Hasil Pencarian  ::  Simpan CSV :: Kembali

"Insidens insufisiensi adrenal pada pasien renjatan sepsis dilaporkan sekitar 40-65. Sitokin IL-1 dan IL-6 dapat menstimulasi sekresi kortisol sedangkan TNF-? serta MIF berperan dalam menghambat pembentukan kortisol. Penelitian ini bertujuan untuk mengetahui peran IL-1, IL-6, TNF-? dan MIF dalam terjadinya insufisiensi adrenal relatif pada renjatan sepsis.Penelitian eksperimental dilakukan di laboratorium FKH IPB berlangsung selama 6 bulan April-September 2015 . Model anak babi yang dipakai berumur 6-8 minggu dengan berat badan 5-10 kg. Pemilihan sampel dengan consecutive sampling dengan total n = 20. Anak babi diberikan infus endoktoksin dengan dosis 50 ug/kg BB. Sampel darah untuk analisis IL-1, IL-6, TNF-?, MIF, ACTH, kortisol, 17 OHP, DHEA, androstenedion diambil sebelum pemberian endotoksin dan tiap 15 menit hingga terjadi renjatan sepsis, kemudian dilakukan uji synacthen. Pemeriksaan imunohistokimia dilakukan pada kelenjar adrenal, hipofisis, dan hipotalamus.Dari 19 anak babi yang dianalisis mengalami renjatan sepsis dalam waktu 60 menit. Karakteristik sampel tidak berbeda bermakna antara kedua kelompok. Kadar IL-6 pada kelompok IAR dibandingkan dengan kelompok tanpa IAR berbeda bermakna pada menit ke-45 0,65 0,5-4,32 pg/dL vs. 0,54 0,51-0,61 pg/dL , p = 0,008 . Kadar IL-1 antara kelompok IAR dibandingkan kelompok tanpa IAR tidak berbeda bermakna. Kadar TNF-? pada kelompok IAR dibandingkan dengan kelompok tanpa IAR berbeda bermakna pada menit ke-15 1862,5 327,9-4511,14 pg/dL vs. 155,38 24,67-394,10 pg/dL , p = 0,002 dan menit ke-30 4295,76 246,9-5913,37 pg/dL vs. 422,90 101,05-4129,42 pg/dL , p = 0,007 . Kadar MIF kelompok IAR dibandingkan dengan kelompok tanpa IAR berbeda bermakna pada saat renjatan sepsis 25,28 18,45-30,64 ng/dL vs. 11,30 7,1-15,14 ng/dL p = 0,003 . Pemeriksaan imunohistokimia hanya pada hipotalamus yang menunjukkan pewarnaan terhadap IL-1, IL-6, TNF-? dan MIF pada kelompok dengan IAR. Pada renjatan sepsis dan insufisiensi adrenal relatif kadar TNF-? meningkat pada menit-menit awal, kemudian kadar IL-6 meningkat kemudian serta terakhir kadar MIF meningkat pada saat renjatan sepsis. Kadar IL-1 tidak terdapat perbedaan antara kedua kelompok. Kata kunci: IL-1, IL-6, insufisiensi adrenal relatif, MIF, renjatan sepsis, TNF-?

---

Incidence of adrenal insufficiency in septic shock ranged between 40 ndash 65 . The mechanism of relative adrenal insufficiency in septic shock is caused by inflammatory mediators. This study aimed to identify the role of IL 6, IL 1 in stimulating ACTH and cortisol release, and the role of TNF and MIF in inhibiting the level of ACTH and cortisol in septic shock with relative adrenal insufficiency RAI in order to develop guidelines for relative adrenal insufficiency marker.Experimental study was conducted in Veterinary Faculty, Bogor Agricultural Institute for 6 months Apri ndash September 2015 . Piglet models Sus scrofa aged 6 ndash 8 weeks weighing 5 ndash 10 kg. Consecutive sampling was used with total 20 piglets. Piglet models were given 50 ug kg endotoxin infusion Escherichia coli O111 B4 Sigma chemical, St. Louis, MO, USA . Blood sample for analysis of IL 1, IL 6, TNF , MIF, ACTH, cortisol, 17 OHP, DHEA, androstenedione was collected before endotoxin administration and every 15 minutes until septic shock occurred. Piglet models were monitored using PiCCO monitor. Stimulation test was then performed using synthetic corticotropin Synacthen and blood sample was collected again along with immunohistochemistry examination of the adrenal, pituitary and hypothalamus glands.From 19 study subjects analized, all subject had septic shock in 60 minutes. Study subject characteristics in each group were similar. The level of IL 6 at 45 minutes had a significant different compared to the group without RAI 0.65 0.5 ndash 4.32 pg dL vs. 0.54 0.51 ndash 0.61 pg dL , p 0.008 . The level of IL 1 during septic shock were not significantly different between both groups. The level of TNF in RAI group had significant different compared to the group without RAI at 15 minutes 1862.5 327.9 ndash 4511.14 pg dL vs. 155.38 24.67 ndash 394.10 pg dL , p 0.002 and at 30 minutes 4295.76 246.9 ndash 5913.37 pg dL vs. 422.90 101.05 ndash 4129.42 pg dL , p 0.007 The level of MIF in group with RAI during septic shock had a significant different compared to the group without RAI t 25.28 18.45 ndash 30.64 ng dL vs. 11.30 7.1 ndash 15.14 ng dL , p 0.003 . Immunohisto chemistry staining of IL 1, IL 6, TNF , and MIF was observed only in the hypothalamus glands of the RAI group. In septic shock and relative adrenal insufficiency, TNF increased in earlier minutes, then IL 6 increased and later MIF increased in septic shock condition. IL 1 level had no difference increment for both group.Keywords IL 1, IL 6, MIF, relative adrenal insufficiency, septic shock, TNF"

"ABSTRAKInflamasi sistemik pada renjatan sepsis dapat menyebabkan insufisiensi adrenal. Kadar asam lemak bebas ALB yang tinggi diketahui menyebabkan inflamasi steril dan menghambat adrenocorticothropic hormone dan sekresi kortisol. Pemberian hidrokortison pada renjatan sepsis diharapkan memperbaiki hemodinamik, menurunkan ketergantungan terhadap obat vasoaktif dan memperbaiki disfungsi organ.Penelitian bersifat studi eksperimental yang bertujuan menilai pengaruh ALB dan pemberian hidrokortison terhadap hemodinamik, kadar laktat, cedera paru dan kadar kortisol darah pada renjatan sepsis model anak babi. Penelitian dilaksanakan di Divisi Bedah dan Radiologi Departemen Klinik Reproduksi dan Patologi Fakultas Kedokteran Hewan Institut Pertanian Bogor FKH IPB pada April -September 2015 dan telah disetujui oleh Komisi Etik Hewan FKH IPB.Delapan model anak babi Sus scrofa berusia 6-8 minggu dengan berat 5-10 kg dibagi dalam 2 kelompok, yaitu kelompok lipid dan kelompok kontrol. Kelompok lipid diberi lipid 20 sebanyak 3 gram/kgbb intravena dan kelompok kontrol tanpa pemberian lipid sebelum induksi sepsis. Pengukuran parameter hemodinamik dengan Pulse Contour Cardiac Output PiCCO . Pengukuran kadar laktat dengan i-Stat. Cedera paru ditentukan dengan pengukuran extravascular lung water index EVLWI dan rontgen toraks. Tes synacthen dilakukan untuk mengetahui adanya insufisiensi adrenal relatif IAR .Pengaruh ALB terhadap hemodinamik dinilai dengan rerata cardiac index 60 menit setelah pemberian hidrokortison yang berbeda bermakna [2,14 0,06 l/menit/m2 vs. 2,75 0,04 l/menit/m2 p 0,002 ]. Jumlah cairan dan obat vasoaktif yang dibutuhkan kelompok lipid untuk mempertahankan mean arterial blood pressure > 65 mmHg lebih banyak dibandingkan kelompok kontrol. Kadar laktat meningkat sebelum induksi sepsis pada kelompok lipid [2,28 0,52 vs. 1,28 0,45 mmol/L p 0,001 ]. Bersihan laktat pada kelompok lipid lebih buruk dibandingkan kelompok kontrol. Extravascular lung water index kelompok lipid lebih tinggi bermakna dibanding kelompok kontrol setelah 60 menit resusitasi [21 4,04 mL/kg vs. 12,38 2,32 mL/kg p 0,004 ]. Gambaran radiologi efusi pleura dan edema pulmonal terjadi pada seluruh model anak babi kelompok lipid. Insufisiensi adrenal relatif terjadi pada 7 model anak babi di kelompok lipid dan 4 di kelompok kontrol.Kesimpulan penelitian ini adalah kadar ALB yang tinggi memperberat inflamasi dan merupakan faktor risiko terjadinya IAR. Kata kunci: Asam lemak bebas, cedera paru, hemodinamik, hidrokortison insufisiensi adrenal relatif, laktat, renjatan sepsis, sepsis.

---

ABSTRACTCortisol deficiency is associated with increased morbidity and mortality during critical illness. Dysregulation of immune system in septic shock triggers adrenal insufficiency. Free fatty acid FFA is known to induced sterile inflammation and inhibit adrenocorticothropic hormone and cortisol secretion. Hydrocortisone administration is expected to improve hemodynamic, decrease dependency of vasoactive drugs and improve organ dysfunction in septic shock.The aim of this study is to find out the effect of FFA and hydrocortisone administration on hemodynamic parameters, lactate, lung injury and blood cortisol levels in septic shock piglet models, conducted in April September 2015 in the Division of Surgery and Radiology School of Veterinary Medicine, Institut Pertanian Bogor IPB and has been approved by the Animal Ethics Committee of School of Veterinary Medicine IPB. Sixteen piglet models Sus scrofa entered the study. The piglets were 6 8 weeks old, weighing 5 10 kg divided into two groups, lipids and control groups. Administration of 3 g kg BW of lipid 20 were performed intravenously before sepsis induction for lipid group. Hemodynamic measurement by Pulse Contour Cardiac Output PiCCO by Picco. Lactate measurement by i Stat. Lung injury was determined by Extravascular lung water index EVLWI and chest X ray. Synacthen test to determine relative adrenal insufficiency RAI .FFA influences was shown on cardiac index 60 min after adminstration of hydrocortisone in lipid group 2.14 0.06 L min m2 and control group 2.75 0.04 L min m2 p 0.002 . Lipid group require fluids and vasoactive drugs more than the control grup to maintain mean arterial blood pressure 65 mmHg. Lactate levels before induction of sepsis lipid group 2.28 0,52 mmol L and control group 1.28 0.45 mmol L p 0.001 . Lactate clearance in lipid group was worse than the control group. Extravascular lung water index at 60 minutes after resuscitation in lipid group 21 4.04 mL kg and control group 12.38 2.32 mL kg p 0.004 . Pleural effusion and pulmonary edema were found in all piglet models in lipid group. Relative adrenal insufficiency occured to 7 piglet model in lipid gorup and 4 in control group.Conclusion High level FFA aggravate inflammation in septic shock and is a risk factor for RAI. Hydrocortisone administration improve circulation and lactate levels. Keywords FFA, hemodynamic, hydrocortisone, lactate, lung injury, relative adrenal insufficiency, sepsis, septic shock"

"Renjatan merupakan kegawat-daruratan tersering pada anak. Laktat sering digunakan sebagai target keberhasilan resusitasi pada renjatan sepsis, namun sepertiga kasus renjatan pada anak tidak mengalami peningkatan kadar laktat alaktatemia . Penilaian laktat sebagai target keberhasilan resusitasi masih menjadi perdebatan. Penelitian sebelumnya menyimpulkan nilai bersihan laktat berkaitan dengan luaran pasien renjatan sepsis. Laktat dehidrogenase LDH -1, LDH-5 dan delivery oxygen DO2 berperan dalam metabolisme laktat dan menyebabkan kondisi alaktatemia dan hiperlaktatemia pada pasien renjatan anak.Penelitian ini bertujuan untuk mencari etiologi alaktatemia pada renjatan anak melalui pemeriksaan isoenzim LDH-1, LDH-5 dan DO2 selama proses resusitasi 6 jam. Penelitian ini adalah penelitian potong lintang pada 56 renjatan sepsis dan 44 hipovolemik berusia 1 bulan sampai 18 tahun di 4 rumah sakit umum. Pemeriksaan tekanan darah mean arterial pressure/ MAP, indeks jantung cardiac index, CI dan indeks tahanan vaskular sistemik systemic vascular resistance index, SVRI , DO2 dan pengambilan darah untuk pemeriksaan LDH-1 dan 5 dilakukan sebelum dan setelah resusitasi.Pada penelitian ini didapatkan usia terbanyak berada dalam rentang 1 ndash;59 bulan 56, dengan pasien yang datang dengan kondisi berat skor pediatric logistic organ dysfunction/PELOD-2 ge; 10 31, median kadar laktat jam ke-0 adalah 2,5 mmol/L. Angka kematian 20 . Proporsi hiperlaktatemia lebih tinggi secara bermakna p = 0,028 pada pasien renjatan dengan skor PELOD-2 ge; 10 71,9 . Tidak ada perbedaan bermakna isoenzim LDH-1, LDH-5 dan DO2 antara kelompok alaktatemia dan hiperlaktatemia. Tidak ada perbedaan bermakna MAP, CI, SVRI antar kelompok alaktatemia dan hiperlaktatemia. Tidak ada perbedaan bermakna luaran pasien berdasarkan nilai bersihan laktat.Simpulan: Pasien yang mengalami alaktatemia tidak terbukti aktivitas LDH-1 meningkat sedangkan pada hiperlaktatemia aktivitas LDH-5 meningkat. Kadar DO2 lebih tinggi pada kelompok alaktatemia dan lebih rendah pada hiperlaktatemia.

---

Shock is the most common emergency condition in pediatric patients. Lactate levels have been used widely as resuscitation target in septic condition. Meanwhile, one third cases did not showed elevated lactate levels alactatemia . Lactate levels as a target for successful resuscitation is still being considered. Previous studies concluded lactate clearance has correlated with the septic shock patients outcome. Lactate dehydrogenase LDH 1, LDH 5 and delivery oxygen DO2 have an important role in lactate metabolism and causing alactatemia and hyperlactatemia in pediatric shock.

The objectives of this study were to determine the alactatemia etiology in pediatric shock using isoenzyme LDH 1, LDH 5 and DO2 examination during 6 hours resuscitation. This was a cross sectional study done in 56 patients with septic shock and 44 patients with hypovolemia, within aged 1 month until 18 years old in 4 general hospitals. Mean arterial pressure MAP , cardiac index CI , and systemic vascular resistance index SVRI , DO2, LDH 1 and LDH 5 were done before and after resuscitation.

This study found the most common age is in average 1 ndash 59 months 56 , proportion of patients who came with severe condition pediatric logistic organ dysfunction PELOD 2 score ge 10 was 31 , median of lactate levels in 0 hours was 2.5 mmol L. Death rate was 20 . Hyperlactatemia proportion was higher significantly p 0.028 in shock patients with PELOD 2 score ge 10 71.9. There was no differences in MAP, CI, SVRI values between alactatemia and hyperlactatemia groups. There was no differences in outcome based on lactate clearance.

Conclusion Patients with alactatemia do not prove that their LDH 1 activity is increased while in hyperlactatemia, the activity of LDH 5 is increased. DO2 levels were higher in the alactatemia group and lower in hyperlactatemia group."

"Latar belakang: Sepsis merupakan salah satu penyebab morbiditas dan mortalitas pada anak. Untuk optimalisasi tatalaksana sepsis diperlukan penanda yang dapat memprediksi kejadian sepsis, derajat keparahan dan luaran sepsis klinis. Tujuan penelitian: Mengetahui kadar plasma Cit H3 sepsis klinis pada anak dan menganalisa hubungannya terhadap derajat keparahan penyakit dan prognostik survivalnya. Metode penelitian: Penelitian observasional pendekatan kohort prospektif dilakukan pada anak usia satu bulan sampai 18 tahun dengan diagnosis sepsis klinis sejak Pebruari - Mei 2018 di RSUPN Cipto Mangunkusumo, Jakarta. Penilaian skor PELOD-2, pSOFA dan Cit H3 dilakukan saat diagnosis ditegakkan dan 48 jam kemudian. Mortalitas dipantau selama tujuh hari. Hasil: Diperoleh 67 anak memenuhi kriteria dengan median kadar plasma Cit H3 1.210 800-32.160 ng/mL. Berdasarkan sepsis-3, kadar plasma Cit H3 pasien sepsis lebih tinggi dibandingkan curiga sepsis. Sensitivitas dan spesifisitas kadar plasma Cit H3 ge; 1.200 ng/mL sebagai penanda kejadian sepsis adalah 83,3 dan 75,7. Perubahan kadar plasma Cit H3 dalam 48 jam berhubungan dengan progresifitas sepsis klinis. Citrullinated histone H3 berkorelasi dengan skor PELOD-2 r=0,338;P

---

Background: Sepsis is a life threatening organ dysfunction causing high morbidity and mortality in children thus, a highly predictive septic marker to forecast its severity and predict mortality is needed.

Aim: To determine plasma Cit H3 levels in clinically sepsis children and analyze its correlation with disease severity and survival rate.

Method: A prospective observational study was conducted in one month ndash 18 years old children with diagnosed clinically sepsis during February ndash April 2018 in Cipto Mangunkusumo Hospital, Jakarta. Evaluation of PELOD 2, pSOFA score, and Cit H3 were done when diagnosis initially made and 48 hours after. Patient rsquo s survival was observed for 7 days.

Results: Sixty seven children with clinically sepsis had median plasma Cit H3 level 1,210 800 ndash 32,160 ng mL. The plasma Cit H3 level in patients who diagnosed with sepsis sepsis 3 was higher than suspected sepsis. As marker sepsis event, plasma Cit H3 level with cut off point ge 1,200 ng mL has sensitivity 83,3 and specificity 75.5. Changes in plasma Cit H3 level in the first 48 hours was significantly correlated with changes in clinical outcome. Plasma Cit H3 level also correlated with PELOD 2 and pSOFA score. Using survival analysis, plasma Cit H3 level ge 1,200 ng mL significantly increased mortality rate.

Conclusion: Plasma Cit H3 level correlates with severity and survival rate of clinically diagnosed sepsis."

"Sepsis memiliki angka kematian yang cukup tinggi di seluruh dunia. Hal ini disebabkan sebagian besar oleh karena penegakan diagnostik, pemantauan, dan tatalaksana yang tidak adekuat. Mortalitas dan morbiditas sepsis masih dalam banyak penelitian di seluruh dunia. Penyebab terbanyak adalah keadaan imunoparalisis pada sepsis. Penelitian ini bertujuan untuk melihat kejadian, gambaran klinis imunoparalisis pada sepsis klinis anak.Penelitian ini dengan desain deskriptif, dimana subjek di IGD, PICU, dan ruang rawat anak RSCM usia 1 bulan ndash; 18 tahun dengan diagnosis sepsis klinis yang memilki 2/lebih dari 4 kriteria: 1 takikardia; 2 takipnu; 3 hipo/hipertermia; 4 leukositosis/leukopenia, dengan bukti infeksi berupa prokalstionin 0,5 ng/mL dan/atau dijumpai pertumbuhan kuman pada kultur. Setelah orangtua subjek mengisi informed consent, pasien dilakukan pemeriksaan darah rutin, analisa gas darah, prokalsitonin, kultur darah, dan darah diambil untuk pemeriksaan TNF alfa ex vivo. Pemeriksaan TNF alfa ex vivo dilakukan dengan menstimulasi darah segar dengan lipopolisakarida salmonella serotipe abortus equii 500 pg/mL yang kemudian akan dilakukan inkubasi pada suhu 370C selama 4 jam dan disentrifugasi 1000XG selama 5 menit, dilakukan pemeriksaan TNF alfa dengan metode ELISA. Subjek dikatakan imunoparalisis jika didapati hasil TNF alfa ex vivo < 200 pg/mL.Hasil penelitian menunjukkan angka kejadian imunoparalisis 12 17,1 dari 70 subjek terdiagnosa sepsis klinis. Proporsi laki:perempuan 1,4:1. Status gizi kurang n=8/66,7 lebih banyak didapati pada imunoparalisis sepsis klinis. Fokus infeksi tersering adalah infeksi pada sistem hematologi, nefrologi dan respirasi. Subjek demam 5 41,7 , takikardia 3 25 , takipnu 3 25 dari 12 subjek imunoparalisis pada sepsis klinis anak Untuk pemeriksaan laboratorium, prokalsitonin >2,0 ng/mL dan jumlah leukosit > 11.000/mm3 lebih sering dijumpai.Simpulan: angka kejadian imunoparalisis pada sepsis klinis anak di RSCM 17,1 . Gambaran pasien imnoparalisis pada sepsis klinis yang memiliki persentase besar adalah gizi kurang; pasien dengan fokus infeksi hematologi, nefrologi, dan respirasi; prokalsitonin ge; 2 ng/mL; dan leukosit ge; 11.000/mm3

---

Mortality in sepsis is high worldwide. It is caused by the diagnostic, monitoring, and inadequate therapeutic. Mortality and morbidity in sepsis is still in research. Immunoparalysis is a leading cause of mortality and morbidity of sepsis. The objectives of this study were investigating incidence, clinical characteristics immunoparalysis in clinically sepsis.Design of study was descriptive. The subjets were children age 1 month-18 years from emergency room, PICU, and pediatric ward with clinically sepsis following ge; 2 of 4 criterias: 1 tachycardia; 2 tachypnea; 3 hypo/hyperthermia; 4 leucocytosis/leucopenia, with proven infection such as procalcitonin 0.5 ng/mL with/without positive culture. After informed consent was filled, subjects were examined blood sample, procalcitonin, blood culture, and TNF alpha ex vivo. Whole blood was stimulated with lipopolysaccharides salmonella serotype abotrtus equii, incubated in 37 0C for 4 hours, centrifugated 1000XG for 5 minutes, and examined for TNF alpha with ELISA. Subjects was defined imunoparalysis with TNF alpha ex vivo < 200 pg/mL.We found the incidence of immunoparalysis was 12 17.1 of 70 clinically sepsis subjects. Malnourished status n=8/66.7 was higher frequency. The large numbers for focus of infection were hematologic, nephrologic, and respiratory system. Subjects had fever 5 41,7 , tachycardia 3 25 , and tachypnea 3 25 from 12 imunoparalysis clinically sepsis subject. Laboratorium findings showed procalcitonin > 2.0 pg/mL 8 66,7 subjects and leucocyte > 11.000/mm3 6 50 subjects.Conclusion: The incidence of imunnoparalysed sepsis was 17.1 . Profile of pediatric clinically sepsis had a big number in malnourished status, focus infectious on hematology, nephrology, and respitarory with laboratorium findings showed procalcitonin > 2.0 ng/mL and leococyte > 11.000/mm3 had a high numbers in immunoparalysed clinically sepsis."

"Latar belakang: Pemberian sedasi dan analgesia yang adekuat sangat penting dalam pemulihan pasien di unit perawatan intensif. Penggunaan yang tidak tepat dapat menyebabkan desaturasi oksigen otak. Studi ini bertujuan untuk mengetahui gambaran oksigenasi serebri yang diukur dengan Near-infrared spectroscopy (NIRS) pada pasien yang menerima sedasi dan analgesia dan mengetahui intervensi inotrop pada kedua kelompok.Metode: Penelitian ini adalah sebuah nested cohort observational study dari penelitian utama yang berjudul “Efektivitas penggunaan protokol sedasi dan penyapihan ventilator dibandingkan keputusan klinis pada anak di PICU RSCM” yang dilakukan secara prospektif di PICU Rumah Sakit Cipto Mangunkusumo (RSCM). Penelitian dilakukan pada anak usia 1 bulan-17 tahun 11 bulan dengan ventilasi mekanik dan diberikan sedasi dan analgesia. Pasien dibedakan menjadi dua kelompok, yaitu sedasi dan analgesia berdasarkan protokol dan berdasarkan keputusan klinis (tanpa protokol). Oksigenasi serebri diukur dengan NIRS dalam lima pengamatan waktu (sebelum sedasi, 5 menit, 1, 6 dan 12 jam setelah sedasi).Hasil: Dari 69 subjek, 39 subjek mendapatkan sedasi dan analgesia berdasarkan protokol dan 30 lainnya tanpa protokol. Tren penurunan nilai NIRS >20% dari data dasar, lebih banyak ditemukan pada kelompok protokol pada 5 menit (6,7%), 1 jam (11,1%), 6 jam (26,3%) dan 12 jam (23,8%). Nilai rerata NIRS lebih rendah dan intervensi inotrop lebih banyak ditemukan pada kelompok sedasi tanpa protokol, walaupun tidak bermakna secara statistik.Simpulan: Penelitian ini menunjukkan penurunan NIRS > 20% didapatkan pada anak dengan penggunaan sedasi dan analgesia berdasarkan protokol, dan NIRS terbukti dapat mengukur desaturasi serebri yang terjadi selama penggunaan obat sedasi dan analgesia.

---

Background: Adequate sedation and analgetic agents are imperative in the recovery patients at intensive care units. Inappropriate use may induce cerebral desaturation. This study aims to know about cerebral oxygenation measured by Near-infrared spectroscopy (NIRS) in children receiving sedation and analgesia and to evaluate the differences use of inotropic agents from two groups.

Methods: This is a nested prospective cohort study of the major study entitled “Effectiveness of ventilator sedation and weaning protocols compared with clinical decisions in children in PICU RSCM”, conducted in Pediatric Intensive Care Unit (PICU), Cipto Mangunkusumo Hospital. Subjects were one-month-old to seventeen-year-old children used mechanical ventilator. They were divided into two groups, sedation and analgetic based on protocol and without protocol. Cerebral oxygenation measured at five different timings (before sedation, 5 minutes, 1, 6 and 12 hours after sedation and analgesia).

Results: There were total 69 children included, 39 subjects were received protocol and 30 subjects without the protocol. NIRS were reduced > 20% from the baseline in the protocol group at 5 minutes (6,7%), 1 hours (11,1%), 6 hours (26,3%) and 12 hours (23,8%). NIRS average was lower and the use of inotropic agents was found more in group without protocol. However, these findings are not statistically significant.

Conclusion: This study shows that NIRS decreased >20% from baseline was observed in children who were sedated using protocol and NIRS are useful to measure cerebral desaturation that happens during the administration of sedation and analgetic agents.

"