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"[ABSTRAKLatar Belakang : Endotelial glikokaliks merupakan bagian penting dalam barrier vaskular. Keadaan inflamasi, hiperglikemia, iskemia, dan hipervolemia dapat menyebabkan kerusakan glikokaliks. Kerusakan glikokaliks menyebabkan cairan terekstravasasi ke interstisial. Pada pasien pasca BPAK terjadi peningkatan syndecan-1 dalam plasma yang merupakan penanda terjadinya kerusakan endotelial glikokaliks. Hipervolemia pasca BPAK juga dapat memperburuk kerusakan glikokaliks dan hipervolemia sendiri berhubungan dengan kejadian komplikasi mayor pasca operasi. Pemilihan jenis cairan yang tepat diperlukan pada kondisi ini.Tujuan : Mengetahui apakah terdapat perbedaan efek pemberian koloid dan kristaloid terhadap endotelial glikokaliks pada pasien pasca bedah pintas arteri koroner.Metode Penelitian : Penelitian ini merupakan studi intervensi acak pada pasien pasca BPAK dengan pengambilan sampel secara konsekutif. Pasien yang tidak responsif terhadap pemberiaan cairan, memiliki fungsi pompa jantung pre oparasi yang turun, memiliki kelainan fungsi ginjal, atau menggunakan IABP saat operasi akan dieksklusi dari penelitian. Responsivitas terhadap cairan dinilai dengan pemeriksaan Doppler karotis. Pasien kemudian akan diberikan cairan koloid atau kristaloid secara acak. Sampel darah diambil pre dan pasca pemberian cairan. Kadar syndecan-1 diperiksa dengan metode ELISA.Hasil : Subyek penelitian sebanyak 54 orang dengan 27 orang mendapat cairan koloid dan 27 orang mendapat cairan kristaloid. Hasil pemeriksaan syndecan-1 pre pemberian cairan adalah 1,97 (0,29-14,03) ng/ml pada kelompok yang mendapat Gelofusine dan 2,14 (0,68-11,80) ng/ml pada kelompok Ringer?s lactate (p = 0,736). Syndecan-1 pasca pemberian cairan adalah 1,78 (0,23-10,98) ng/ml pada kelompok Gelofusine dan 2,08 (0,72-12,23) ng/ml pada kelompok Ringer?s lactate (p=0,276). Selisih antara syndecan-1 pre dan pasca pemberian cairan adalah 0,23 (-1,3 - 3,55) ng/ml pada kelompok Gelofusine dan 0,14 (-2,12 - 1,80) ng/ml pada kelompok Ringer?s lactate (p = 0,043). Syndecan-1 turun pada 23 pasien (85,5%) kelompok Gelofusine dan 15 pasien (55,6%) kelompok Ringer?s lactate (p = 0,017). Analisis bivariat pada beberapa faktor yang diduga mempengaruhi perubahan syndecan-1 menunjukkan bahwa jenis cairan merupakan satu-satunya faktor yang berpengaruh.Kesimpulan : Penelitian ini membuktikan bahwa terdapat perbedaan efek antara pemberian koloid (Gelofusine) dan kristaloid (Ringer?s lactate) terhadap endotelial glikokaliks pada pasien pasca BPAK. Pemberian koloid dapat lebih memperbaiki kerusakan endotelial glikokaliks yang terjadi pasca BPAK.

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ABSTRACTBackground : Endothelial glycocalyx is an important part of vascular barrier. Inflammation, hyperglycemia, ischemia, and hypervolemia contribute to shedding of the glycocalyx. Damage to the glycocalyx can make fluid extravasation to interstitial. Increasing syndecan-1 value in plasma as marker of shedding the endothelial glycocalyx can occured in the post CABG patients. Hypervolemia is a worsening factor of the shedding in glycocalyx and hypervolemia contribute to major complication after operation. It is important to choose the appropriate fluid for this patient.Objective : The aim of this study is to examine the difference effect of colloid and crystalloid administration on endothelial glycocalyx in post CABG patients.Methods : This is a randomized trial which recruits post CABG patients cosecutively. Non fluid responsive, reduced left ventricle ejection fraction, reduced renal function, or used of IABP during operation are excluded. Fluid responsiveness will be measured by carotis Doppler. Patients then given colloid or crytalloid randomly. Blood sample were taken before and after fluid loading. Syndecan-1 value examined using ELISA method.Result : The total of 54 subjects with 27 patients received colloid and 27 patients received crystalloid. Syndecan-1 pre loading are 1,97 (0,29-14,03) ng/ml in Gelofusine group vs 2,14 (0,68-11,80) ng/ml in Ringer?s lactate group (p = 0,736). Syndecan-1 post loading are 1,78 (0,23-10,98) ng/ml in Gelofusine group vs 2,08 (0,72-12,23) ng/ml in Ringer?s lactate group (p=0,276). The difference of syndecan-1 value in pre and post fluid loading are 0,23 (-1,3 - 3,55) ng/ml in Gelofusine group and 0,14 (-2,12 - 1,80) ng/ml in Ringer?s lactate group (p = 0,043). Lowering syndecan-1 occured in 23 patients (85,2%) in Gelofusine group and 15 (55,6%) in Ringer?s lactate group (p= 0,017). Bivariat analysis showed that kind of fluid is the only factor can influence the difference of syndecan-1. Conclusion : There is contrasting effect of colloid and crystalloid administration on endothelial glycocalyx in post CABG patients. Colloid can reduce shedding of the endothelial glycocalyx after CABG., Background : Endothelial glycocalyx is an important part of vascular barrier. Inflammation, hyperglycemia, ischemia, and hypervolemia contribute to shedding of the glycocalyx. Damage to the glycocalyx can make fluid extravasation to interstitial. Increasing syndecan-1 value in plasma as marker of shedding the endothelial glycocalyx can occured in the post CABG patients. Hypervolemia is a worsening factor of the shedding in glycocalyx and hypervolemia contribute to major complication after operation. It is important to choose the appropriate fluid for this patient.Objective : The aim of this study is to examine the difference effect of colloid and crystalloid administration on endothelial glycocalyx in post CABG patients.Methods : This is a randomized trial which recruits post CABG patients cosecutively. Non fluid responsive, reduced left ventricle ejection fraction, reduced renal function, or used of IABP during operation are excluded. Fluid responsiveness will be measured by carotis Doppler. Patients then given colloid or crytalloid randomly. Blood sample were taken before and after fluid loading. Syndecan-1 value examined using ELISA method.Result : The total of 54 subjects with 27 patients received colloid and 27 patients received crystalloid. Syndecan-1 pre loading are 1,97 (0,29-14,03) ng/ml in Gelofusine group vs 2,14 (0,68-11,80) ng/ml in Ringer’s lactate group (p = 0,736). Syndecan-1 post loading are 1,78 (0,23-10,98) ng/ml in Gelofusine group vs 2,08 (0,72-12,23) ng/ml in Ringer’s lactate group (p=0,276). The difference of syndecan-1 value in pre and post fluid loading are 0,23 (-1,3 - 3,55) ng/ml in Gelofusine group and 0,14 (-2,12 - 1,80) ng/ml in Ringer’s lactate group (p = 0,043). Lowering syndecan-1 occured in 23 patients (85,2%) in Gelofusine group and 15 (55,6%) in Ringer’s lactate group (p= 0,017). Bivariat analysis showed that kind of fluid is the only factor can influence the difference of syndecan-1. Conclusion : There is contrasting effect of colloid and crystalloid administration on endothelial glycocalyx in post CABG patients. Colloid can reduce shedding of the endothelial glycocalyx after CABG.]"

"Penggantian plasma yang hilang karena peningkatan permeabilitas vaskular merupakan tatalaksana untuk demam berdarah dengue. Dua jenis volume expander digunakan untuk mengganti cairan yang hilang dalam pengelolaan DBD adalah cairan koloid dan cairan kristaloid. Dilihat dari aspek biaya terapi, cairan koloid memiliki harga yang lebih mahal dibandingkan dengan cairan kristaloid. Tujuan dari penelitian ini adalah untuk mengetahui efektivitas-biaya cairan koloid dibandingkan dengan cairan kristaloid pada pasien rawat inap Rumah Sakit Umum Daerah Ciawi pada tahun 2021. Penelitian retrospektif ini merupakan penelitian observasional yang menggunakan desain cross-sectional dengan pengumpulan data rekam medis dan biaya dilihat dari perspektif rumah sakit. Sebanyak 50 pasien memenuhi kriteria penelitian dibagi menjadi dua kelompok , yaitu kelompok intervensi yang mendapatkan terapi cairan koloid dan kelompok komparator yang mendapatkan terapi cairan kristaloid. Data efektivitas berdasarkan lama rawat inap dan total biaya medis dianalisis menggunakan uji Chi-Square dan rumus rasio efektivitas-biaya (REB). Terdapat perbedaan signifikan antara kelompok cairan koloid dan cairan kristaloid dalam efektivitasnya terhadap lama rawat inap (p<0,05) dan dikatakan efektif apabila dirawat < 5 hari. Berdasarkan hasil perhitungan REB, efektivitas-biaya kelompok terapi cairan koloid adalah Rp2.133.108,34/unit efektivitas dan kelompok terapi cairan kristaloid adalah Rp7.206.321,42/unit efektivitas. Kelompok cairan koloid memiliki nilai REB yang lebih rendah dibandingkan kelompok cairan kristaloid sehingga terapi cairan koloid lebih efektif-biaya dibandingkan cairan kristaloid.

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Replacement of plasma lost to increased vascular permeability is the treatment for dengue hemorrhagic fever. Two types of volume expanders are used to replace fluids lost in the management of DHF, namely colloid and crystalloid fluids. Viewed from the aspect of therapy costs, colloid have a more expensive price than crystalloid fluids. The purpose of this study was to determine the cost-effectiveness of colloid compared to crystalloid fluid in inpatients at the RSUD Ciawi in 2021. This observational study using a cross-sectional design with medical record data and costs seen from hospital perspective. A total of 50 patients who met the study criteria were divided into two groups, the intervention group receiving colloid fluid and the comparator group receiving crystalloid fluid. Effectiveness on length of stay (LOS) were analyzed using the Chi-Square test, total medical costs using Mann-Whitney test, and cost-effectiveness ratio (CEA) formula. There was a significant difference between the colloid and crystalloid fluid groups in their effectiveness on the LOS (p<0.05) and it was said to be effective if treated <5 days. Based on the results of the CEA calculation, the cost-effectiveness of the colloid fluid therapy group was Rp2,133,108.34/effectiveness unit and the crystalloid fluid therapy group was Rp7,206.321,42/effectiveness unit. The colloid fluid group had a lower CEA value than the crystalloid group so that colloid fluid therapy was more cost-effective than crystalloid fluid"

"Latar belakang. Iskemia miokard sering terjadi karena efek klem silang aorta selama bedah jantung terbuka dengan pemakaian mesin pintas jantung paru. Kardioplegia sebagai metode kardioproteksi, dapat berupa kardioplegia darah maupun kristaloid. Telaah sistematik ini bertujuan mengidentifikasi semua uji acak yang membandingkan tingkat cedera miokard, kejadian fibrilasi atrial, infark miokard, penggunaan inotropik, lama perawatan intensif dan mortalitas pascabedah.Metodologi. Telaah sistematik dilakukan dengan melakukan pencarian literatur melalui database pada COCHRANE, PubMed, PMC, dan Google Scholar untuk mengidentifikasi semua uji acak yang membandingkan tingkat cedera miokard, kejadian fibrilasi atrial, infark miokard, penggunaan inotropik, lama perawatan intensif dan mortalitas pascabedah antara kardioplegia darah dan kristaloid pada seluruh prosedur operasi bedah jantung terbuka dewasa dengan mesin pintas jantung paru yang dipublikasikan dalam bahasa Inggris. Artikel sekunder yang bukan merupakan jurnal dan research article akan dieksklusi. Cochrane Risk of Bias digunakan untuk menilai potensi bias.Hasil penelitian. Kami mengidentifikasi 6 uji acak yang dengan total 796 pasien yang menjalani bedah jantung terbuka (CABG, bedah katup, transplantasi), 431 mendapatkan perlakuan kardioplegia darah, 365 lain mendapat perlakuan kardioplegi kristaloid. Subyek berkisar antara 60 hingga 297 pasien. Mayoritas membahas perbandingan kardioplegia darah dan kristaloid pada bedah jantung revaskularisasi koroner (CABG). Keseluruhan studi memiliki risiko bias rendah.Kesimpulan. Kardioplegia darah menunjukkan luaran yang lebih baik dibandingkan kardioplegia kristaloid. Namun, perlu dilakukan penelitian lebih lanjut terkait analisis dari hasil perlindungan miokard masing-masing larutan kardioplegia.

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Background. Myocardial ischemia is commonly occured due to aortic cross-clamping during open-heart surgery using a cardiopulmonary bypass (CPB) machine. Cardioplegia, as cardioprotective method, can be divided into blood or crystalloid base. This systematic review aims to describe the effectiveness of two types of cardioplegic solutions in adult open-heart surgery procedures by focusing on their effects on cardiac enzyme, atrial fibrillation incidence, myocardial infarction, inotropic use, length of stay in ICU, and postoperative mortality

Methodology. We searched on several databases, including COCHRANE, PubMed, PMC, and Google Scholar to identify all randomized controlled trials published in English that compared levels of myocardial injury, atrial fibrillation incidence, myocardial infarction, inotropic use, intensive care length of stay, and mortality postsurgery between adults underwent CPB who received blood cardiolegia and crystalloid cardioplegia. Secondary publications were excluded. Cochrane Risk of Bias tool was used to assess for potential biases.

Outcome. We identified 6 randomized trials with a total of 796 patients underwent open heart surgery (CABG, valve surgery, transplantation), 431 receiving blood cardioplegia, another 365 receiving crystalloid cardioplegia. Subjects ranged from 60 to 297 patients. Most studies discussed the comparison of blood cardioplegia and crystalloids in CABG. The entire study had a low risk of bias.

Conclusion. Blood cardioplegia provided better outcome compared to crystalloid cardioplegia. However, further analysis should be developed to facilitate the conduct of high quality trials.

Keywords. Cardiac surgery, cardiac enzyme, blood cardioplegia, crystalloid cardioplegia.

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"Latar Belakang: Hipotermia pasca bedah merupakan kejadian yang umum terjadi pada pasien pascabedah, khususnya geriatri yaitu sebesar 70%. Hipotermia memiliki dampak serius, antara lain gangguan koagulasi dan perdarahan, gangguan metabolisme obat, infeksi, iskemia miokardial, aritmia, hospitalisasi lama, dan peningkatan morbiditas serta mortalitas pascabedah. Di Indonesia, khususnya di RSUPN dr. Cipto Mangunkusumo memiliki karakteristik distribusi status fisik preoperasi, jumlah pemberian cairan, dan indeks massa tubuh yang berbeda dari negara lain.Tujuan: Studi ini dilakukan untuk menganalisa hubungan status fisik preoperasi, jumlah pemberian cairan kristaloid intraoperasi, dan indeks massa tubuh terhadap hipotermia pascabedah pada pasien geriatri.Metode: Penelitian menggunakan metode potong-lintang dengan uji observasional terhadap 108 subjek penelitian dari rekam medis sejak November 2018-Januari 2019. Subjek penelitian adalah pasien geriatri yang telah menjalani pembedahan dalam anestesi umum dengan/tanpa anestesi regional dan dirawat di RSUPN dr. Cipto Mangunkusumo. Kriteria eksklusi yaitu pasien tidak memiliki catatan rekam medis lengkap, meninggal pada saat operasi atau saat tiba di rumah sakit, dan sudah mengalami hipotermia sebelum pembedahan.Hasil: Pada penelitian ini didapatkan proporsi hipotermia pascabedah pada pasien geriatri adalah 67,6%. Hasil penelitian antara hipotermia pascabedah dengan status fisik preoperasi, jumlah pemberian cairan kristaloid intraoperasi, dan indeks massa tubuh pada pasien geriatri yaitu nilai p = 0,997, p = 0,310, p = 0,413.Kesimpulan: Hipotermia pascabedah pada pasien geriatri tidak memiliki hubungan yang bermakna dengan status fisik preoperasi, jumlah pemberian cairan kristaloid intraoperasi, dan indeks massa tubuh pada pasien geriatri.

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Background: Postoperative hypothermia is commonly found in postoperative patients, especially in geriatrics, which is 70%. Hypothermia also has serious effects, including coagulation and bleeding disorders, drug metabolism disorders, infections, myocardial ischemia, arrhythmias, prolonged hospitalization, and increased postoperative morbidity and mortality. In Indonesia, especially in Centre Cipto Mangunkusumo Hospital subjects characteristics, the distribution of preoperative physical status, amount of fluid administration, and body mass index are different from other countries.

Objective: This study was conducted to analyze the association between preoperative physical status, the amount of intraoperative crystalloid fluid administration, and body mass index for postoperative hypothermia in geriatric patients.

Methods: This was a cross-sectional observational study which included 108 research subjects and obtained from the medical records since November 2018-January 2019. Subjects were geriatric patients who under going surgery with general anesthesia with/without regional anesthesia in Centre dr. Cipto Mangunkusumo Hospital. Exclusion criteria were patient who did not have a complete medical record, died during surgery or when arrived at the hospital, and had history of hypothermia before surgery.

Results: In this study, the incidence of postoperative hypothermia among geriatric patients was 67.6%. The results of the study between postoperative hypothermia with preoperative physical status, the amount of intraoperative crystalloid fluid administration, and body mass index in geriatric patients were p = 0.997, p = 0.310, p = 0.413.

Conclusion: Postoperative hypothermia in geriatric patients did not have significant association with preoperative physical status, amount of intraoperative crystalloid fluid administration, and body mass index in geriatric patients."