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"ABSTRAKLatar belakang dan tujuan: Modalitas radiografi toraks merupakan pemeriksaanrutin dan tersedia di hampir setiap rumah sakit. Pengukuran secara kuantitatifberupa vascular pedicle width (VPW), cardiothoracic ratio (CTR) maupunvascular pedicle-thoracic ratio (VPTR) melalui radiografi toraks dapat membantudalam membedakan jenis edema paru dengan mengetahui titik potong rerataVPTR berdasarkan kombinasi VPW dan CTR. Metode: Penelitian dilakukan retrospektif dengan descriptive cross sectional pada100 pasien dengan klinis edema paru yang telah melakukan radiografi toraks diICU Rumah Sakit CiptoMangunkusumo (RSCM) dalam rentang waktu Januari2013 ? Desember 2015. Subjek dibagi menjadi edema kardiogenik dan nonkardiogenik berdasarkan kombinasi pengukuran VPW dan CTR. Kemudiandilakukan pengukuran VPTR dan ditentukan titik potong rerata VPTR, sensitivitasdan spesifisitas berdasarkan kombinasi VPW dan CTR dalam membedakan edemaparu.Hasil: Dari total 100 subjek penelitian di ICU RSCM dengan metode ReceiverOperating Curve (ROC) didapatkan titik potong VPTR sebesar 25,1% dengansentivitas 90,5% dan spesifisitas 86,1% dalam membedakan edema parukardiogenik dan non kardiogenik. Selain itu diperoleh juga proporsi edema parukardiogenik sebesar 21%, sedangkan edema paru non kardiogenik sebesar 79%.Kesimpulan: Titik potong VPTR berdasarkan kombinasi VPW dan CTR memilikisensitivitas dan spesifisitas yang cukup tinggi dalam membedakan edema parukardiogenik dan non kardiogenik.

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ABSTRACTBackground and purpose: Pulmonary edema in critically ill patient werechallenging in intensive care unit (ICU). Radiography of thorax is routineexamination and widely available in almost every hospital. Measurementquantitatively of vascular pedicle width (VPW), cardiothoracic ratio (CTR) andvascular pedicle-thoracic ratio in thorax radiography can help in differentiatingthe type of pulmonary edema through the cut off of VPTR based on combinationVPW and CTR. Methods: Descriptive cross sectional restrospective in 100 patients with clinicallypulmonary edema which have examined by thorax radiography at ICU RSCM inJanuary 2013 to Desember 2015. Subject divided to cardiogenic and noncardiogenic pulmonary edema based on combination VPW and CTR. Then,VPTR were measured and the cut off of VPTR determined based on combinationVPW and CTR in differentiaiting pulmonary edema.Results: From total 100 subject study at ICU RSCM using Receiver OperatingCurve (ROC) metode, the cut off of VPTR is 25,1% with sensitivity 90,5% andspecificity 86,1% in differentiating cardiogenic and non cardiogenic pulmonaryedema. Beside that, the prevalence of cardiogenik pulmonary edema is 21% andnon cardiogenic pulmonary edema is 79%.Conclusion : The cut off of VPTR based on combination VPW and CTR havesignificant sensitivity and specificity in differentiating cardiogenic and noncardiogenic pulmonary edema."

"Resusitasi cairan yang berlebihan selama pengobatan awal syok septik pediatri berhubungan dengan komplikasi seperti edema paru dan disfungsi organ. Pada pasien dewasa, penggunaan vasopresor dini dianjurkan untuk mengembalikan perfusi tanpa menyebabkan kelebihan cairan. Namun, penelitian mengenai penggunaan awal norepinefrin (NE) pada anak dengan syok sepsis masih terbatas. Penelitian ini bertujuan untuk menilai pengaruh pemberian NE dini terhadap jumlah cairan resusitasi, kadar laktat, dan kejadian edema paru pada anak dengan syok sepsis. Penelitian ini merupakan uji klinis acak dengan label terbuka yang dilakukan di satu pusat yaitu RS Cipto Mangunkusumo Jakarta pada bulan Maret hingga Mei 2024. Penelitian ini melibatkan 42 pasien anak dengan sepsis. Peserta dibagi secara acak menjadi dua kelompok: kelompok intervensi yang menerima loading cairan dengan tambahan NE dini 0,1 mcg/kg/menit (n=21) dan kelompok kontrol yang mendapat loading cairan sesuai protokol standar (n=21). Parameter jumlah cairan yang diberikan, kadar laktat, edema paru, dan hemodinamik dievaluasi dengan melakukan pemeriksaan klinis serta pemeriksaan USCOM, dan ultrasonografi paru. Hasil penelitian didapatkan bahwa pemberian NE sejak awal resusitasi tidak terbukti mengurangi jumlah cairan resusitasi pada anak dengan syok sepsis yang bermakna, namun tren jumlah cairan resusitasi lebih sedikit pada kelompok perlakuan dibanding kelompok kontrol (p=0,060), Selain itu, juga tidak terbukti adanya perbedaan kadar laktat pasca-pemberian NE dini dibandingkan kontrol [8/21(38%) vs 4/21 (28,6%), p=0,306], serta tidak terbukti adanya perbedaan kejadian edema paru pasca-pemberian NE dini dibandingkan kontrol [7/21 (33%) vs 5/21 (24%); p=0,734]. Sedangkan untuk pengukuran stroke volume index, cardiac index, dan systemic vascular resistancy index, tidak terbukti terdapat perbedaan antara kelompok loading cairan ditambah NE dini dengan kelompok loading cairan saja. Simpulan dari penelitian ini adalah pemberian NE dini tidak terbukti mengurangi jumlah cairan resusitasi pada anak dengan syok sepsis, namun tren jumlah cairan resusitasi lebih sedikit.

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Excessive fluid resuscitation during initial treatment of pediatric septic shock is associated with complications such as pulmonary edema and organ dysfunction. In adult patients, early use of vasopressors is recommended to restore perfusion without causing fluid overload. However, research on the early use of norepinephrine (NE) in children with septic shock is limited. This study aims to assess the effect of early NE administration on the amount of resuscitation fluid, lactate, and pulmonary edema in children with septic shock. This study was a single-site, randomized, open-label clinical trial conducted at Cipto Mangunkusumo Hospital, Jakarta from March to May 2024. This study involved 42 pediatric patients with sepsis. Participants were divided randomly into two groups: the intervention group received fluid loading with additional early NE 0.1 mcg/kg/minute (n=21), the control group received fluid loading according to standard protocol (n=21) Parameters such as the amount of fluid administered , lactate levels, pulmonary edema, and hemodynamics were evaluated using clinical examination, USCOM, and lung ultrasonography. The research results showed that it was not proven to reduce the amount of resuscitation fluid in children with septic shock, but the trend was that the amount of resuscitation fluid was less in the treatment group than the control group (p=0.060), it was not proven that there was no increase in lactate levels after early NE administration compared to controls [8/21 (38%) vs 4/21 (28.6%), p=0.306], and there was no proven difference in the incidence of pulmonary edema after early NE administration compared to controls [7/21 (33%) vs 5/21 (24%) ; p=0.734]. Meanwhile, measurements of stroke volume index, cardiac index, and systemic vascular resistance index did not prove to be a difference between the fluid loading plus early NE group and the fluid loading only group. The conclusion of this study is that early NE administration is not proven to reduce the amount of resuscitation fluid in children with septic shock, but the trend for the amount of fluid to be less."