Hasil Pencarian  ::  Simpan CSV :: Kembali

"Latar belakang: Renjatan merupakan masalah utama di ruang emergensi dan rawat intensif anak. Resusitasi cairan pada renjatan hanya memberikan repons pada 50% pasien. Pemberian cairan yang berlebih akan meningkatkan morbiditas dan mortalitas. Indeks dinamis memiliki keterbatasan dalam memprediksi fluid responsiveness. Left Ventricular End Diastolic Volume Index (LVEDVI) belum banyak diteliti dan dapat mengatasi keterbatasan indeks dinamis.Tujuan: Mengidentifikasi peran LVEDVI sebagai prediktor fluid responsiveness terhadap pemberian cairan resusitasi pada anak dengan renjatan.Metode: Ini adalah penelitian uji diagnostik-potong lintang pada anak dengan renjatan di ruang emergensi dan rawat intensif anak RSUPN Cipto Mangunkusumo Juni hingga November 2018. Pengukuran LVEDVI dilakukan menggunakan USCOM dan dibandingkan dengan peningkatan isi sekuncup ≥15% setelah fluid challenge sebagai kriteria fluid responsive. Sampel dimasukkan ke dalam kelompok fluid responsive dan fluid nonresponsive.Hasil: Dari 40 subyek penelitian, didapatkan 60 sampel fluid challenge. Terdapat 31 sampel di kelompok fluid responsive dan 29 sampel di kelompok fluid nonresponsive. Tidak terdapat perbedaan bermakna rerata LVEDVI pada kedua kelompok (p=0,161). Nilai AUROC LVEDVI 40,9% pada titik potong 68,95 mL/m², dengan sensitivitas 45,16% dan spesifisitas 44,83%.Simpulan: Penelitian ini tidak dapat membuktikan LVEDVI dapat berperan sebagai prediktor fluid responsiveness.

---

Background: Shock is a major problem in the Pediatric Emergency and Intensive Care Unit. Fluid resuscitation for shock only provides response in 50% of patients. Excessive fluid administration will increase morbidity and mortality. Dynamic indexes have limitations in predicting fluid responsiveness. Left Ventricular End Diastolic Volume Index (LVEDVI) has not been widely studied and can overcome the limitations of dynamic indexes.Objective: To identify LVEDVI as a predictor of fluid responsiveness in children with shock.Method: This was a cross-sectional diagnostic study in children with shock in the emergency room and pediatric intensive care unit of Cipto Mangunkusumo Hospital RSUPN from June to November 2018. The LVEDVI measurements were performed using USCOM and compared with an increase in stroke volume ≥15% after fluid challenge as fluid responsiveness criteria. Sample then categorized into fluid responsive and fluid nonresponsive group.Results: Of 40 subjects, 60 fluid challenge samples were obtained. There were 31 samples in the fluid responsive group and 29 in the fluid nonresponsive group. There was no significant mean difference of LVEDVI in the two groups (p=0.161). The AUROC of LVEDVI is 40,9% with cut off value of 68,95mL/m². The sensitivity and specificity are 45,16% and 44,83% respectively.Conclusion: This study cannot prove LVEDVI can act as a predictor of fluid responsiveness."

"Latar belakang: Penilaian fluid responsiveness merupakan masalah dalam tatalaksana pasien, terutama pasien dengan penyakit kritis. Stroke volume variation (SVV) adalah parameter hemodinamik untuk menilai fluid responsiveness. Pengukuran SVV dapat dilakukan dengan USCOM, yang merupakan alat pemantauan hemodinamik non invasif berbasis ekokardiografi DopplerTujuan: Mengetahui nilai cut-off point (titik potong optimal) SVV dengan USCOM sebagai prediktor fluid responsiveness pada pasien yang bernapas spontan maupn dengan ventilasi mekanik.Metode: Penelitan dilaksanakan di Pediatric Intensive Care Unit (PICU) dan UGD (Unit Gawat Darurat). Penelitian ini merupakan uji diagnostik dengan menggunakan peningkatan stroke volume (SV) setelah challenge cairan ringer laktat 10 ml/kg berat badan selama 15 menit sebagai indek. Subyek penelitian baik yang bernapas spontan maupun dengan ventilasi mekanik. Peningkatan nilai SV ≥10% disebut responder dan < 10% disebut non responder. Pengukuran SV dengan USCOM dilakukan sebelum dan setelah challenge, dan pengukuran SVV dilakukan sebelum challenge cairan.Hasil: Sebanyak 73 pengukuran terhadap subyek di PICU dan UGD. Area under curve (AUC) untuk seluruh subyek adalah 85,6% (95% IK 77,1% - 94,1%), p < 0,05. Titik potong optimal SVV adalah 28,5%, dengan sensitivitas 81,8% dan spesisifitas 75,9%. AUC subyek ventilasi mekanik adalah 76,6% (95% IK 60,1%-93,1%), p < 0,05. Titik potong optimal SVV adalah 30%, dengan sensitivitas 72,7% dan spesisifitas 70%. AUC subyek dengan pernapasan spontan adalah 93,7% (95% IK 84,6% - 100%), p < 0,05. Titik potong optimal SVV 28,5%, dengan sensitivitas 90,9% dan spesisifitas 84,2%.Simpulan USCOM memilki validitas yang baik untuk menilai SVV baik pada pasien bernapas spontan maupun dengan ventilasi mekanik.

---

Background: Assessment of fluid responsiveness is a problem in the management of patients, particularly patients with critical illness. Stroke volume variation (SVV) is a hemodynamic parameter to assess fluid responsiveness. Measurement of SVV could be done by USCOM, which is a non-invasive hemodynamic monitoring tool based on Doppler echocardiography.Objective: To determine the optimal SVV cut-off point measured by USCOM as a predictor of fluid responsiveness in spontaneously breathing and mechanically ventilated patients.Methods: Research was conducted in the pediatric intensive care unit (PICU) and emergency room (ER). This study is a diagnostic test based on the increment of stroke volume (SV) after fluid challenge using Ringer's lactate 10 mL / kg body weight for 15 minutes as an index. The subjects are both spontaneously breathing and mechanically ventilated patients. Responders are those who experienced increment ≥10% from baseline SV, and non-responders are those who did not meet the criteria. Measurements of SV using USCOM were performed before and after fluid challenge, meanwhile SVV measurement was performed before fluid challenge.Results: A total of 73 measurements were performed at the PICU and ER. Area under the curve (AUC) for all subjects was 85.6% (95% CI 77.1% - 94.1%), p value <0.05. Optimal SVV cut-off point was 28.5%, with sensitivity of 81.8% and specificity 75.9%. In mechanically ventilated subgroup, the AUC was 76.6% (95% CI 60.1% -93.1%), p value <0.05. The optimal SVV cut-off point of this group was 30%, with sensitivity of 72.7% and specificity of 70%. Lastly, the AUC of subjects with spontaneous breathing was 93.7% (95% CI 84.6% - 100%), p value <0.05. The optimal SVV cut of point in this group was 28.5%, with sensitivity of 90.9% and specificity of 84.2%.Conclusion: USCOM is valid for assessing SVV as a fluid responsiveness predictor, in patients with spontaneous breathing and mechanical ventilation."

"Latar Belakang: Morbiditas dan mortalitas akibat renjatan pada anak di seluruh dunia dilaporkan masih tinggi. Pengenalan dini dan tatalaksana yang tepat penting untuk menurunkan morbiditas dan mortalitas akibat renjatan. Indikator penting untuk mendeteksi hipoksia jaringan global adalah pengukuran saturasi oksigen mixed vein (SmvO₂) dari kateter arteri pulmonal atau vena sentral namun kedua pemeriksaan ini sulit dan invasif sehingga tidak rutin dilakukan. Near infrared spectroscopy (NIRS) merupakan alternatif pemeriksaan non invasif, real time, kontinu dan praktis untuk mengukur saturasi oksigen regional sekaligus menggambarkan saturasi oksigen vena global.Tujuan: Mengetahui kenaikan nilai NIRS serebral pascarenjatan teratasi serta korelasinya dengan perubahan parameter hemodinamik non invasif.

Metoda: Penelitian potong lintang pada anak usia 1 bulan-18 tahun yang mengalami renjatan di RSUPN Cipto Mangunkusumo, RSUD Pasar Rebo dan RSUD Tarakan pada bulan Maret-Juni 2019. Terhadap subjek yang mengalami renjatan dilakukan pengukuran NIRS serebral, MAP, serta pengukuran non invasif Cardiac Index (CI), Systemic Vascular Resistance Index (SVRI), Delivery Oxygen (DO₂), Inotrophy Index (INO), Stroke Volume Index (SVI) menggunakan Ultrasonic Cardiac Output Monitoring (USCOM) pada saat renjatan dan diulang ketika renjatan teratasi. Uji korelasi dilakukan untuk menilai hubungan antara perubahan nilai NIRS serebral dan parameter hemodinamik non invasif.

Hasil: Dari 32 subjek yang diteliti ditemukan peningkatan nilai NIRS serebral sebesar 27,7% pascarenjatan teratasi. Parameter hemodinamik, kecuali untuk SVRI, juga mengalami peningkatan pasca renjatan namun tidak berkorelasi dengan peningkatan nilai NIRS.

Simpulan: Hasil pengukuran NIRS serebral menggambarkan perfusi dan oksigenasi ke jaringan perifer namun tidak berkorelasi dengan parameter hemodinamik non invasif pada penelitian ini.

Kata kunci: Near infrared spectroscopy; parameter hemodinamik non invasif; renjatan; USCOM

---

Background: Pediatric shock accounts for significant morbidity and mortality worldwide. Early recognition and timely intervention are critical for successful treatment of pediatric shock. A strong indicator of global tissue hypoxia by measuring mixed venous oxygen saturation from pulmonary artery catheter (PAC) or central vein catheter (CVC) is rarely used due to its highly invasive character. Near infrared spectroscopy (NIRS) is a noninvasive, real time, continuous and practical modality is a safe alternative for regional and global oxygen saturation measurement.

Objective: To evaluate the increment of cerebral NIRS post-resuscitation in pediatric shock and its correlation with noninvasive hemodynamic measurements.

Methods: This cross sectional study was conducted at Cipto Mangunkusumo Hospital, Pasar Rebo Hospital and Tarakan Hospital between March and June 2019. Children whose age ranged from1 month to 18 years admitted to Emergency Department (ED) or Pediatric Intensive Care Unit (PICU) due to shock were included. Measurement of cerebral NIRS, MAP, as well as Cardiac Index (CI), Systemic Vascular Resistance Index (SVRI), Delivery Oxygen (DO₂), Inotrophy Index (INO), Stroke Volume Index (SVI) using Ultrasonic Cardiac Output Monitoring (USCOM) were performed on admission and after resuscitation when the shock has resolved and the patients were stable. Correlation between cerebral NIRS and other noninvasive hemodynamic parameters were then analysed.

Results: There were 32 subjects participated in this research. Following resuscitation, cerebral NIRS measurements showed an increment of 27,7% compared to cerebral NIRS in shock state. All non invasive hemodynamic parameters, except for SVRI, were also increased after resuscitation but no correlation observed between these parameters to cerebral NIRS (p>0,005).

Conclusion: Cerebral NIRS is a sensitive parameter of peripheral perfusion but showed not correlation with hemodynamic parameters in this research."

"

Syok pada anak masih menjadi masalah utama karena mortalitas yang tinggi. Penilaian respons terhadap resusitasi cairan dapat menggunakan parameter klinis dan parameter hemodinamik invasif maupun non-invasif. Modalitas ultrasound cardiac output monitor (USCOM) pada populasi anak dengan syok memiliki korelasi yang baik dengan baku emas parameter hemodinamik invasif, tetapi memiliki beberapa keterbatasan. Modalitas lain yang semakin berkembang yaitu menggunakan point of care ultrasound (POCUS), dengan salah satu penilaian yang dapat dilakukan adalah pemeriksaan indeks kolapsibilitas vena jugularis interna (IKVJI). Tujuan penelitian ini adalah mengetahui hubungan antara stroke volume dengan IKVJI dalam menilai respons resusitasi cairan pada anak syok. Penelitian ini menggunakan desain observasional analitik, dilakukan di RSUPN Cipto Mangunkusumo pada bulan Maret hingga Juni 2024. Subyek penelitian adalah anak usia 1 bulan hingga 18 tahun yang mengalami syok yang memenuhi kriteria inklusi. Parameter klinis, penilaian stroke volume dengan USCOM dan IKVJI dinilai sebelum dan sesudah resusitasi cairan. Berdasarkan analisis studi didapatkan 47 subyek sampel penelitian, 27 orang perempuan (57,4%), dengan median usia 82,9 (4,0–212,0) bulan. Status gizi, terbanyak adalah gizi baik (42,6%). Diagnosis terbanyak adalah syok hipovolemik (74,5%) diikuti syok sepsis (25,5%). Sebanyak 2 pasien meninggal dalam 24 jam pertama.  Pemantuan post-resusitasi cairan menunjukkan perbaikan laju nadi, tekanan darah, dan mean arterial pressure (p<0,0001), peningkatan nilai stroke volume (p<0,0001), dan perubahan nilai IKVJI (p<0,0001). Korelasi delta stroke volume dan delta IKVJI adalah negatif lemah (r=-0,309, p=0,035). Korelasi MAP dan IKVJI juga negatif lemah  (r=-0,359, p=0,013).

---

Shock in children is still a major problem due to high mortality. Assessment of the response to fluid resuscitation can be done using clinical and hemodynamic parameters through invasive and non-invasive tools. The ultrasound cardiac output monitor (USCOM) among children with shock has a good correlation with the gold standard of invasive hemodynamic parameters but has some limitations. Another commonly used modality is point-of-care ultrasound (POCUS), with one of the assessments being the examination of the internal jugular vein collapsibility index (IJV-CI). The aim of this study is to determine the correlation between stroke volume and IJV-CI changes in order to assess fluid responsiveness in children with shock. Between March and June 2024, an analytical observational study was undertaken in the emergency department and pediatric intensive care unit of a tertiary referral hospital. The study subjects were children aged 1 month to 18 years who experienced shock and met the inclusion criteria. A thorough history taking, physical examination, and stroke volume assessment using the Ultrasonic Cardiac Output Monitor, and IJV-CI utilizing ultrasound before and after fluid resuscitation were conducted. This study included 47 subjects, of which there were 27 females (57.4%), with a median age of 82.9 (4.0–212.0) months. For nutritional status, most were normal (42.6%). The most common diagnosis was hypovolemic shock (74.5%) followed by septic shock (25.5%). Mortality in the first 24 hours was 2 patients. After fluid resuscitation, there was an improvement in pulse rate, blood pressure, and mean arterial pressure (p<0.0001), as well as increased stroke volume post fluid resuscitation (p<0.0001) and changes in IJV-CI post fluid resuscitation (p<0.0001). The correlation between stroke volume delta and IJV-CI delta was negative and weak (r=-0.309, p=0.035). The correlation between IJV-CI and MAP was also negative and weak (r=-0.359, p=0.013).

 

"

"Latar belakang : Anemia akut sering terjadi pada anak sakit kritis yang dirawat diPICU, memiliki konsekuensi hipoksia global yang dapat mengakibatkan disfungsimiokardium. Transfusi PRC masih menjadi salah satu pilihan dalam rangkamemperbaiki oksigenasi dan kinerja jantung saat terjadi anemia. Bukti-bukti pengaruhtransfusi pada perbaikan performa jantung masih terbatas.Tujuan : Mengevaluasi kadar NT-proBNP, pasokan oksigen, indeks inotropi dan rasioenergi potensial:energi gerak pada jantung sebelum dan sesudah transfusi PRC padaanak sakit kritis yang mengalami anemia akut.Metode : Penelitian analitik observasional potong lintang sejak April sampai Agustus2019 pada anak usia 1 bulan-18 tahun dengan sakit kritis yang dirawat di PICURSUPN Dr. Cipto Mangunkusumo. Penilaian hemodinamik menggunakan USCOM.Hasil : Penelitian ini melibatkan 31 subyek dengan median umur 3,6 tahun (rentang0,1-17,5 tahun). Kadar Hb naik sebesar 29,1±15,9% setelah mendapat transfusi PRC9±3,3 mL/KgBB. Rerata kadar hemoglobin sebelum dan sesudah transfusi adalah7,94±1,46 dan 10,17±1,92 g/dL (p<0,000 IK 95%: 1,80-2,64). Kadar NT-proBNPmeningkat tak bermakna sebesar 12% (-77,0-199) setelah transfusi dari 4214±6678menjadi 5182±8327 pg/mL (p=0,186 IK 95%: -493-2428). Tidak terdapat korelasiantara persen perubahan Hb dan NT-proBNP (Spearman correlation r=0,124; p=0,505).Terdapat kenaikan pasokan oksigen pasca transfusi sebesar 20,7±38,9% dan berkorelasidengan kanaikan hemoglobin (Pearson correlation r=0,39; p=0,029). Uji Chi-squaremenunjukkan adanya hubungan bermakna antara kelompok yang mengalami kenaikanDO dengan perbaikan indeks inotropi (uji Chi square, p=0,031) dan perbaikan PKR(p=0,008), namun tak ada hubungan dengan perubahan NT-proBNP (p=0,511).Simpulan : Tidak terdapat perubahan bermakna kadar NT-proBNP sebelum dansesudah transfusi PRC pada anak sakit kritis yang mengalami anemia akut. Peningkatanpasokan oksigen pasca transfusi PRC berkorelasi dengan peningkatan indeks inotropi(Smith-Madigan Inotropy Index) dan perbaikan potensial to kinetic ratio (PKR)

---

Background: Acute anemia often occurs in critically ill children in PICU, which hasglobal hypoxic consequences resulting myocardial dysfunction. Transfusion of PRC isstill choosen in order to improve oxygenation and cardiac performance during anemia.Evidence of the effect of transfusion on improving cardiac performance is still limited.Objective: To evaluate NT-proBNP levels, delivery oxygen (DO2), inotropy index andthe potential to kinetic energy ratio (PKR) of heart before and after PRC transfusion incritically ill children with acute anemia.Methods: A cross-sectional observational analytic study conducted from April toAugust 2019 in children aged 1 month-18 years cared in PICU Dr. CiptoMangunkusumo Hospital. Hemodynamic assessment using USCOM.Results: This study involved 31 subjects with a median age of 3.6 years (range 0.1-17.5years). Hb levels increased by 29.1±15.9% after receiving a 9±3.3 mL / KgBBtransfusion PRC. The mean hemoglobin levels before and after the transfusion were7.94±1.46 and 10.17±1.92 g / dL (p <0.000; CI 95%: 1.80-2.64). NT-proBNP levelsslight increased but not statistically sgnificant by 12%(-77.0 - 199) after PRCtransfusion from 4214±6678 to 5182±8327 pg/mL (p = 0.186; CI 95%: -493 - 2428).There was no correlation between percent change in Hb and NT-proBNP (Spearmancorrelation r=0.124; p=0.505). There was increasing in DO2 after transfusion by20.7±38.9% and correlated with increased hemogolobin (Pearson correlation r=0.39;p=0.029). Chi-square test showed a significant relationship between groups thatexperienced an increase in DO2 with an improvement in the inotropy index (Chi squaretest, p=0.031) and improvement in PKR (p=0.008), but there was no relationship withNT-proBNP changes (p=0.511) .Conclusions: There was no significant change in NT-proBNP levels before and afterPRC transfusion in critically ill children who had acute anemia. Increased DO2 afterPRC transfusion correlates with an increase in the inotropy index (Smith-MadiganInotropy Index) and improvement in potential to kinetic ratio (PKR)."