Tesis

Smith-Madigan Inotropy Index dan Rasio Energi Potensial Kinetik sebagai Prediktor Respons Epinefrin pada Syok Sepsis Pediatri = Smith-Madigan Inotropy Index and Potential Kinetic Ratio as Response Predictor to Epinephrine in Pediatric Septic Shock.

Latar belakang: Syok sepsis masih menjadi penyebab utama perawatan rumah sakit, morbiditas, dan mortalitas anak di seluruh dunia. Angka sepsis induced myocardial dysfunction (SMD) pada anak cukup tinggi, yaitu sekitar 40-50%. Survival sepsis campaign (SSC) merekomendasikan penilaian status jantung sebelum pemberian inotropik. Jika terdapat gangguan fungsi jantung, disarankan pemberian epinefrin. Jika pasien yang akan berespons terhadap pemberian inotropik dapat diidentifikasi pada fase awal syok setelah pemberian cairan, maka penggunaan inotropik akan lebih efektif untuk tata laksana pasien. Smith-Madigan Inotropy Index (SMII) merupakan suatu indeks inotropik yang tidak dipengaruhi preload dan afterload. Tujuan: menilai SMII sebagai prediktor respons kenaikan volume sekuncup pada pasien anak dengan syok sepsis yang diberikan epinefrin. Metode: desain observasional analitik yang dilakukan di RSUPN Cipto Mangunkusumo dan RSUD Pasar Rebo pada bulan Oktober hingga Desember 2024. Subyek penelitian merupakan anak usia 1 bulan hingga 18 tahun dengan diagnosis syok sepsis refrakter cairan yang diberikan epinefrin dengan dosis 0,1 -0,3 mcg/kg/menit. Pemantauan hemodinamik dilakukan melalui USCOM dengan menilai parameter SVI, SVRI, SMII dan PKR. Hasil: dari total 44 subyek penelitian, angka SMD adalah 72,7%, dan 59% subyek cold shock. Sebanyak 25 (56,8%) subyek tergolong responder, sedangkan 1 9 tergolong non-responder. Hasil menunjukkan bahwa terdapat perbedaan bermakna nilai SMII (p < 0,0001), SVI (p < 0,0001) pada cold shock dan SMII serta SVRI pada warm shock pre dan pasca-pemberian epinefrin. Tidak terdapat perbedaan bermakna antara SMII dan PKR pre-epinefrin antara kelompok responder dan non-responder. Simpulan: Terdapat perbedaan bermakna pada nilai SMII, SVI, dan SVRI pascapemberian epinefrin pada anak syok sepsis refrakter cairan. Pada penelitian ini, nilai SMII dan PKR belum terbukti bisa memprediksi respons volume sekuncup terhadap pemberian inotropik.
Kata kunci: syok sepsis, Smith-Madigan inotropy index, rasio energi potensial kinetik, epinefrin


Bacground: Septic shock remains one of the leading causes of hospital stays, morbidity, and mortality in children worldwide. The incidence of sepsis-induced myocardial dysfunction in children is considered high, at 40-50%. The Survival Sepsis Campaign (SSC) recommends assessing cardiovascular function before administering inotropic drugs. If cardiovascular function is compromised, administration of epinephrine is recommended. Suppose the patient who will respond to inotropic medications can be identified in the early stages of shock after fluid administration. In that case, using inotropic will be more effective in their management. The Smith-Madigan Inotropy Index is an inotropy index that is not influenced by preload and afterload. Objective: This study aims to assess SMII as a predictor for the response of stroke volume increase in pediatric patients with septic shock who were administered epinephrine. Methods: This study utilizes an analytical observational design conducted at RSUPN Cipto Mangunkusumo and RSUD Pasar Rebo from October to December 2024. Study subjects are children aged 1 month to 18 years diagnosed with fluid refractory septic shock who were given epinephrine at doses of 0.1 -0.3 mcg/kg/min. The hemodynamic assessment was performed with USCOM, and the parameters assessed were SVI, SVRI, SMII, and PKR. Results: Based on the study analysis of 44 subjects, SMD happened in 72.7% of subjects, and 59% were categorized as having a cold shock. Twenty-five were classified as responders, and 1 9 were non-responders. Results showed a significant difference between the values of SMII (p < 0.0001), SVI (p < 0.0001) in cold shock, and SMII and SVRI in warm shock before and after the administration of epinephrine. There was no significant difference between pre-epinephrine SMII and PKR values among the responders and nonresponders groups. Conclusion: Significant differences in SMII, SVI, and SVRI values were observed after epinephrine administration in children with septic shock. This study's SMII and PKR values have no evidence to predict these patients' epinephrine administration response.
Keywords: septic shock, Smith-Madigan Inotropy Index, potential kinetic ratio, epinephrine