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Abstrak :
Latar belakang: Sepsis merupakan penyebab kematian dan kesakitan utama di unit perawatan intensif anak. Pemberian bolus cairan masih menjadi pilihan utama dalam mengatasi renjatan sepsis dan digunakan pada panduan tata laksana internasional. Terapi bolus cairan bertujuan memperbaiki pasokan oksigen dengan meningkatkan curah jantung. Bukti yang mendukung panduan tersebut sangat terbatas sehingga menimbulkan kontroversi. Tujuan: Menilai perubahan pasokan oksigen, indeks curah jantung dan hemoglobin pada anak renjatan sepsis yang mendapat bolus cairan saat resusitasi. Metode: Penelitian observasional terhadap 35 subyek dari Februari-Mei 2019 di unit perawatan intensif anak Rumah Sakit Cipto Mangunkusumo (RSCM), Rumah Sakit Umum Daerah (RSUD) Tarakan dan Pasar Rebo Jakarta. Subyek dipilih secara consecutive sampling dan ditata laksana sampai selesai sesuai prosedur yang berlaku. Hasil: Terdapat 23 dari 35 subyek yang mendapat  cairan bolus sampai 40 mL/kg dan 12 subyek hanya mendapat 20 mL/kg. Tidak terdapat perubahan indeks curah jantung dan pasokan oksigen sebelum dan sesudah pemberian cairan bolus (p= 0,235 dan p=0,340). Terdapat perubahan kadar Hb setelah pemberian cairan bolus (p=0,002). Simpulan: Penurunan kadar hemoglobin terjadi setelah pemberian cairan bolus tetapi tidak terbukti menyebabkan perubahan indeks curah jantung dan pasokan oksigen pada penelitian ini. ......Background: Sepsis is a leading cause of morbidity and mortality in children with a worldwide prevalence in pediatric intensive care units. Fluid bolus (FB) is a first line therapy for resuscitation of septic shock and has been recommended in international guidelines. FB aimed to increase delivery oxygen with increasing cardiac output. The supporting evidence based are still limited and controversy. Objective: To evaluate the changing of delivery oxygen (DO₂), cardiac index (CI) and hemoglobin (Hb) in pediatric septic shock after fluid bolus in resuscitation. Methods: An observational study of 35 subject that conducted from February till May 2019 in Pediatric Intensive Care Unit (PICU) Rumah Sakit Cipto Mangunkusumo (RSCM), Rumah Sakit Umum Daerah (RSUD) Tarakan and Pasar Rebo Jakarta. The selection of subject with inclusion criteria through consecutive sampling and managed according to standard operating procedure. Result: There were 23 from 35 subject got 40 mL/kg and 12 subject got 20 mL/kg fluid bolus only. There were no changing of DO₂ and CI after FB (p=0.235;p=0.340) then there was changing of hemoglobin after FB (p=0.002). Conclusion: Hemoglobin decreases after FB without change of CI and DO₂ can be proved in this study.

Abstrak :
Latar belakang : Anemia akut sering terjadi pada anak sakit kritis yang dirawat di PICU, memiliki konsekuensi hipoksia global yang dapat mengakibatkan disfungsi miokardium. Transfusi PRC masih menjadi salah satu pilihan dalam rangka memperbaiki oksigenasi dan kinerja jantung saat terjadi anemia. Bukti-bukti pengaruh transfusi pada perbaikan performa jantung masih terbatas. Tujuan : Mengevaluasi kadar NT-proBNP, pasokan oksigen, indeks inotropi dan rasio energi potensial:energi gerak pada jantung sebelum dan sesudah transfusi PRC pada anak sakit kritis yang mengalami anemia akut. Metode : Penelitian analitik observasional potong lintang sejak April sampai Agustus 2019 pada anak usia 1 bulan-18 tahun dengan sakit kritis yang dirawat di PICU RSUPN Dr. Cipto Mangunkusumo. Penilaian hemodinamik menggunakan USCOM. Hasil : Penelitian ini melibatkan 31 subyek dengan median umur 3,6 tahun (rentang 0,1-17,5 tahun). Kadar Hb naik sebesar 29,1±15,9% setelah mendapat transfusi PRC 9±3,3 mL/KgBB. Rerata kadar hemoglobin sebelum dan sesudah transfusi adalah 7,94±1,46 dan 10,17±1,92 g/dL (p<0,000 IK 95%: 1,80-2,64). Kadar NT-proBNP meningkat tak bermakna sebesar 12% (-77,0-199) setelah transfusi dari 4214±6678 menjadi 5182±8327 pg/mL (p=0,186 IK 95%: -493-2428). Tidak terdapat korelasi antara 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 berkorelasi dengan kanaikan hemoglobin (Pearson correlation r=0,39; p=0,029). Uji Chi-square menunjukkan adanya hubungan bermakna antara kelompok yang mengalami kenaikan DO 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 dan sesudah transfusi PRC pada anak sakit kritis yang mengalami anemia akut. Peningkatan pasokan oksigen pasca transfusi PRC berkorelasi dengan peningkatan indeks inotropi (Smith-Madigan Inotropy Index) dan perbaikan potensial to kinetic ratio (PKR)

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Background: Acute anemia often occurs in critically ill children in PICU, which has global hypoxic consequences resulting myocardial dysfunction. Transfusion of PRC is still 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 and the potential to kinetic energy ratio (PKR) of heart before and after PRC transfusion in critically ill children with acute anemia. Methods: A cross-sectional observational analytic study conducted from April to August 2019 in children aged 1 month-18 years cared in PICU Dr. Cipto Mangunkusumo Hospital. Hemodynamic assessment using USCOM. Results: This study involved 31 subjects with a median age of 3.6 years (range 0.1-17.5 years). Hb levels increased by 29.1±15.9% after receiving a 9±3.3 mL / KgBB transfusion PRC. The mean hemoglobin levels before and after the transfusion were 7.94±1.46 and 10.17±1.92 g / dL (p <0.000; CI 95%: 1.80-2.64). NT-proBNP levels slight increased but not statistically sgnificant by 12%(-77.0 - 199) after PRC transfusion 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 (Spearman correlation r=0.124; p=0.505). There was increasing in DO2 after transfusion by 20.7±38.9% and correlated with increased hemogolobin (Pearson correlation r=0.39; p=0.029). Chi-square test showed a significant relationship between groups that experienced an increase in DO2 with an improvement in the inotropy index (Chi square test, p=0.031) and improvement in PKR (p=0.008), but there was no relationship with NT-proBNP changes (p=0.511) . Conclusions: There was no significant change in NT-proBNP levels before and after PRC transfusion in critically ill children who had acute anemia. Increased DO2 after PRC transfusion correlates with an increase in the inotropy index (Smith-Madigan Inotropy Index) and improvement in potential to kinetic ratio (PKR).