Tesis

Korelasi antara Near-Infrared Spectroscopy Serebral dengan Perubahan Parameter Hemodinamik Pasca Resusitasi Cairan pada Sus Scrofa sebagai Hewan Model Renjatan Hemoragik = Correlation between Cerebral Near-Infrared Spectroscopy and Macrohemodynamic Changes in Sus Scrofa Model of Hemorrhagic Shock.

Latar belakang Renjatan hemoragik pada anak merupakan kondisi kritis yang membutuhkan penanganan segera. Kecukupan perfusi jaringan dan pasokan oksigen pada organ target merupakan tujuan utama tata laksana pasien sakit kritis. Hingga kini metode pemantauan sirkulasi darah regional, seperti oksigenasi serebral masih belum optimal. Tujuan Mengetahui korelasi antara near-infrared spectroscopy (NIRS) serebral dengan parameter hemodinamik invasif pasca resusitasi cairan pada renjatan hemoragik. Metode Dilakukan induksi perdarahan untuk memicu timbulnya renjatan hemoragik pada 18 ekor Sus scrofa, selanjutnya dilakukan resusitasi cairan normovolemik dan hipervolemik. Parameter hemodinamik invasif dipantau menggunakan pulse contour continous cardiac output (PiCCO) dan oksigenasi serebral menggunakan NIRS secara kontinu. Hasil Terdapat korelasi kuat antara NIRS serebral dan cardiac output (CI), stroke volume indeks (SVI), dan oxygen delivery (DO2) selama renjatan hemoragik dan pasca resusitasi cairan (p < 0.05). Pada fase normovolemik dan hipervolemik, terjadi perubahan nilai absolut CI, SVI, dan DO2 yang signifikan (p < 0.05), akan tetapi perubahan NIRS serebral tidak signifikan (p > 0.05). Kesimpulan Target strategi tata laksana renjatan hemoragik berupa perbaikan oksigenasi serebral dapat dicapai dengan optimalisasi DO2, meningkatkan CI dan transfusi darah. Resusitasi cairan secara moderat dibandingkan dengan resusitasi cairan secara agresif tidak menunjukkan perbedaan oksigenasi serebral.
Kata kunci : near-infrared spectroscopy; pasokan oksigen; renjatan hemoragik; resusitasi cairan


Background Hemorrhagic shock in pediatric patient is a critical and timesensitive condition. Current resuscitation approach focused on macrohemodynamic circulation, whereas adequate tissue perfusion and end-organ oxygen delivery should be the primary goals. Accurate monitoring to detect changes in regional blood flow such as cerebral oxygenation remain less than optimal. Aim To investigate the correlation between cerebral near-infrared spectroscopy (NIRS) and invasive macrohemodynamic parameters during hemorrhagic shock and fluid resuscitation. Methods Eighteen Sus scrofa received blood removal to induce hemorrhagic shock, and then treated with fluid resuscitation protocols. The first step was bolus normal saline with the exact blood volume loss aiming normovolemic state. The second step was bolus normal saline 40 ml/kg to induce hypervolemic state. During the process, hemodynamic parameters was monitored using pulse contour continuous cardiac output (PiCCO) and cerebral NIRS as a surrogate marker of cerebral tissue oxygenation. The Sus scrofa’s physiological profile, mean arterial pressure (MAP), cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index (SVRI), and cerebral NIRS were recorded, while the oxygen delivery (DO2) was calculated. Result There were strong correlation between cerebral NIRS and CI, SVI and DO2 during the hemorrhagic shock and post fluid resuscitation (p < 0.05). Mean arterial pressure and SVRI showed no correlation with cerebral NIRS during shock and resuscitation phase (p > 0.05). While comparing the macrohemodynamic parameters between normovolemic and hypervolemic fluid resuscitation, there were significant differences between CI, SVI and DO2 (p < 0.05) but NIRS changes statistically not significant (p > 0.05). Conclusion Targeting DO2 by optimizing CI and hemoglobin level were advised in order to maintain better brain tissue oxygenation in hemorrhagic shock. Moderate fluid resuscitation versus agressive fluid resuscitation showed no significant difference in terms of cerebral oxygenation.
Keywords: near-infrared spectroscopy; hemorrhagic shock; fluid resuscitation; oxygen delivery