Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
Latar Belakang: Disfungsi kognitif pascabedah adalah salah satu komplikasi pembedahan jantung yang telah diketahui. Hipoperfusi jaringan otak diduga sebagai penyebabnya, terutama dihubungkan dengan penggunaan mesin pintas jantung-paru. Near-infrared spectroscopy muncul sebagai alat pemantauan saturasi oksigen otak. Penelitian ini bertujuan untuk mengetahui hubungan antara nilai NIRS dan kandungan oksigen intrabedah dengan kejadian disfungsi kognitif pascabedah jantung terbuka. Metode: Penelitian ini merupakan kohort prospektif yang dilakukan di Rumah sakit Cipto Mangunkusumo, Indonesia. Sebanyak 60 pasien elektif yang akan menjalani bedah jantung terbuka dilakukan uji neurokognisi pada 1 hari sebelum pembedahan dan hari ke 5 pascabedah. Disfungsi kognitif pascabedah dinyatakan jika terdapat penurunan >20% dari nilai uji prabedah, pada 2 dari 3 ranah kognisi. Pemantauan saturasi oksigen regional (rSO2¬) menggunakan probe NIRS yang ditempel pada dahi subjek penelitian. Nilai rSO2¬ secara kontinu direkam sepanjang pembedahan. Desaturasi rSO2 adalah penurunan rSO2>20% nilai baseline, nilai terendah, durasi desaturasi rSO2, luas area under the curve rSO2 yang dihitung oleh INVOS 5100 dalam satuan min% dicatat pada berbagai fase pembedahan. Analisis bivariat variabel numerik menggunakan Independent T-test atau Mann-Whitney dengan SPSS 20.0. Variabel-variabel dengan nilai p<0.25 pada analisis bivariat selanjutnya dimasukkan dalam regresi logistik. Hasil: Sebanyak 31 dari 60 pasien (51,6%) mengalami POCD. Durasi desaturasi rSO2>20% secara signifikan lebih lama pada kelompok POCD dibandingkan non-POCD, terutama pada fase intraCPB dan pascaCPB. Didapatkan desaturasi total rSO2 dan nilai AUC rSO2 yang lebih panjang pada kelompok POCD dibandingkan kelompok non-POCD (median 55 [0-245] vs 0 (0-140) menit, p= 0.007) dan (412 [0-4875] vs 0 [0-472], p= 0,003). Hasil analisis multivariat menunjukkan AUC rSO2 sebagai variabel yang paling berpengaruh terhadap POCD. Kualitas persamaan regresi logistik baik dengan AUC 83,5% (CI 95%; 72,8%-94,2%).

---

Introduction. Cardiac surgery has been known to cause postoperative cognitive dysfunction (POCD). Cerebral hypoperfusion is suspected as the cause, mainly related to the use of cardiopulmonary bypass (CPB) machine. Near infrared spectroscopy had been introduced as a method to monitor cerebral oxygen saturation. This study aims to investigate the role of near infrared spectroscopy (NIRS) monitoring in preventing POCD after cardiac surgery. Purpose: To evaluate association between intraoperative Near-Infrared Spectroscopy value and arterial oxygen content with POCD in open heart surgery Methods. This prospective cohort study was conducted at Cipto Mangunkusumo Hospital, Indonesia. We included sixty adult patients scheduled for elective open-heart surgery and assessed their cognitive function 1 day before surgery and postoperative day 5. To measure regional oxygen saturation (rSO¬¬2), NIRS probe was placed on the subjects forehead, the values were recorded until the end of surgery. A decrease in rSO2 >20% of baseline value was considered as rSO2 desaturation. The lowest rSO2 value and duration of desaturation were recorded before, during, after CPB. Another variable of NIRS value was Area under the curve of rSO2; an output measured by INVOS 5100 labelled as AUC rSO2 in min%. Data were compared using Students t test or the Mann-Whitney U test with SPSS 20.0 software. Logistic regression was applied to variables with p-value above 0.25 on bivariate analysis. Results: In this study 31 out of 60 patients (51.6%) developed POCD. Duration of rSO2 desaturation 20% baseline was significantly higher in POCD group, espescially during and after CPB phase. We observed a median of 55 (0-245) minutes of total desaturation time in POCD group, compared to the non-POCD group, who experienced a median desaturation time of 0 (0-140) minutes (p = 0.007). Quality of regression equity based on good discrimination with AUC was 83.5% (CI 95%; 72.8%-94.2%). From multivariate analysis, it was found that variables of NIRS AUC could affect logistic regression equity.

Abstrak :
Keperawatan medikal bedah merupakan bidang praktik khusus dalam keperawatan profesional yang fokus dalam perawatan respon pasien terhadap masalah kesehatan aktual maupun potensial. Clinical nurse specialist (CNS) didefinisikan sebagai clinical leader dalam praktik keperawatan yang memiliki pengetahuan dan keterampilan tingkat lanjut seperti keahlian klinis dalam bidang tertentu, praktik berbasis bukti, kolaborasi, konsultasi, edukator, mentoring, dan manajemen. Peran CNS meliputi direct patient care, nursing practice, dan organization atau system. Peran perawat direct patient care diterapkan pada 31 pasien kasus kardiovaskuler baik medikal maupun bedah dengan pendekatan Model Adaptasi Roy. Hasil analisis praktik menunjukkan bahwa Model Adaptasi Roy dapat diterapkan dalam memberikan asuhan keperawatan pasien dengan gangguan sistem kardiovaskuler. Penerapan peran perawat nursing practice, yaitu perawat menerapkan praktik yang berbasis bukti (evidence) adalah efektivitas cold therapy sebelum latihan napas dalam (deep breathing) dan batuk efektif (coughing) terhadap nyeri akut pada pasien post cardiac surgery. Penerapan peran perawat organisation atau system, yaitu perawat membuat pengembangan profesional melalui inovasi terbaru untuk perkembangan asuhan keperawatan dengan menyusun SPO rehabilitasi jantung fase 1 pada pasien sindrom koroner akut (SKA). ......Medical surgical nursing is a special area of nursing profesional practice that focuses on the care of patient s response to actual and potential health problems. Clinical nurse specialist (CNS) is defined as a clinical leader in nursing practice that has advance knowledge and skill such as clinical expertise in a particular area, evidence-based practice, collaboration, consulting, eduvator, menoting, and management. The role of CNS included direct patient care, nursing practice, and organization or system. The role as a direct patient care was applied to 31 cardiovascular patients both medical and surgical with the Roy s Adaptation Model approach. The result of practice analysis showed that Roy s Adaptation Model could be applied in providing nursing care in cardiovascular disease. The application of nursing practice nursing role, that nurse applied evidence-based practice that was effectiveness of cold therapy before deep breathing and coughing for acute pain post cardiac surgery patient. Aplication of the role of nurse organization or system, that nurses made professional development through the innovation for the development of nursing care. It was 1st phase cardiac rehabilitation in patient with acute coronary syndrome by formed standard operational procedure (SOP).

Abstrak :
The main target of clinical and academic cardiology activities is to optimize the patient's management and ultimately their welfare. Professionals manage patients according to their own understanding of disease process; clinicians concentrate on alleviating the symptoms and echocardiographers on identifying the disease. This book helps to 'cross the barrier' and describes the common ground between physiologic disturbances and their management which should ideally form the shared basis for understanding and managing all cardiac problems. A practical review of the many uses of echocardiography in clinical practice, Clinical Echocardiography is designed to integrate and refine the investigation of cardiac disorders within the framework of the pathologic, physiologic and surgical appearances of heart disease. It has been common to consider echocardiographic findings separately from the more physical aspects of heart disease. However, with the development of new imaging modalities such as three- and four-dimensional echocardiography, it has become necessary to consider this imaging as a window on the heart.

Abstrak :

Consensus Statement of Standards for Interventional Cardiovascular Nursing Practice menetapkan  domain standar praktik interventional keperawatan kardiovaskular  meliputi mampu berfikir kritis dan menganalisis intervensi kardiovaskular dalam praktik keperawatan, terlibat dalam hubungan terapeutik dan hubungan profesional untuk meningkatkan pelayanan dan pengalaman dalam pemberian asuhan keperawatan.  The dynamic nurse-patient relationship model telah digunakan sebagai teori dasar dalam memberikan asuhan keperawatan pada praktik keperawatan, yang menekankan  prinsip-prinsip dasar pemikiran kritis, pendekatan yang berpusat pada klien intervensi serta berorientasi pada tujuan, dan penggunaan  rekomendasi intervensi keperawatan berbasis bukti. Penerapan The dynamic nurse-patient relationship model pada praktik residensi menetapkan penurunan curah jantung sebagai diagnosis keperawatan utama pada pasien kelolaan utama dan 30 pasien lainnya, dengan cardiac care sebagai pilihan intervensi keperawatan untuk mengoptimalkan fungsi jantung dan menurunkan beban kerja jantung. CAM-ICU sebagai instrumen diagnostik memiliki keandalan yang sempurna untuk menilai delirium pasca pembedahan jantung (sensitifitas 100% dan spesitifitas 100%), lain halnya BHIS sebagai istrumen untuk menilai risiko kejadian SSI pasca pembedahan jantung memiliki keandalan yang sedang ( sensitifitas 70% dan spesitifitas 67%), artinya BHIS perlu dikembangkan kembali dengan memperhatikan faktor-faktor yang berhubungan dengan kejadian SSI.

 

---

The Consensus Statement of Standards for Interventional Cardiovascular Nursing Practice has established the standard domain of interventional cardiovascular nursing practices which includes the ability to think critically and to analyze cardiovascular interventions in nursing practice, engaging in therapeutic relationships and professional relationships to improve service and experience in providing nursing care. The dynamic nurse-patient relationship model has been used as a primary theory, providing nursing care approach into nursing practice which emphasizes the basic principles of critical thinking, client-centered and intervention-oriented approaches, and the use of evidence-based nursing intervention recommendations. The dynamic nurse-patient relationship model in residency practice establishes a decrease in cardiac output as the main nursing diagnosis in primary management patients and 30 other patients, with cardiac care as the choice of nursing intervention to optimize cardiac function and reduce cardiac workload. CAM-ICU as a diagnostic instrument has perfect reliability to assess delirium after cardiac surgery (100% sensitivity and 100% specificity). BHIS as an instrument to assess the risk of SSI events after cardiac surgery has moderate reliability (70% sensitivity and 67% specificity), meaning that BHIS needs to be developed by taking into account the factors related to SSI events.

 

Keywords: ida jean orlando, delirium, CAM-ICU, surgical site infection, cardiac surgery, low cardiac output, respiratory muscle training.

Abstrak :
Latar Belakang: Disfungsi kognitif pascabedah (postoperative cognitive dysfunction/POCD) merupakan komplikasi pascabedah yang sering ditemui pada pasien yang menjalani bedah jantung terbuka yang mengganggu fungsi sosial dan ekonomi serta berkaitan dengan peningkatan mortalitas. Patofisiologi POCD belum diketahui secara jelas, namun diperkirakan melibatkan hipoksia serebral. Penurunan kandungan oksigen dan penurunan ekstraksi oksigen perioperatif diperkirakan berkontribusi terhadap POCD. Penggunaan pemantauan nearinfrared spectroscopy (NIRS) memungkinkan pengukuran status oksigenasi pada jaringan otak. Protein S100B adalah penanda biologis kerusakan jaringan otak. Penelitian ini bertujuan meneliti pengaruh kandungan oksigen dan ekstraksi oksigen intra dan pascabedah, desaturasi serebral dan peningkatan kadar protein S100B terhadap kejadian POCD. Metode: Rancangan penelitian ini adalah kohort prospektif di unit Pelayanan Jantung Terpadu RS dr. Cipto Mangunkusumo. Penelitian dimulai setelah mendapatkan persetujuan komite etik dan ijin lokasi. Kriteria penerimaan adalah pasien berusia ≥18 tahun yang dijadwalkan menjalani bedah jantung terbuka dengan menggunakan mesin cardiopulmonary bypass (CPB), sehat secara mental, dapat membaca dan berbahasa Indonesia. Pasien akan menjalani evaluasi kognitif menggunakan 6 tes psikometrik pada 1 hari prabedah dan diulang pada 5 hari pascabedah. POCD didefinisikan sebagai penurunan >20% skor kognitif pascabedah dibandingkan prabedah pada 2 atau lebih tes. Sampel darah arteri dan vena diambil untuk menilai kandungan dan ekstraksi oksigen pada 5 waktu: (1) sebelum induksi, (2) intra-CPB, (3) pasca-CPB, (4) enam jam pascabedah, dan (5) 24 jam pascabedah. Pemantauan saturasi serebral menggunakan NIRS dilakukan sepanjang pembedahan. Kadar protein S100B diukur pada 2 waktu: sebelum induksi dan 6 jam pascabedah. Data dianalisis dengan uji statistik yang sesuai menggunakan piranti lunak SPSS versi 20. Hasil:Lima puluh lima subyek mengikuti penelitian ini. POCDditemukan pada 31 (56,4%) subyek. Kandungan oksigen dan ekstraksi oksigen ditemukan tidak berbeda bermakna di antara kedua kelompok pada seluruh waktu. Desaturasi serebral ditemukan lebih lama (55 [0-324] vs. 6 [0-210], p=0,03) dan nilai AUC rScO2 lebih tinggi (228 [0-4875] vs. 33 [0- 1100], p <0,01) pada pasien yang mengalami POCD dibandingkan yang tidak. Dengan analisis ROC ditemukan nilai AUC rScO2 >80 menit% berpengaruh terhadap kejadian POCD (RR 3,38, IK 95%: 1,68-6,79, p <0,01). Kadar protein S100Bmeningkat 1,5x lebih tinggi pada pasien POCD, namun tidak mencapai kemaknaan statistik. Simpulan:Desaturasi serebral yang diukur menggunakan NIRS berpengaruh pada kejadian POCD. ......Background: Postoperative cognitive dysfunction/POCD is commonly found postoperative complication after cardiac surgery with profound social and economic effect and also known correlated with mortality. The pathophysiology remains unclear and multifactorial, but hipoxia have been postulated as one of the mechanisms. Reduced arterial oxygen content (CaO2) and reduced oxygen extraction perioperatively may contribute to POCD. Use of near-infrared spectroscopy (NIRS) monitoring may provide oxygenation status on brain tissue. S100B protein is known brain injury biological marker. This trial aims to investigate effects of perioperative oxygen content and extraction, cerebral oxygenation status and S100B protein level changes to POCD. Methods: This prospective cohort study was conducted at Integrated Heart Service unit of RS dr. Cipto Mangunkusumo, a tertiary teaching hospital in Jakarta, Indonesia. This study was started after ethical approval obtained. Inclusion criteria was 18 years old or above patients scheduled for open-heart surgery using cardiopulmonary bypass machine, healthy mental status, and can speak/read Indonesian language. Subjects were undergone 6 psychometric evaluation on day prior to surgery and 5 days after surgery. POCDdefined as decrease of >20% score from baseline on 2 or more tests. Arterial and venous blood samples were taken on 5 moments: (1) before induction of anesthesia, (2) during CPB, (3) After separation of CPB, (4) six hours after surgery, and (5) 24 hours after surgery. NIRS monitoring was applied continously during surgery. S100B protein level was measured on before induction of anesthesia and 6 hours after surgery.Data was analyzed with appropriate statistical tests using SPSS 20 software. Results: Fifty-five subjects were included in this study. POCD was found in 31 (56.4%) subjects. Oxygen contents and extractions were found not differ in both groups at all times. Cerebral desaturation was found more longer (55 [0-324] vs. 6 [0-210]mins, p = 0.03) and severe (AUC rScO2 228 [0-4875] vs. 33 [0-1100] min%, p <0,01) in subjects with POCD compared to non-POCD. Using ROC analysis, it is determined subjects with AUC rScO2 >80 min% were exposed with higher risk of POCD(RR3.38x, 95%CI: 1.68-6.79, p <0.01). S100B protein level increased higher in subjects with POCDbut no statistical significant was found. Conclusion: Cerebral desaturation measured by NIRSmonitoring contributes to POCD.

Abstrak :
Penggunaan ventilasi mekanik yang memanjang merupakan salah satu komplikasi utama pada pasien pasca-bedah jantung yang dapat menyebabkan morbiditas dan mortalitas. Prediksi lama penggunaan ventilasi mekanik merupakan hal penting dalam penatalaksanaan pasien operasi jantung. Skor ACEF (Age, Creatinine, Ejection Fraction) merupakan sistem prediksi sederhana dengan menggunakan tiga variabel pra-bedah yang diukur secara objektif, memiliki performa yang baik dalam memprediksi morbiditas dan mortalitas pada pasien pasca-bedah jantung. Penggunaan skor ACEF dalam memprediksi kejadian penggunaan ventilasi mekanik memanjang pasca-bedah jantung belum ada, namun variabel yang dipakai pada sistem skor ini merupakan prediktor terkuat kejadian penggunaan ventilasi mekanik memanjang pasca-bedah jantung. Penelitian ini bertujuan untuk mengetahui kemampuan skor ACEF dalam memprediksi kejadian penggunaan ventilasi mekanik yang memanjang pada pasien pasca-bedah jantung dewasa di PJT RSCM. Penelitian ini adalah penelitian kohort retrospektif yang melibatkan 206 subjek penelitian yang menjalani operasi jantung terbuka di Pelayanan Jantung Terpadu RSCM. Hasil penelitian ini didapatkan hasil AUC = 0,6336 (95% CI : 0,55-0,71), nilai sensitivitas sebesar 35,8%, spesivisitas 88%, dan akurasi 67,48%. Dari hasil yang diperoleh, dapat disimpulkan Skor ACEF memiliki kemampuan prediksi yang kurang dalam memprediksi kejadian penggunaan ventilasi mekanik memanjang pada pasien pasca-bedah jantung. ...... Prolonged mechanical ventilation is one of the main complications in post-cardiac surgery patients that can cause morbidity and mortality. Prediction of the duration mechanical ventilation is important in the management of cardiac surgery patients. The ACEF score (Age, Creatinine, Ejection Fraction) is a simple prediction system using three measured pre-operative variables objectively, which performs well in predicting post-operative morbidity and mortality in cardiac surgery patients. The use of the ACEF score in predicting prolonged mechanical ventilation after cardiac surgery does not yet exist, but the variables used in this scoring system are the strongest predictors of prolonged mechanical ventilation after cardiac surgery. This study aims to determine the ability of the ACEF score to predict the incidence of prolonged of mechanical ventilation in post-cardiac surgery patients at RSCM PJT. This study is a retrospective cohort study involving 206 subjects who underwent open heart surgery at PJT RSCM. The results of this study showed that AUC = 0.6336 (95% CI: 0.55-0.71), the sensitivity is 35,8%; specificity is 88%, and accuracy is 67,48%. From the results obtained, it can be concluded that the ACEF score has poor predictive ability in predicting the incidence of prolonged mechanical ventilation in post-cardiac surgery patients.

Abstrak :
This project represents a concise review of normal and abnormal cardiac anatomy and physiology, the evolution of SVR to EVLPP with validation of near normal ventricular restoration, plus act as a reference guide for cardiac surgeons with interest in SVR. The authors review normal and abnormal cardiac anatomy following post myocardial infarction and physiology, with focus on the evolution of surgical techniques aimed at establishing an ellipsoid ventricular shape, resulting in near-normal physiological hemodynamics evident at long term.

Abstrak :
Therapeutic hypothermia has emerged as a very important treatment option for patients with cardiac arrest as it provides significant protection from developing neurologic injury once the patient has been successfully resuscitated. Studies have demonstrated over 15% absolute risk reduction in death and neurologic injury using this therapy. Although hospitals and medical centers have become familiar with this important intervention it still remains greatly under utilized due to an experience and lack of resources to safely and effectively deploy such a program. The objective of this book is to educate and familiarize both providers and institutions as to how to develop and deploy and provide therapeutic hypothermia to their patients. The current knowledge for this is provided by speakers and national experts and also by literature review. There are several courses being provided on this as well throughout the US. These are good venues for people to come and see and get hands on experience, but there still needs to be a concrete book with references on how to go about getting this program started.

Abstrak :
Tetralogy of fallot is the most common form of cyanotic congenital heart disease, and one of the first to be successfully repaired by congenital heart surgeons. Although “fixed”, patients born with tetralogy of fallot cannot be considered “cured”. Improving survival and quality of life for this ever-increasing adult population will continue to challenge the current and future generations of cardiologists. Adult patients with tetralogy of fallot should be seen by a cardiologist specializing in the care of adults with congenital heart disease, to be monitored for late complications. They need to be checked regularly for any subsequent complications or disturbances of heart rhythm. This monograph is intended as both an introduction to the subject and a timely, comprehensive review, and will be welcomed by adult cardiologists, pediatric cardiologists, internists, surgeons, obstetricians, and intensivists who wish to learn about the most recent discoveries and advances concerning tetralogy of Fallot in adults. It will also be of interest to advanced undergraduates wanting to learn more about the subject.

Abstrak :
Approximately 120 different surgical procedures are used to correct congenital heart diseases, and the burden that this places on the surgeon is compounded by the exceptional complexity of the techniques and the rarity of many of the lesions. Training is problematic, not least because of legal issues, and currently available texts, drawings, and images are no substitute for real ‘live’ surgery. Against this background, the authors have set out to create an interactive multimedia manual that covers many aspects of congenital heart surgery. Each heart defect is addressed in an individual chapter, elaborating specific surgical anatomy and indication for surgery of heart defect first, followed by video clips depicting the operative approach and technique. The clips are accompanied by a clear descriptive narrative, and patient history and diagnostic images are available to provide a clear backdrop to the operation.