 \up0 \expndtw-
6\charscalex100 antara 1 (satu) jam paska ekstubasi dengan hari ke-\line \up0
\expndtw-2\charscalex100 3, 4 dan 5 setelah intervensi (p= 0,007; p= 0,002;
\line \up0 \expndtw-8\charscalex100 p= 0,005, \u945?= 0,05), tetapi tidak ada
perbedaan yang \line \up0 \expndtw-3\charscalex100 bermakna pada hari ke-2 (p=
0,191, \u945?= 0,05).\par\pard\qj \li6407\sb0\sl-279\slmult0 \par\pard\qj
\li21\ri838\sb8\sl-279\slmult0 \up0 \expndtw-1\charscalex100 Ada perbedaan bermakna
antara fungsi VO paru \line \up0 \expndtw-2\charscalex100 antara 1 jam paska
ekstubasi dengan hari ke-2, 3, \line \up0 \expndtw-8\charscalex100 4 dan 5 pada
kontrol (p= 0,020; p= 0,023; p= 0,009; \line \up0 \expndtw-8\charscalex100 p=
0,035, \u945?= 0,05). Ada perbedaan bermakna antara \line \up0
\expndtw0\charscalex102 fungsi VO paru hari ke-4 dan 5 pada kelompok \line \up0
\expndtw0\charscalex102 intervensi dibandingkan kontrol (p= 0,018; p= \line
\up0 \expndtw0\charscalex101 0,004, \u945?= 0,05), tetapi tidak ada perbedaan
ber-\line \up0 \expndtw0\charscalex103 makna hari ke-2 dan 3 (p= 0,691; p=
0,063, \u945?= \line \up0 \expndtw-4\charscalex100 0,05) (grafik 1).\par\pard\ql
\ul0\nosupersub\cf6\f7\fs24 Pola Pernapasan\par\pard\qj \li21\ri842\sb139\sl-
280\slmult0 \up0 \expndtw0\charscalex101 \ul0\nosupersub\cf2\f3\fs24 Ditemukan
perbedaan bermakna pada pola per-\line \up0 \expndtw0\charscalex101 napasan hari
ke-4 dan 5 di kedua kelompok (p= \line \up0 \expndtw0\charscalex101 0,011; p=
0,027, \u945?= 0,05). Mulai hari ke-2 pada \line \up0 \expndtw0\charscalex101 kedua
kelompok menunjukkan pola pernapasan \line \up0 \expndtw-6\charscalex100 efektif
(skor> 3). Pada hari ke-4 dan 5 pada kelom-\line \up0 \expndtw-4\charscalex100 pok
intervensi tidak mengalami perubahan karena \line \up0 \expndtw-3\charscalex100
fungsi VO paru telah efektif (lihat grafik 2). \par\pard\sect\sectd\sbknone \ql
\li4636\sb0\sl-230\slmult0 \par\pard\ql\li4636\sb180\sl-230\slmult0 \up0 \expndtw-
3\charscalex100 \ul0\nosupersub\cf8\f9\fs20 Grafik 1. Fungsi VO Paru Responden
\par\pard\sect\sectd\fs24\paperw12240\paperh15840{\shp
10000\shplid3
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a28a00fffd9}}}}}\pard\sb0\sl-240{\bkmkstart Pg4}{\bkmkend
Pg4}\par\pard\li1123\sb0\sl-276\slmult0\par\pard\li1123\sb0\sl-
2011; hal 23 -
\expndtw-4\charscalex100 \ul0\nosupersub\cf6\f7\fs24 Kapasitas Vital
Paru\par\pard\qj \li1080\ri315\sb138\sl-280\slmult0 \up0 \expndtw-
7\charscalex100 \ul0\nosupersub\cf2\f3\fs24 Terdapat perbedaan bermakna antara
kapasitas vital \up0 \expndtw-7\charscalex100 paru pada hari ke-4 dan 5 pada
kelompok intervensi \up0 \expndtw0\charscalex102 dibandingkan kontrol (p= 0,021; p=
0,003, \u945?= \up0 \expndtw-8\charscalex100 0,05), tetapi ternyata nilai
kapasitas vital paru kedua \up0 \expndtw-4\charscalex100 kelompok tidak dapat
mencapai nilai normal yaitu \up0 \expndtw-3\charscalex100 > 400 mL/min (lihat
grafik 3).\par\pard\ql \li1080\sb0\sl-276\slmult0 \par\pard\ql \li1080\sb10\sl-
276\slmult0 \up0 \expndtw-3\charscalex100 \ul0\nosupersub\cf6\f7\fs24 Saturasi
O\ul0\sub\cf7\f8\fs21 2\ul0\nosupersub\cf6\f7\fs24 (SaO\ul0\sub\cf7\f8\fs21
2\ul0\nosupersub\cf6\f7\fs24 )\par\pard\qj \li1080\ri325\sb138\sl-280\slmult0
\up0 \expndtw-6\charscalex100 \ul0\nosupersub\cf2\f3\fs24 Tidak ditemukan perbedaan
bermakna antara SaO2 \up0 \expndtw0\charscalex100 pada hari ke-2, 3, 4 dan 5 pada
kedua kelompok \up0 \expndtw-3\charscalex100 (p= 0,915; 0,068; 0,670; 0,100, \u945?
= 0,05). Mulai 1 \up0 \expndtw-2\charscalex100 jam paska ekstubasi sampai hari ke-5
pada kedua \up0 \expndtw0\charscalex100 kelompok, Sa O\ul0\sub\cf4\f5\fs21
2\ul0\nosupersub\cf2\f3\fs24 telah mencapai nilai normal (> \up0 \expndtw-
4\charscalex100 97%) (lihat grafik 4).\par\pard\ql \li1080\sb242\sl-276\slmult0
\up0 \expndtw-4\charscalex100 \ul0\nosupersub\cf6\f7\fs24 Faktor
Perancu\par\pard\qj \li1080\ri323\sb144\sl-280\slmult0 \up0 \expndtw0\charscalex100
\ul0\nosupersub\cf2\f3\fs24 Tidak ditemukan pengaruh usia, IMT, kadar Hb \up0
\expndtw-4\charscalex100 dan jenis kelamin dengan fungsi VO paru (p= 0,1; \up0
\expndtw-5\charscalex100 p= 0,147; p= 0,151; p= 0,136; p= 0,131; p= 0,982; \up0
\expndtw-3\charscalex100 p= 0,614; 1,000, \u945?= 0,05).\par\pard\ql
\ul0\nosupersub\cf1\f2\fs28 Pembahasan\par\pard\qj \li1080\ri317\sb169\sl-
280\slmult0 \up0 \expndtw0\charscalex103 \ul0\nosupersub\cf2\f3\fs24 DBE merupakan
salah satu bentuk latihan per-\line \up0 \expndtw0\charscalex101 napasan yang
dilakukan dengan berbagai modi-\line \up0 \expndtw0\charscalex109 fikasi sesuai
dengan kebutuhan. DBE belum \line \up0 \expndtw0\charscalex100 banyak dikembangkan
dalam pelayanan kepera-\line \up0 \expndtw-4\charscalex100 watan intensif,
khususnya bagi klien post ventilasi\par\pard\column \ql \li6407\sb0\sl-
276\slmult0 \par\pard\ql \li21\sb226\sl-276\slmult0 \up0 \expndtw0\charscalex105
mekanik. Klien post ventilasi mekanik mem-\par\pard\qj \li21\ri837\sb0\sl-
280\slmult0 \up0 \expndtw-2\charscalex100 butuhkan kemampuan adaptasi terhadap
kemam-\line \up0 \expndtw-2\charscalex100 puan ventilasi untuk memberikan suplai
terhadap \line \up0 \expndtw0\charscalex106 kebutuhan O\ul0\sub\cf4\f5\fs21
2\ul0\nosupersub\cf2\f3\fs24 jaringan. Kemampuan ventilasi \line \up0 \expndtw-
4\charscalex100 didukung oleh \ul0\nosupersub\cf3\f4\fs24
compliance\ul0\nosupersub\cf2\f3\fs24 paru dan kekuatan otot \line \up0 \expndtw-
5\charscalex100 inspirator yang adekuat melalui DBE. Klien paska \line \up0
\expndtw-6\charscalex100 ventilasi mekanik perlu menerapkan latihan khusus \line
\up0 \expndtw0\charscalex102 tersebut sesuai kemampuan toleransi fisik yang
\line \up0 \expndtw-3\charscalex100 masih lemah.\par\pard\qj \li21\ri834\sb276\sl-
280\slmult0 \up0 \expndtw0\charscalex100 Adanya perbedaan yang bermakna antara
kedua \up0 \expndtw-6\charscalex100 kelompok pada fungsi VO paru antara 1 jam paska
\up0 \expndtw-1\charscalex100 ekstubasi dengan hari ke-2, 3, 4 dan 5 perawatan \up0
\expndtw0\charscalex107 paska ekstubasi. Hal ini menunjukkan bahwa \up0
\expndtw0\charscalex106 perawatan yang diterapkan di RS telah sesuai \up0
\expndtw0\charscalex105 standar dan berhasil meningkatkan fungsi VO \up0 \expndtw-
3\charscalex100 paru, walaupun masih termasuk dalam klasifikasi \up0 \expndtw-
3\charscalex100 kurang baik sampai hari ke-5.\par\pard\qj \li21\ri833\sb276\sl-
280\slmult0 \up0 \expndtw0\charscalex103 Beberapa tindakan yang telah diberikan
seperti \line \up0 \expndtw0\charscalex100 \ul0\nosupersub\cf3\f4\fs24
suctioning\ul0\nosupersub\cf2\f3\fs24 , oksigenasi nasal kanula, alih baring, \line
\up0 \expndtw-5\charscalex100 pemenuhan kebutuhan dasar lainnya seperti cairan
\line \up0 \expndtw-3\charscalex100 elektrolit, nutrisi, eliminasi, dan
\ul0\nosupersub\cf3\f4\fs24 personal hygiene \line \up0 \expndtw0\charscalex100
\ul0\nosupersub\cf2\f3\fs24 yang dilakukan oleh perawat selama ini menjadi \line
\up0 \expndtw-3\charscalex100 bagian dalam pelayanan asuhan keperawatan. Hal
\line \up0 \expndtw0\charscalex105 ini sejalan dengan Ignatavicius dan Workman
\line \up0 \expndtw-2\charscalex100 (2006), menerangkan bahwa pengawasan selama
\line \up0 \expndtw-5\charscalex100 perawatan paska ekstubasi juga perlu terus
dilaku-\line \up0 \expndtw0\charscalex101 kan untuk mencegah kejadian gagal
pernapasan \line \up0 \expndtw-6\charscalex100 berulang dan komplikasi lain yang
lebih kompleks. \par\pard\sect\sectd\sbknone \ql \li4617\sb222\sl-230\slmult0
\up0 \expndtw-4\charscalex100 \ul0\nosupersub\cf8\f9\fs20 Grafik 2. Pola Pernapasan
Responden \par\pard\sect\sectd\fs24\paperw12240\paperh15840{\shp
10000\shplid4
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14514005145140051451401fffd9}}}}}\pard\sb0\sl-240{\bkmkstart Pg5}{\bkmkend
\expndtw-1\charscalex100 Beberapa tindakan yang telah diterapkan selama\par\pard\qj
\li1080\ri316\sb0\sl-280\slmult0 \up0 \expndtw-4\charscalex100 ini, berdampak pada
peningkatan fungsi VO paru, \up0 \expndtw-5\charscalex100 walaupun sampai hari ke-5
pada kelompok kontrol \up0 \expndtw0\charscalex106 belum dapat mencapai fungsi VO
paru yang \up0 \expndtw-7\charscalex100 normal. Ada perbedaan bermakna antara
fungsi VO \up0 \expndtw-4\charscalex100 paru antara 1 jam paska ekstubasi dengan
hari ke-\line \up0 \expndtw-5\charscalex100 3, 4 dan 5 setelah melakukan DBE pada
kelompok \up0 \expndtw-6\charscalex100 intervensi dan mulai hari ke-3 yang telah
mencapai \up0 \expndtw-4\charscalex100 fungsi VO paru baik.\par\pard\qj
\expndtw0\charscalex105 Hal tersebut membuktikan bahwa DBE mem-\line \up0 \expndtw-
2\charscalex100 berikan efek positif dengan melengkapi prosedur \line \up0
\expndtw0\charscalex110 perawatan yang telah diterapkan selama ini. \line \up0
\expndtw0\charscalex102 Pencapaian tersebut akibat dari adanya pening-\line \up0
\expndtw0\charscalex107 katan kemampuan otot-otot inspirator karena \line \up0
\expndtw0\charscalex107 DBE merupakan kegiatan untuk melatih otot \line \up0
\expndtw0\charscalex102 inspirasi pernapasan. Padula dan Yeaw (2006) \line \up0
\expndtw0\charscalex103 menyebutkan bahwa latihan tersebut bertujuan \line \up0
\expndtw0\charscalex100 untuk meningkatkan kemampuan otot inspirator \line \up0
\expndtw0\charscalex101 dalam berbagai kondisi yang minimal termasuk \line \up0
\expndtw-3\charscalex100 pada post ventilasi mekanik.\par\pard\qj
\li1080\ri322\sb277\sl-280\slmult0 \up0 \expndtw0\charscalex102 Roussos dan
Zakynthinos (1996 dalam Padula \line \up0 \expndtw-4\charscalex100 & Yeaw, 2006)
menyebutkan bahwa kondisi yang \line \up0 \expndtw0\charscalex103 membutuhkan
kekuatan pernapasan yaitu pada \line \up0 \expndtw-3\charscalex100 kelemahan,
kelelahan, istirahatnya otot inspirator \line \up0 \expndtw-1\charscalex100 yang
terlalu lama. Penelitian eksperimen Weiner \line \up0 \expndtw0\charscalex105
(Padula & Yeaw, 2006) menunjukkan bahwa \line \up0 \expndtw-1\charscalex100
\ul0\nosupersub\cf3\f4\fs24 inspirator muscle training\ul0\nosupersub\cf2\f3\fs24
berdampak signifikan\par\pard\ql \li1108\sb0\sl-230\slmult0 \par\pard\ql
\ul0\nosupersub\cf8\f9\fs20 Grafik 3. Kapasitas Paru Responden\par\pard\column
\ql \li6407\sb0\sl-276\slmult0 \par\pard\ql \li21\sb207\sl-276\slmult0 \up0
\expndtw0\charscalex108 \ul0\nosupersub\cf2\f3\fs24 terhadap penurunan keluhan
sesak nafas, pe-\par\pard\qj \li21\ri843\sb0\sl-283\slmult0 \up0
\expndtw0\charscalex100 ningkatan FVC dan mengurangi berbagai gejala \up0 \expndtw-
4\charscalex100 gangguan paru.\par\pard\qj \li21\ri837\sb255\sl-280\slmult0 \up0
\expndtw0\charscalex103 Sperlich, et al. (2009) juga menyatakan bahwa \line \up0
\expndtw0\charscalex106 latihan pernapasan dapat meningkatkan pe-\line \up0
\expndtw-2\charscalex100 nampilan fisik seseorang yang terbebas dari kon-\line \up0
\expndtw0\charscalex101 disi kelemahan dan kelelahan. DBE merupakan \line \up0
\expndtw-2\charscalex100 salah satu latihan pernapasan yang terbukti dapat \line
\up0 \expndtw0\charscalex106 meningkatkan kemampuan kekuatan otot ins-\line \up0
\expndtw0\charscalex101 pirator, seperti yang telah dikembangkan dalam \line
\up0 \expndtw-5\charscalex100 beberapa penelitian oleh Westerdahl, et al.
(2005), \line \up0 \expndtw-4\charscalex100 El Batanouny, et al. (2009) dan
Nusdwinuringtyas \line \up0 \expndtw-4\charscalex100 (2008).\par\pard\qj
\li21\ri836\sb238\sl-280\slmult0 \up0 \expndtw0\charscalex106 Otot inspirator yang
terlatih akan meningkat-\line \up0 \expndtw0\charscalex101 kan
\ul0\nosupersub\cf3\f4\fs24 compliance\ul0\nosupersub\cf2\f3\fs24 paru dan
mencegah \ul0\nosupersub\cf3\f4\fs24 atelektasis\ul0\nosupersub\cf2\f3\fs24 . \line
\up0 \expndtw0\charscalex102 Westerdahl, et al (2005) menyimpulkan bahwa \line \up0
\expndtw-7\charscalex100 latihan pernapasan dapat dengan cepat menurunkan \line
\up0 \expndtw0\charscalex104 area atelektasis dan meningkatkan oksigenasi. \line
\up0 \expndtw0\charscalex106 \ul0\nosupersub\cf3\f4\fs24
Compliance\ul0\nosupersub\cf2\f3\fs24 dada yang baik memungkinkan \line \up0
\expndtw-5\charscalex100 ventilasi oksigenasi adekuat sehingga tidak mudah \line
\up0 \expndtw-3\charscalex100 terjadi \ul0\nosupersub\cf3\f4\fs24
atelektasis\ul0\nosupersub\cf2\f3\fs24 .\par\pard\qj \li21\ri843\sb257\sl-
280\slmult0 \up0 \expndtw0\charscalex106 DBE\ul0\nosupersub\cf3\f4\fs24
\ul0\nosupersub\cf2\f3\fs24 mengurangi reaksi simpatik tetapi tidak \line \up0
\expndtw0\charscalex104 merubah aktivitas parasimpatik secara signifi-\line \up0
\expndtw0\charscalex108 kan untuk meningkatkan fungsi pernapasan, \line \up0
\expndtw-3\charscalex100 mengurangi stres, dan kecemasan (Yadav, Singh, \line
\up0 \expndtw0\charscalex107 & Singh (2009). Kontrol pernapasan dengan \line
\up0 \expndtw0\charscalex106 rangsang simpatik dapat memperbaiki ritme \line \up0
\expndtw0\charscalex110 dan frekuensi pernapasan tanpa menggangu \line \up0
\expndtw0\charscalex104 peran parasimpatik yang berguna menjaga ke-\line \up0
\expndtw0\charscalex107 langsungan aktifitas pernapasan secara terus-\line \up0
\expndtw0\charscalex100 menerus. Sejalan dengan penelitian Westerdahl, \line
\up0 \expndtw0\charscalex107 et al (2005), yang menyebutkan bahwa DBE \line
\up0 \expndtw-1\charscalex100 dapat meningkatkan fungsi ventilasi dengan
per-\line \up0 \expndtw0\charscalex105 baikan karakteristik frekuensi dan
keteraturan \line \up0 \expndtw-3\charscalex100 pernapasan.\par\pard\qj
\li21\ri840\sb258\sl-280\slmult0 \up0 \expndtw0\charscalex104 Di rumah sakit tempat
penelitian, peran moni-\line \up0 \expndtw0\charscalex104 toring melalui
\ul0\nosupersub\cf3\f4\fs24 bed side monitor\ul0\nosupersub\cf2\f3\fs24 dan
\ul0\nosupersub\cf3\f4\fs24 pulse oxi-\line \up0 \expndtw0\charscalex105
metry\ul0\nosupersub\cf2\f3\fs24 telah diterapkan dengan baik dan sesuai \line
\up0 \expndtw0\charscalex109 prosedur, sedangkan pemeriksaan terhadap \line
\up0 \expndtw0\charscalex104 kapasitas vital paru jarang dilakukan.
\ul0\nosupersub\cf3\f4\fs24 Skrining \line \up0 \expndtw-2\charscalex100
\ul0\nosupersub\cf2\f3\fs24 terhadap volume dan kapasitas vital paru penting
\line \up0 \expndtw0\charscalex102 dilakukan setelah ekstubasi (Westerdahl, et al.,
\line \up0 \expndtw-4\charscalex100 2005).
\par\pard\sect\sectd\fs24\paperw12240\paperh15840{\shp
10000\shplid5
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51450014514500145145001451450014514500145145007ffd9}}}}}\pard\sb0\sl-240{\bkmkstart
Pg6}{\bkmkend Pg6}\par\pard\li1123\sb0\sl-276\slmult0\par\pard\li1123\sb0\sl-
2011; hal 23 -
\expndtw0\charscalex102 \ul0\nosupersub\cf2\f3\fs24 Penelitian ini menemukan
perbedaan yang ber-\par\pard\qj \li1080\ri323\sb0\sl-280\slmult0 \up0
\expndtw0\charscalex105 makna antara fungsi VO paru hari ke-4 dan 5 \line \up0
\expndtw0\charscalex102 pada kedua kelompok yang menunjukkan DBE \line \up0
\expndtw0\charscalex103 dapat mempercepat perbaikan fungsi VO paru. \line \up0
\expndtw0\charscalex106 DBE dapat dianggap sebagai terapi modalitas \line \up0
\expndtw0\charscalex106 keperawatan pada konteks perawatan intensif \line \up0
\expndtw-2\charscalex100 serta menjadi kajian terbaru dalam peranan nyata \line
\up0 \expndtw0\charscalex103 dan mandiri perawat yang mengedepankan pe-\line
\up0 \expndtw0\charscalex102 layanan keperawatan profesional. Monitor pola \line
\up0 \expndtw0\charscalex104 pernapasan termasuk keluhan sesak nafas me-\line
\up0 \expndtw0\charscalex106 rupakan tugas perawat dalam rangka evaluasi \line \up0
\expndtw0\charscalex109 pencapaian perbaikan kondisi klien selama \line \up0
\expndtw-4\charscalex100 perawatan (Ignatavicius & Workman, 2006).\par\pard\qj
\expndtw0\charscalex104 Pola pernapasan 1 (satu) jam paska ekstubasi \up0
\expndtw0\charscalex105 pada kelompok kontrol lebih tinggi dibanding \up0
\expndtw0\charscalex100 kelompok intervensi. Akan tetapi ada perbedaan \up0
\expndtw0\charscalex106 bermakna dalam pola pernapasan paru di hari \up0
\expndtw0\charscalex109 ke-4 dan 5 pada kelompok intervensi. Pada \up0
\expndtw0\charscalex108 kelompok intervensi terdapat perbaikan pola \up0 \expndtw-
3\charscalex100 pernapasan pada hari ke-2.\par\pard\qj \li1080\sb0\sl-
280\slmult0 \par\pard\qj \li1080\ri321\sb31\sl-280\slmult0 \up0 \expndtw-
7\charscalex100 Menurut Westerdahl, et al (2005), bahwa perbaikan \line \up0
\expndtw0\charscalex104 frekuensi dan keteraturan pernapasan merupa-\line \up0
\expndtw-1\charscalex100 kan indikator peningkatan fungsi ventilasi. DBE \line \up0
\expndtw0\charscalex107 akan mengurangi reaksi simpatik guna mem-\line \up0
\expndtw0\charscalex102 perbaiki pola pernapasan dan mengurangi kon-\line \up0
\expndtw-1\charscalex100 traksi otot inspirasi dan ekspirasi (Yadav, Singh,
\line \up0 \expndtw-4\charscalex100 & Singh, 2009).\par\pard\ql \li1113\sb0\sl-
\ul0\nosupersub\cf8\f9\fs20 Grafik 4. Saturasi Oksigen Responden\par\pard\column
\ql \li6407\sb0\sl-276\slmult0
\ul0\nosupersub\cf2\f3\fs24 DBE sangat efektif untuk memperbaiki
pola\par\pard\qj \li21\ri839\sb0\sl-280\slmult0 \up0 \expndtw0\charscalex109
pernapasan pada hari ke-4 dan ke-5. Latihan \line \up0 \expndtw0\charscalex105
menghirup dan menghembuskan udara secara \line \up0 \expndtw-1\charscalex100
perlahan dan dalam yang dilakukan secara terus-\line \up0 \expndtw-2\charscalex100
menerus merupakan kegiatan yang terpola antara \line \up0 \expndtw0\charscalex104
kontrol di pusat pernapasan dengan kombinasi \line \up0 \expndtw-2\charscalex100
kemampuan kinerja otot pernapasan, \ul0\nosupersub\cf3\f4\fs24 compliance \line
\up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf2\f3\fs24 paru dan struktur rangka
dada yang dapat meng-\line \up0 \expndtw0\charscalex102 hasilkan adaptasi terhadap
ritme dan kecepatan \line \up0 \expndtw-3\charscalex100 pernapasan.\par\pard\qj
\li21\ri837\sb237\sl-280\slmult0 \up0 \expndtw-6\charscalex100 Kelemahan otot
pernapasan post ventilasi mekanik \up0 \expndtw0\charscalex101 menyebabkan
ketidakmampuan melakukan ins-\line \up0 \expndtw0\charscalex103 pirasi secara
optimal, sehingga pemenuhan ke-\line \up0 \expndtw-6\charscalex100 butuhan oksigen
menurun. Kesenjangan suplai dan \up0 \expndtw0\charscalex100 kebutuhan oksigen
dapat diatasi dengan melatih \up0 \expndtw-3\charscalex100 otot inspirator melalui
DBE.\par\pard\qj \li6407\sb0\sl-280\slmult0 \par\pard\qj \li21\ri835\sb25\sl-
280\slmult0 \up0 \expndtw0\charscalex104 Menurut Price dan Wilson (2006), bahwa
otot \up0 \expndtw0\charscalex101 pernapasan dikendalikan oleh pusat pernapasan
\up0 \expndtw0\charscalex100 sebagai pusat aspek pernapasan yang terdiri dari
\up0 \expndtw0\charscalex111 neuron dan reseptor pada \ul0\nosupersub\cf3\f4\fs24
pons\ul0\nosupersub\cf2\f3\fs24 dan \ul0\nosupersub\cf3\f4\fs24 medulla \up0
\expndtw0\charscalex103 oblongata\ul0\nosupersub\cf2\f3\fs24 . Perbaikan yang
ditimbulkan karena \up0 \expndtw-1\charscalex100 adanya keterhubungan koordinasi
otot pernapas-\line \up0 \expndtw-3\charscalex100 an dan
\ul0\nosupersub\cf3\f4\fs24 desentisasi dypnea\ul0\nosupersub\cf2\f3\fs24
.\par\pard\qj \li6407\sb0\sl-280\slmult0 \par\pard\qj \li21\ri835\sb26\sl-
280\slmult0 \up0 \expndtw0\charscalex101 Menurut Smeltzer, et al. (2008), yang
menyata-\line \up0 \expndtw0\charscalex108 kan bahwa pola pernapasan tertentu
menjadi \line \up0 \expndtw-1\charscalex100 karakteristik dari keadaan penyakit
spesifik, me-\line \up0 \expndtw0\charscalex108 ngamati dan mendokumentasikan irama
per-\line \up0 \expndtw-1\charscalex100 napasan dan penyimpangan dari keadaan
normal \line \up0 \expndtw-3\charscalex100 merupakan fungsi keperawatan yang
penting.\par\pard\qj \li6407\sb0\sl-280\slmult0 \par\pard\qj \li21\ri838\sb25\sl-
280\slmult0 \up0 \expndtw0\charscalex101 Ditemukannya perbedaan bermakna pada
kapa-\line \up0 \expndtw0\charscalex102 sitas vital paru pada hari ke-4 dan 5
menunjuk-\line \up0 \expndtw-4\charscalex100 kan bahwa
DBE\ul0\nosupersub\cf3\f4\fs24 \ul0\nosupersub\cf2\f3\fs24 dapat membantu paru
melakukan \line \up0 \expndtw-2\charscalex100 adaptasi paska ekstubasi. Latihan
menghirup dan \line \up0 \expndtw-2\charscalex100 menghembuskan udara membantu
mengembang-\line \up0 \expndtw0\charscalex106 kan lingkar dada dan melatih otot
pernapasan \line \up0 \expndtw-7\charscalex100 sehingga dapat meningkatkan volume
dan kapasitas \line \up0 \expndtw-4\charscalex100 vital.\par\pard\qj
\expndtw0\charscalex102 Pada kegagalan pernapasan terjadi cedera pada \line \up0
\expndtw-5\charscalex100 membran alveolar paru yang dapat mengakibatkan \line
\up0 \expndtw-4\charscalex100 kebocoran cairan ke dalam jejaring kapiler hingga
\line \up0 \expndtw-1\charscalex100 mengarah pada ketidakseimbangan ventilasi
dan \par\pard\sect\sectd\fs24\paperw12240\paperh15840\pard\sb0\sl-240{\bkmkstart
Pg7}{\bkmkend
\expndtw0\charscalex108 oksigenasi. \ul0\nosupersub\cf3\f4\fs24
Compliance\ul0\nosupersub\cf2\f3\fs24 paru menjadi sangat\par\pard\qj
\li1080\ri331\sb0\sl-283\slmult0 \up0 \expndtw0\charscalex104 menurun sehingga
terjadi penurunan kapasitas \up0 \expndtw-3\charscalex100 paru, hipoksia dan
hipokapnia.\par\pard\qj \li1080\sb0\sl-280\slmult0 \par\pard\qj
\li1080\ri320\sb23\sl-280\slmult0 \up0 \expndtw0\charscalex100 Padula dan Yeaw
(2006) dan Nusdwinuringtyas \up0 \expndtw0\charscalex101 (2008) dalam penelitiannya
menjelaskan bahwa \up0 \expndtw-1\charscalex100 melatih otot inspirator dapat
membantu mening-\line \up0 \expndtw0\charscalex102 katkan kapasitas vital paru.
Latihan pernapasan \up0 \expndtw0\charscalex100 dapat meningkatkan kapasitas vital
paru melalui \up0 \expndtw0\charscalex105 pengukuran nilai FEV1 dan FVC.
Terlatihnya \up0 \expndtw0\charscalex102 otot inspirator akan meningkatkan
kemampuan \up0 \expndtw0\charscalex107 paru untuk menampung udara, sehingga
nilai \up0 \expndtw-3\charscalex100 FEV1 akan mengalami peningkatan.\par\pard\qj
\expndtw0\charscalex103 Menurut Smeltzer, et al. (2008), menerangkan \line \up0
\expndtw-3\charscalex100 bahwa fisiologis fungsi
paru\ul0\nosupersub\cf3\f4\fs24 \ul0\nosupersub\cf2\f3\fs24 dapat diukur dengan
\line \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf3\f4\fs24 spirometry/ peak
flowmeter\ul0\nosupersub\cf2\f3\fs24 untuk menilai FEV1. \line \up0
\expndtw0\charscalex102 Rerata pada 1 (satu) jam paska ekstubasi hanya \line
\up0 \expndtw-5\charscalex100 yang mampu mencapai nilai FEV1 tidak lebih dari \line
\up0 \expndtw0\charscalex102 160 mL/min. Hal ini menunjukkan bahwa kon-\line
\up0 \expndtw-4\charscalex100 disi awal paru paska ekstubasi yang sangat lemah,
\line \up0 \expndtw0\charscalex104 tetapi setelah menjalani perawatan, meningkat
\line \up0 \expndtw-3\charscalex100 hingga 275 mL/min.\par\pard\qj \li1080\sb0\sl-
\expndtw0\charscalex106 Beberapa kondisi seperti PPOK dan penyakit \up0
\expndtw0\charscalex100 pernapasan lainnya menunjukkan nilai kapasitas \up0
\expndtw0\charscalex105 vital paru dalam kondisi normal hanya sekitar \up0
\expndtw0\charscalex107 200-300 mL/min, sehingga nilai rerata FEV1 \up0
\expndtw0\charscalex101 dari hasil penelitian ini menggambarkan bahwa \up0
\expndtw0\charscalex102 responden mempunyai faktor penyebab berupa \up0
\expndtw0\charscalex103 gangguan pernapasan. Peningkatan rerata nilai \up0
\expndtw-4\charscalex100 FEV1 yang tidak dapat melebihi 275 mL/min me-\line \up0
\expndtw-1\charscalex100 rupakan hasil terbaik yang diperoleh, mengingat \up0
\expndtw-5\charscalex100 rerata responden mempunyai faktor penyakit paru. \up0
\expndtw-3\charscalex100 Klien dengan penyakit paru telah terbiasa dengan \up0
\expndtw-3\charscalex100 kondisi kapasitas vital yang rendah.\par\pard\qj
\expndtw0\charscalex103 Mulai 1 (satu) jam paska ekstubasi sampai hari \line
\up0 \expndtw-3\charscalex100 ke-5, saturasi oksigen telah mencapai nilai di
atas \line \up0 \expndtw0\charscalex102 97%. Hal tersebut berkenaan syarat klien
dapat \line \up0 \expndtw0\charscalex109 dilakukan \ul0\nosupersub\cf3\f4\fs24
weaning \ul0\nosupersub\cf2\f3\fs24 dan ekstubasi bila SaO2 \line \up0
\expndtw0\charscalex101 cukup adekuat lebih dari 95%. Menurut Guyton \line \up0
\expndtw0\charscalex105 dan Hall (2006) dan Price dan Wilson (2006), \line \up0
\expndtw0\charscalex109 yang menjelaskan bahwa proses transportasi \line \up0
\expndtw0\charscalex102 oksigen dan oksigenasi jaringan secara lansung \line
\up0 \expndtw0\charscalex101 dipengaruhi oleh sistem kardiovaskuler dan
he-\par\pard\column \ql \li6407\sb0\sl-276\slmult0 \par\pard\ql \li21\sb216\sl-
276\slmult0 \up0 \expndtw0\charscalex100 matologi yang didukung status fungsi paru
yang\par\pard\ql \li21\sb2\sl-276\slmult0 \up0 \expndtw-3\charscalex100
memadai.\par\pard\qj \li6407\sb0\sl-279\slmult0 \par\pard\qj \li21\ri838\sb5\sl-
279\slmult0 \up0 \expndtw0\charscalex108 Saturasi oksigen juga ditentukan oleh
proses \line \up0 \expndtw-5\charscalex100 kimiawi oksihemoglobin dalam tubuh.
Nilai SaO2 \line \up0 \expndtw0\charscalex106 selama perawatan hari ke-2 sampai
hari ke-5, \line \up0 \expndtw0\charscalex105 menunjukkan DBE tidak berdampak
terhadap \line \up0 \expndtw-6\charscalex100 penurunan nilai di bawah normal,
artinya tidak ada \line \up0 \expndtw0\charscalex104 efek yang merugikan dari
latihan tersebut. Hal \line \up0 \expndtw0\charscalex108 tersebut searah dengan
pola pernapasan dan \line \up0 \expndtw0\charscalex105 kapasitas vital paru yang
mampu ditingkatkan \line \up0 \expndtw-1\charscalex100 dengan baik selama perawatan
sampai hari ke-5, \line \up0 \expndtw0\charscalex110 sehingga oksigenasi ke
jaringan masih tetap \line \up0 \expndtw-3\charscalex100 adekuat.\par\pard\ql
\ul0\nosupersub\cf1\f2\fs28 Kesimpulan\par\pard\qj \li21\ri836\sb194\sl-279\slmult0
\up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf2\f3\fs24 Penelitian ini menemukan
pengaruh positif DBE \line \up0 \expndtw0\charscalex103 terhadap fungsi VO paru
hari ke-2, 3, 4, dan 5. \line \up0 \expndtw0\charscalex101 Ada perbedaan yang
bermakna pada fungsi VO \line \up0 \expndtw0\charscalex104 paru, pola pernapasan
dan kapasitas vital paru \line \up0 \expndtw0\charscalex100 pada hari ke-4 dan 5
antara kelompok intervensi \line \up0 \expndtw0\charscalex108 dan kontrol tetapi
tidak ada perbedaan untuk \line \up0 \expndtw0\charscalex101 saturasi oksigen pada
hari-2, 3, 4 dan 5.Perawat \line \up0 \expndtw-3\charscalex100 perlu menerapkan DBE
dalam asuhan keperawat-\line \up0 \expndtw0\charscalex109 an. Penetapan DBE sebagai
terapi modalitas \line \up0 \expndtw0\charscalex101 keperawatan seharusnya menjadi
pertimbangan \line \up0 \expndtw-3\charscalex100 pengelola RS.\par\pard\qj
\expndtw-1\charscalex100 Bagi institusi pendidikan untuk dapat memasuk-\line
\up0 \expndtw0\charscalex105 kan DBE sebagai bahan pembelajaran praktik \line
\up0 \expndtw-3\charscalex100 klinik dengan memperhatikan kajian terbaru ilmu \line
\up0 \expndtw-5\charscalex100 keperawatan. Peneliti berikutnya diperlukan untuk
\line \up0 \expndtw-4\charscalex100 mengidentifikasi efektifitas manajemen
pernapas-\line \up0 \expndtw0\charscalex106 an terhadap keberhasilan
\ul0\nosupersub\cf3\f4\fs24 weaning\ul0\nosupersub\cf2\f3\fs24 ventilasi
\line \up0 \expndtw-4\charscalex100 mekanik (INR).\par\pard\ql \li6407\sb0\sl-
\ul0\nosupersub\cf1\f2\fs28 Referensi\par\pard\ql \li21\ri859\sb198\sl-
240\slmult0\tx434\tx434 \up0 \expndtw0\charscalex112 \ul0\nosupersub\cf13\f14\fs22
Anne, T., Pippin H., & Hill S. (2009). \ul0\nosupersub\cf14\f15\fs22
Cough-\line \tab \up0 \expndtw0\charscalex110 deep breathing
exercises\ul0\nosupersub\cf13\f14\fs22 . Diperoleh dari \line \tab \up0
\expndtw-2\charscalex100 http://phicare.com/docs/clinical/B160pdf.\par\pard\ql
\li21\ri859\sb240\sl-240\slmult0\tx434\tx434\tx434 \up0 \expndtw0\charscalex103 El-
Batanouny, M.M., Amin, M.A., Salem, E.Y., & \line\tab \up0 \expndtw0\charscalex113
El-Nahas, H.E. (2009) . Effect of exercise \line \tab \up0 \expndtw0\charscalex109
on ventilatory function in welders. \ul0\nosupersub\cf14\f15\fs22 Egyptian \line
\tab \up0 \expndtw-3\charscalex100 Journal of
Bronchology\ul0\nosupersub\cf13\f14\fs22 , 3 (1), 67 - 73.
{\shp
}}\par\pard\sect\sectd\fs24\paperw12240\paperh15840\pard\sb0\sl-240{\bkmkstart Pg8}
{\bkmkend Pg8}\par\pard\li1099\sb0\sl-276\slmult0\par\pard\li1099\sb0\sl-
2011; hal 23 -
\expndtw0\charscalex110 \ul0\nosupersub\cf13\f14\fs22 Guyton, A.C., & Hall, J.E.
(2006). \ul0\nosupersub\cf14\f15\fs22 Textbook of\par\pard\qj \li1483\ri346\sb0\sl-
240\slmult0 \up0 \expndtw0\charscalex106 medical
physiology\ul0\nosupersub\cf13\f14\fs22 (11th Ed.). Philadelphia: \up0 \expndtw-
3\charscalex100 WB. Saunders Company.\par\pard\ql \li1080\sb0\sl-253\slmult0
\par\pard\ql \li1080\sb4\sl-253\slmult0 \up0 \expndtw0\charscalex112 Ignatavicius,
D.D., & Workman, M.L. (2006).\par\pard\qj \li1483\ri351\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex111 \ul0\nosupersub\cf14\f15\fs22 Medical surgical nursing:
Critical thinking \up0 \expndtw0\charscalex108 for collaborative
care\ul0\nosupersub\cf13\f14\fs22 (5th Ed., Vol. 2). St. \up0 \expndtw-
2\charscalex100 Louis: Elsevier Saunders.\par\pard\ql \li1080\sb0\sl-253\slmult0
Nusdwinuringtyas, N. \up0 \expndtw0\charscalex117
(2008).\ul0\nosupersub\cf14\f15\fs22 Efek latihan\par\pard\qj
\li1483\ri349\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex108 otot -otot
pernapasan pada penyakit paru \line \up0 \expndtw0\charscalex111 obstruksi
kronis di Instalasi Rehabilitasi \line \up0 \expndtw0\charscalex109 Medik RSUPN
Dr. Cipto Mangunkusumo\par\pard\qj \li1483\ri346\sb0\sl-240\slmult0 \up0
\expndtw0\charscalex106 Jakarta\ul0\nosupersub\cf13\f14\fs22 (Master Tesis, tidak
dipublikasikan). \line \up0 \expndtw0\charscalex114 Program Pascasarjana Fakultas
Kesehatan \line \up0 \expndtw-2\charscalex100 Masyarakat Universitas Indonesia,
Depok - Jawa\par\pard\ql \li1483\sb1\sl-237\slmult0 \up0 \expndtw-2\charscalex100
Barat.\par\pard\ql \li1080\sb0\sl-240\slmult0 \par\pard\ql \li1080\ri340\sb25\sl-
240\slmult0\tx1483\tx1483\tx1483\tx1483 \up0 \expndtw0\charscalex100 Padula, C.A.,
& Yeaw E. (2006). Inspiratory muscle \line\tab \up0 \expndtw0\charscalex112
training: integrative review.\ul0\nosupersub\cf14\f15\fs22 Research and \line
\tab \up0 \expndtw0\charscalex103 Theory for Nursing Practice: An International
\line \tab \up0 \expndtw0\charscalex104 Journal\ul0\nosupersub\cf13\f14\fs22 , 20
(4), 291-304. Doi: 10.1891/rtnp-\line \tab \up0 \expndtw-3\charscalex100
v20i4a005\par\pard\qj \li1080\sb0\sl-240\slmult0 \par\pard\qj
\li1080\ri341\sb29\sl-240\slmult0\tx1483 \up0 \expndtw-3\charscalex100 Price, S.A.,
& Wilson, L.M. (2006). \ul0\nosupersub\cf14\f15\fs22 Pathophysiology: \line\tab
\up0 \expndtw0\charscalex117 Clinical concepts of disease process \up0 \expndtw-
4\charscalex100 \ul0\nosupersub\cf13\f14\fs22 (6 th\par\pard\ql \li1483\sb0\sl-
240\slmult0 \up0 \expndtw-2\charscalex100 Ed.). Philadelpia: Elsevier
Science.\par\pard\column \ql \li6407\sb0\sl-253\slmult0 \par\pard\ql
\li21\sb239\sl-253\slmult0 \up0 \expndtw0\charscalex107 Rodriguez, P., Dojat, M., &
Brochard, L. (2005).\par\pard\ql \li424\sb1\sl-237\slmult0 \up0
\expndtw0\charscalex110 Mechanical ventilation: changing concepts.\par\pard\ql
\li424\sb1\sl-240\slmult0 \up0 \expndtw0\charscalex116
\ul0\nosupersub\cf14\f15\fs22 Indian Journal of Critical Care
Medicine\par\pard\qj \li424\ri860\sb0\sl-240\slmult0 \up0 \expndtw-
5\charscalex100 \ul0\nosupersub\cf13\f14\fs22 [serial online], 9 (4), 235-243. Doi:
10.4103/0972-\line \up0 \expndtw-3\charscalex100 5229.19765.\par\pard\ql
\li6407\sb0\sl-240\slmult0 \par\pard\ql \li21\ri857\sb58\sl-240\slmult0\tx434\tx434
\up0 \expndtw0\charscalex100 Smeltzer, S.C., Bare, B.G., Hinkle, J.L., &
Cheever, \line\tab \up0 \expndtw0\charscalex110 K.H. (2008 ).
\ul0\nosupersub\cf14\f15\fs22 Brunner & Suddarth\u8217?s Text-\line \tab \up0
\expndtw0\charscalex112 book of Medical-Surgical Nursing \up0 \expndtw-
3\charscalex100 \ul0\nosupersub\cf13\f14\fs22 (11 th\par\pard\qj
\li424\ri863\sb0\sl-240\slmult0 \up0 \expndtw0\charscalex101
Ed.).\ul0\nosupersub\cf14\f15\fs22 \ul0\nosupersub\cf13\f14\fs22 Philadelphia, PA:
Lippincott, Williams & \up0 \expndtw-4\charscalex100 Wilkins.\par\pard\ql
\li6407\sb0\sl-240\slmult0 \par\pard\ql \li21\ri858\sb57\sl-
240\slmult0\tx434\tx434\tx434\tx434\tx434 \up0 \expndtw0\charscalex103 Westerdahl,
E., Linmark, B., Eriksson, T., Friberg, \line\tab \up0 \expndtw0\charscalex108 O.,
Hedenstierna, G., & Tenling, A. (2005). \line \tab \up0 \expndtw0\charscalex110
Deep-breathing exercises reduce atelectasis \line \tab \up0 \expndtw0\charscalex100
and improve pulmonary function after coronary \line \tab \up0
\expndtw0\charscalex105 artery bypass surgery. \ul0\nosupersub\cf14\f15\fs22 Chest,
\ul0\nosupersub\cf13\f14\fs22 128 (5), 3482-\line \tab \up0 \expndtw-
2\charscalex100 3488. Doi: 10.1378/chest.128.5.3482\par\pard\ql \li6407\sb0\sl-
240\slmult0 \par\pard\ql \li21\ri860\sb58\sl-240\slmult0\tx434\tx434\tx434\tx434
\up0 \expndtw0\charscalex107 Yadav A., Singh S., & Singh K.P. ( 2009). Role
\line\tab \up0 \expndtw0\charscalex108 of pranayama breathing exercise in
rehabili-\line \tab \up0 \expndtw0\charscalex113 tation of coronary artery disesase
patient-a \line \tab \up0 \expndtw0\charscalex116 pilot study.
\ul0\nosupersub\cf14\f15\fs22 Indian Journal of Traditional \line \tab \up0
\expndtw-3\charscalex100 Knowledge\ul0\nosupersub\cf13\f14\fs22 , 8 (3), 455-458.
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