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Abstrak :
Peran NT-proBNP sebagai penanda biologis untuk mengetahui terjadinya sindrom curah jantung rendah pada pasien pediatrik dengan penyakit jantung bawaan sianotik pascabedah jantung terbuka belumlah diketahui. NT-proBNP diharapkan dapat menjadi penanda sindrom curah jantung rendah sehingga dapat mengurangi morbiditas dan mortalitas. Penelitian cross sectional ini melibatkan 40 pasien pediatrik dengan penyakit jantung bawaan sianotik yang menjalani pembedahan jantung terbuka di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita, selama bulan Maret 2019-April 2019. Terdapat perbedaan bermakna antara kadar NT-proBNP prabedah, 4 jam pascabedah, 24 jam pascabedah dan 72 jam pascabedah terhadap kejadian sindrom curah jantung rendah (p<0,001). Kadar NT-proBNP tertinggi pada 24 jam pasca bedah dengan perbedaan bermakna terhadap kadar NT-proBNP prabedah (p<0,001), 4 jam pascabedah dan 72 jam pascabedah (p<0,001). Diperoleh pula variabel lain yang berhubungan secara bermakna dengan NT-proBNP yaitu usia, berat badan, jenis penyakit jantung bawaan sianotik, lama aortic cross clamp, lama cardiopulmonary bypass, lama ventilasi mekanik dan lama rawat PICU. Dapat disimpulkan bahwa kadar NT-proBNP yang tinggi sebagai penanda kejadian sindrom curah jantung rendah. ......The role of NT-proBNP as a biological marker to determined the occurrence of low cardiac output syndromes in pediatric patients with cyanotic congenital heart disease after open heart surgery was unknown. NT-proBNP was expected to be a marker of low cardiac output syndrome so that it can reduce morbidity and mortality. This cross-sectional study involved 40 pediatric patients with cyanotic congenital heart disease who underwent open heart surgery at National Cardiovascular Centre Harapan Kita, during March 2019-April 2019. There were significant differences between pre-operative levels of NT-proBNP, 4 hours postoperatively, 24 hours postoperatively and 72 hours postoperatively with the incidence of low cardiac output syndrome (p <0.001). The highest NT-proBNP level was 24 hours postoperatively with a significant difference in preoperative levels of NT-proBNP (p <0.001), 4 hours postoperatively and 72 hours postoperatively (p <0.001). Other variables that were significantly associated with NT-proBNP were age, body weight, type of cyanotic congenital heart disease, duration of aortic cross clamp, duration of cardiopulmonary bypass, duration of mechanical ventilation and length of stay of PICU. It can be concluded that high NT-proBNP level as a marker of low cardiac output syndrome.

Abstrak :
Latar belakang: Penyakit jantung bawaan merupakan jenis kelainan bawaan lahir paling umum, dan merupakan penyebab kematian tersering pada bayi. Sindrom curah jantung rendah masih merupakan masalah yang dihadapi pada subjek pediatrik pascaoperasi jantung terbuka. Deteksi sindrom curah jantung rendah dengan kriteria klinis dan indikator laboratorik masih dirasa belum cukup, yang terbukti dengan masih adanya angka morbiditas dan mortalitas. Peranan penanda biologis NT-proBNP diharapkan dapat digunakan untuk dapat mendeteksi sindrom curah jantung rendah pada pediatrik. Metode: Penelitian pendahuluan kohort retrospektif dengan jumlah 47 subjek yang memenuhi kriteria inklusi dan eksklusi yang menjalani pembedahan jantung terbuka paliatif; PA banding, Bidirectional cavopulmonary shunt, BT-shuntdan Fontan, pada periode Oktober 2019 hingga Maret 2020 di Rumah Sakit Jantung dan Pembuluh darah Nasional Harapan Kita, Indonesia. Data prabedah, intrabedah dan pascaoperasi termasuk kejadian sindrom curah jantung rendah dicatat. Kadar NT-proBNP akan diambil prabedah, 4 jam, 24 jam dan 72 jam pascaoperasi. Analisis data menggunakan uji Mann-Whitney. Hasil: Kadar NT-proBNP pada prosedur palitif khususnya Fontan pada prabedah (137 pg/ml), 4 jam pascaoperasi (685 pg/ml), 24 jam pascaoperasi (5.715 pg/ml), dan 72 jam pascaoperasi (970 pg/ml). Kadar NT-proBNP prabedah, 4 jam pascaoperasi, 24 jam pascaoperasi, dan 72 jam pascaoperasi tidak berbeda bermakna dengan kejadian sindrom curah jantung rendah (nilai p >0,05). Kesimpulan: Ditemukan peningkatan nilai NT-Pro BNP pada subjek pascaoperasi jantung paliatif khususnya Fontan dan bidirectional cavopulmonary shunt yang mengalami sindrom curah jantung rendah pada jam ke-24. Namun kesimpulan diatas masih berdasarkan jumlah sampel dengan kekuatan penelitian <80% sehingga hanya berlaku sebagai kesimpulan sementara berdasarkan studi pendahuluan. ...... Background: Congenital heart disease is the most common type of birth defects, and is the most common cause of death in infants. Cardiac syndrome is still a problem faced by pediatric patients after heart surgery. Detection of Low Cardiac Output Syndrome with clinical criteria and laboratory indicators is still considered insufficient, which is proven to still contain morbidity and mortality rates. The role of NT-proBNP biological markers is expected to be used to support the detection of low cardiac output syndrome in pediatrics. Methods: A Preliminary retrospective cohort with 47 subjects fulfilling the inclusion and exclusion criteria who underwent palliative open heart surgery PA banding, Bidirectional cavopulmonary shunt, BT-shunt and Fontan from October, 2019 to March, 2020 at the Harapan Kita National Heart and Vascular Hospital, Indonesia. Preoperative, operative and postoperative data including the incidence of low cardiac output syndrome were recorded. NT-proBNP levels will be taken pre-surgery, 4 hours, 24 hours and 72 hours after surgery. Data analysis using the Mann-Whitney test. Results: NT-proBNP levels in the cardiac palliative surgery especially Fontan procedure at pre-surgery (137 pg/mL), 4 hours after surgery (685 pg/mL), 24 hours after surgery (5,715 pg/mL), and 72 hours after surgery (970 pg/mL). NT-proBNP levels at pre-surgery, 4 hours after surgery, 24 hours after surgery, and 72 hours after surgery were not significantly different from the incidence of low cardiac output syndrome (p value> 0.05). Conclusion: There is an increase in NT-Pro BNP values ​​in subjects with Fontan palliative heart surgery and bidirectional cavopulmonary shunt. However, the above conclusions are still based on the number of samples with research powers<80% and can only be taken as a provisional conclusion based on preliminary studies.

Abstrak :
ABSTRAK
Tujuan : Koreksi transatrial-transpulmonary tanpa transannular patch (TA-TP tanpa TAP) memiliki keuntungan berupa preservasi annulus katup pulmonal dan fungsi ventrikel kanan, Namun sering terjadi gradien RV-PA dan pRV/LV ratio yang masih tinggi sehingga terjadi low cardiac output syndrome (LCOS). Penelitian ini bertujuan untuk mencari batasan gradien RV-PA dan pRV/LV ratio yang merupakan nilai prediktif terbaik terhadap kejadian LCOS pascakoreksi tetralogi Fallot TA-TP tanpa TAP. Metode : Pada bulan Oktober 2012 sampai Maret 2013, sebanyak 30 pasien TF menjalani koreksi TF TA-TP tanpa TAP (mean usia 8,37±7,90 tahun). Dilakukan pengukuran gradien RV-PA dan pRV/LV ratio intraoperatif dan postoperatif di ICU. Evaluasi kejadian LCOS dilakukan selama perawatan di ICU. Sebelum pasien pulang, dilakukan pemeriksaan ekokardiografi untuk menilai gradien RV-PA, fungsi ventrikel kanan, defek septum ventrikel residual, derajat regurgitasi katup pulmonal dan katup trikuspid. Hasil : Sebanyak 30 (100%) subjek penelitian memiliki z-value ≥ -1, menjalani koreksi TF TA-TP tanpa TAP. Mean gradien RV-PA intraoperatif adalah 21,13±10,60 mm Hg dan mean pRV/LV ratio intraoperatif adalah 0,53±0,14. Mean gradien RV-PA di ICU adalah 20,83±7,10 mmHg dan mean pRV/LV ratio di ICU adalah 0,49±0,10. Tidak terjadi LCOS pada 30 (100%) subjek penelitian sehingga tidak dapat dilakukan analisis untuk mencari batasan nilai gradien RV-PA dan pRV/LV ratio sebagai nilai prediktif terbaik terhadap kejadian LCOS pascakoreksi TF TA-TP tanpa TAP. Mean gradien RV-PA sebelum subjek penelitian rawat jalan adalah 23,47±6,95 mmHg. Regurgitasi katup pulmonal ringan pada 15 (50%) subjek penelitian dan regurgitasi katup trikuspid trivialmild pada 16 (53%) subjek penelitian. Disfungsi ventrikel kanan ringan 3 (10%), sedang 20 (67%) dan berat pada 7 (23%) subjek penelitian. Mean TAPSE postoperatif adalah 1,03±0,19. DSV residual tidak dijumpai, aritmia tidak dijumpai, reoperasi dan mortalitas tidak ada. Simpulan : Koreksi TF TA-TP tanpa TAP memberikan hasil operasi dini yang baik pada pasien TF dengan z-value katup pulmonal ≥ -1, pRV/LV ratio < 0,5 dan gradien RV-PA < 25 mmHg pascakoreksi.

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ABSTRACT
Objective : The benefits of the transatrial-transpulmonary (TA-TP) without transannular patch (TAP) correction of tetralogy of Fallot (TOF) are preservation of pulmonary valve annulus and right ventricular function. However, TA-TP without TAP correction of TOF had a higher incidence of low cardiac output syndrome (LCOS) because of the high right ventricle and pulmonary artery (RV-PA) pressure gradient and right ventricle and left ventricle pressure (pRV/LV) ratio. The purpose of this study were to analyze the cut off value of RV-PA pressure gradient dan pRV/LV ratio as the best predictor value for postoperative LCOS in TA-TP without TAP correction of TOF. Methods : Between Oktober 2012 and Maret 2013, 30 patients with TOF underwent TATP without TAP correction (mean age 8,37±7,90 years, range 1-27 years). At the end of correction, all patients underwent intraoperative direct measurement of RV-PA pressure gradient and pRV/LV ratio. The patients were evaluated for postoperative LCOS at the Intensive Care Unit (ICU). All the patients underwent echocardiographic examination before hospital discharge. This included investigation of the presence RV-PA pressure gradien, RV function, residual VSD, pulmonary and tricuspid valve insufficiency. Results : Thirty patients with pulmonary valve annulus z-value ≥ -1, underwent TA-TP without TAP correction of TOF. Mean intraoperative RV-PA pressure gradient was 21,13±10,60 mmHg and mean intraoperative pRV/LV ratio was 0,53±0,14. Mean RV-PA pressure gradient measured 24 hours after correction at the ICU was 20,83±7,10 mmHg and mean pRV/LV ratio measured at 24 hours after correction at the ICU was 0,49±0,10. No patient had LCOS, we could not analyze the cut off value of RV-PA pressure gradient and pRV/LV ratio as the best predictor value for postoperative LCOS in this study. No patient had residual VSD. Mean RV-PA pressure gradient before hospital discharge was 23,47±6,95 mmHg. Fifteen (50%) patients had mild pulmonary valve insufficiency and 16 (53%) patients had trivial-mild tricuspid valve insufficiency. Three (10%) patients had mild RV dysfunction. Postoperative mean TAPSE was 1,03±0,19. No patient had arrhythmia, reoperation and mortality in this study. Conclusions : The TA-TP without TAP correction of TOF was applied successfully in 30 patients with pulmonary valve annulus z-value ≥ -1, post-correction RV-PA pressure gradient < 25 mmHg and pRV/LV ratio < 0,5.

Abstrak :
Latarbelakang : Defek septum atrium sekundum (DSAS) adalah salah satu penyakit kongenital yang paling sering dijumpai pada pasien anak dan dewasa. Prevalensi DSAS sebanyak 80 kasus menurut database Bedah pediatrik dan kongenital PJNHK. Salah satu morbiditas pascaoperasi penutupan DSAS yaitu LCOS. LCOS akibat dari volume overload dari atrium-ventrikel kanan dan underload pada atrium-ventrikel kiri. Hal ini mengakibatkan ventrikel kiri akan lebih smallish dibandingkan ventrikel kanan. Kurangnya volume pengisian ke ventrikel kiri yang smallish menyebabkan gangguan fungsi diastolik kiri. Setelah dilakukan penutupan DSAS, aliran darah dari atrium kiri ke atrium kanan akan berhenti dan aliran darah dari atrium kiri ke ventrikel kiri akan meningkat. ventrikel kiri yang smallish akan menerima darah lebih banyak secara tiba-tiba sehingga dapat menyebabkan gagal sirkulasi. Maka dari itu penting untuk mengetahui ukuran volume ventrikel kiri sebelum dilakukan penutupan DSAS untuk menghindari LCOS. MRI merupakan pemeriksaan gold standar untuk mengukur volume ventrikel. Metode : Dilakukan studi kohort retrospektif pada pasien DSAS yang berumur >5 tahun yang memilikidata preoperasi MRI LVEDVi untuk menilai volume ventrikel kiri periode waktu Januari 2018-Desember 2019. Analisis bivariat menggunakan uji student t-test tidak berpasangan. Uji diagnostik menggunakan ROC untuk mendapatkan nilai AUC. Penentuan cut-off point berdasarkan nilai sensitivitas dan spesifisitas yang seimbang kemudian dinilai positive predictive value dan negatif predictive value. Hasil : Terdapat 62 subjek dari penelitian ini Subjek yang mengalami kejadian LCOS di ICU mempunyai rerata LVEDVi 45±7,42mL/m2. Subjek yang tidak mengalami kejadian LCOS rerata LVEDVi 64,15±13,37mL/m2 (p< 0,001). Nilai AUC 96% (95% CI: 92-100%). Nilai cut off LVEDVi terbaik terhadap kejadian LCOS pascaoperasi penutupan DSAS yaitu ≤53,3mL/m2. Memiliki sensitivitas 87,1%, spesifisitas 87,1%, positive predictive value 87,1%, negative predictive value 87,1% dan diagnostic accuracy 87,1%. Simpulan : LVEDVi terbukti dapat dijadikan prediktor kejadian LCOS pascaoperasi penutupan DSAS dengan titik potongyang baik.  Nilai cut off LVEDVi terbaik terhadap kejadian LCOS pascaoperasi penutupan DSAS yaitu 53,3mL/m2. ......Background : SecundumAtrial Septal Defect (ASD) is one of the most common congenital diseases in pediatric and adult patients. The prevalence of secundum ASDis 80 cases according to the NCCHKPediatric and Congenital Surgery database. One of the postoperative morbidity of secundum ASDclosure is LCOS. LCOS results from volume overload from the right atrium-ventricle and underload in the left atrium-ventricle. This results in the left ventricle being smaller than the right ventricle. The lack of filling volume to the smallish left ventricle causes impaired left diastolic function. After secundum ASDclosure, blood flow from the left atrium to the right atrium will stop and blood flow from the left atrium to the left ventricle will increase. The smallish left ventricle will receive more blood suddenly so that it can cause circulation failure. Therefore it is important to know the size of the left ventricular volume before secundum ASDclosure to avoid LCOS. MRI is a gold standard examination to measure ventricular volume. Method : A retrospective cohort study was performed on secundum ASDpatients aged >5 years who had MRI LVEDVi preoperative data to assess the volume of the left ventricle during the January 2018-December 2019 period. Bivariate analysis usingan unpaired student t-testwas done. Diagnostic test uses ROC to get the AUC value. Determination of cut-off points was done based on balanced sensitivity and specificity values, after that we assesspositive predictive value and negative predictive value. Results : There were 62 subjects from this study. Subjects who experienced the occurrence of LCOS in the ICU had an average LVEDVi 45±7,42mL/m2. Subjects who did not experience an LCOShad an averageLVEDVi 64,15±13.37mL/m2 (p <0.001). AUC value of 96% (95%CI: 92-100%). The best LVEDVi cut off value for the incidence of LCOSpostoperative secundum ASDclosureis ≤53.3mL/m2.Ithas a sensitivity of 87,1%, specificity 87,1%, positive predictive value 87,1%, negative predictive value 87,1% and diagnostic accuracy 87,1%. Conclusion : LVEDVi is proven to be a predictor of the occurrence of LCOS events postoperative secundum ASDclosure with good cut points. The best LVEDVi cut off value for the occurrence of LCOS events postoperativesecundum ASDclosure is 53,3 mL/m2.

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.

 

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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.