Penerapan Bundle Keperawatan untuk Pencegahan Komplikasi pada Pasien Stroke Hemoragik dengan Prolonged Ventilator: A Case Study

Sari

ABSTRACT

Hemorrhagic stroke is a neurological emergency with higher mortality and morbidity rates compared to ischemic stroke. Patients with extensive bleeding often require prolonged mechanical ventilation, which increases the risk of complications such as ventilator-associated pneumonia (VAP), pressure ulcers, and respiratory muscle weakness. Although international guidelines recommend bundle-based prevention strategies, their implementation still varies across healthcare facilities. A 67-year-old female patient with a diagnosis of post-craniectomy decompression due to spontaneous intracerebral hemorrhage in the right basal ganglia was admitted to the ICU. The patient underwent treatment with a prolonged ventilator for 38 days. Nursing interventions included a VAP prevention bundle (head-of-bed elevation, aseptic suctioning with pre-oxygenation, chest physiotherapy, nebulization, and oral hygiene), repositioning every two hours using a pressure-relieving mattress, passive mobilization, cuff pressure monitoring every eight hours, and provision of enteral nutrition according to daily calorie and protein targets. During 38 days of ICU care, the patient showed no clinical or radiological signs of pneumonia. Chest X-ray and sputum culture confirmed the absence of pulmonary infection. The patient also did not develop pressure ulcers, maintained oxygen saturation within the range of 95–99%, had reduced sputum production, and remained hemodynamically stable. The patient was deemed fit to be transferred to the neurology ward to continue therapy. This report demonstrates that consistent implementation of a nursing bundle is effective in preventing complications in patients with hemorrhagic stroke requiring prolonged ventilation, and highlights the importance of nurse compliance in maintaining the quality of critical care.

Keywords: Complication Prevention, Hemorrhagic Stroke, Nursing Bundle, Nursing Strategy, Prolonged Ventilator.

ABSTRAK

Stroke hemoragik merupakan kegawatdaruratan neurologis dengan angka mortalitas dan morbiditas lebih tinggi dibandingkan stroke iskemik. Pasien dengan perdarahan luas sering membutuhkan ventilasi mekanik jangka panjang yang meningkatkan risiko komplikasi, seperti ventilator-associated pneumonia (VAP), luka tekan, dan kelemahan otot pernapasan. Meskipun pedoman internasional merekomendasikan strategi pencegahan berbasis bundle, implementasinya masih bervariasi antar fasilitas kesehatan. Seorang pasien perempuan berusia 67 tahun dengan diagnosis post-craniectomy decompression akibat perdarahan intraserebral spontan pada basal ganglia kanan dirawat di ICU. Pasien menjalani perawatan dengan prolonged ventilator selama 38 hari. Intervensi keperawatan difokuskan pada pencegahan komplikasi, meliputi: (1) bundle pencegahan VAP (elevasi kepala, suction aseptik dengan pre-oksigenasi, fisioterapi dada, nebulisasi, dan oral hygiene); (2) reposisi tiap dua jam dengan pressure-relieving mattress; (3) mobilisasi pasif dan latihan pernapasan sederhana untuk mempertahankan fungsi otot pernapasan; (4) pemantauan cuff pressure setiap delapan jam (20–30 cmH₂O) untuk mencegah aspirasi; serta (5) pemberian nutrisi enteral sesuai target kalori dan protein dengan posisi kepala elevasi. Selama 38 hari perawatan di ICU, pasien tidak menunjukkan tanda klinis maupun radiologis VAP. Foto toraks dan kultur sputum mendukung tidak adanya infeksi paru. Pasien juga tidak mengalami luka tekan, saturasi oksigen stabil pada kisaran 95–99%, produksi sputum berkurang, serta kondisi hemodinamik tetap stabil. Pasien dinilai layak dipindahkan ke ruang perawatan neurologi untuk melanjutkan terapi. Laporan kasus ini menggambarkan bahwa penerapan bundle keperawatan secara konsisten dapat membantu mencegah komplikasi pada pasien stroke hemoragik dengan prolonged ventilator. Laporan kasus ini juga menekankan pentingnya kepatuhan perawat dalam melaksanakan intervensi berbasis bukti untuk mendukung stabilitas klinis pasien kritis.

Kata Kunci: Bundle Keperawatan, Pencegahan Komplikasi, Prolonged Ventilator, Strategi Keperawatan, Stroke Hemoragik.