Tesis

Gambaran Perubahan Isi Sekuncup dan Total Arterial Compliance pada Anak dengan Syok Sepsis Refrakter Cairan yang Mendapatkan Epinefrin di RS. Dr. Cipto Mangunkusumo = A review of Studies on Changes in Stroke Volume and Total Arterial Compliance in Children with Fluid-Resistant Septic Shock After Receiving Epinephrine at Dr Cipto Mangunkusumo General Hospital.

Syok sepsis masih menjadi penyebab utama perawatan rumah sakit, morbiditas, dan mortalitas anak di seluruh dunia. Pada SSC 2020, pemantauan hemodinamik pada syok sepsis menekankan pentingnya penilaian fungsi jantung serta fungsi vaskular yang bertujuan untuk membantu menilai inisiasi pemberian, peningkatan, dan penurunan dosis inotropik maupun vasopressor. Pasien yang akan berespons terhadap pemberian inotropik bila dapat diidentifikasi pada fase awal syok sepsis, maka akan lebih efektif untuk tata laksana pasien. stroke volume (SV), cardia index (CI), systemic vascular resistance index (SVRI) dan Smith Madigan inotropy index (SMII) merupakan parameter hemodinamik yang digunakan untuk memantau respon pemberian terapi pada syok sepsis. Penelitian ini bertujuan untuk mengetahui perubahan isi sekuncup dan total arterial compliance (TAC) pada pasien syok sepsis anak refrakter cairan yang mendapatkan epinefrin. Penelitian ini menggunakan desain observasional analitik, dilakukan di RSUP Dr. Cipto Mangunkusumo pada bulan Januari hingga April 2025. Subyek penelitian merupakan anak usia 1 bulan hingga 18 tahun dengan diagnosis syok sepsis yang diberikan epinefrin dengan dosis 0,1 hingga 0,3 mg/kgBB/menit. Pemantauan hemodinamik dilakukan menggunakan USCOM untuk menilai parameter SV, CI , SVRI, SMII serta menggunakan Masimo Radical-7 untuk memantau indeks perfusi. Berdasarkan analisis studi dari 42 subyek penelitian, syok sepsis dapat dibedakan berdasarkan nilai SMII dan SVRI, dengan 57,1 % 22 subjek memiliki nilai SMII rendah SVRI normal. Pasca pemberian epinefrin syok teratasi pada 30 subjek dengan 70% subjek berada pada kelompok SMII rendah SVRI normal atau tinggi. Peningkatan isi sekuncup didapatkan pada 23 subjek dan penurunan TAC pada 26 subjek pasca pemberian epinefrin. Nilai CI dan SMII diharapkan dapat dijadikan petunjuk untuk memulai pemberian epinefrin. Kesimpulan: Terdapat perubahan pada nilai SV, CI, SVRI, SMII pasca pemberian epinefrin pada anak dengan syok sepsis resisten cairan. Penggunakan IP dan TAC belum efektif untuk memantau hemodinamik pada syok sepsis pada anak.
Kata kunci: epinefrin; isi sekuncup; syok sepsis; total arterial compliance


Septic shock remains one of the leading causes of hospital stays, morbidity, and mortality in children worldwide. The SSC 2020, haemodynamic monitoring in sepsis shock is essential for assessing cardiac and vascular function. This helps to determine the initiation, increase and decrease of inotropic and vasopressor doses. Ifcardiovascular function is compromised, administration of epinephrine is recommended. If the patient who will respond to inotropic medications can be identified in the early stages of shock after fluid administration, the use of inotropics will be more effective in their management. stroke volume (SV), cardiac index (CI), systemic vascular resistance index (SVRI) and SmithMadigan inotropy index (SMII) are used to monitor the response to therapy in sepsis shock. This study aims to determine the changes in the stroke volume and total arterial compliance (TAC) of fluid-refractory paediatric sepsis shock patients receiving epinephrine.. This study utilizes an analytical observational design conducted at RSUPN Cipto Mangunkusumo from January to April 2025. Study subjects are children aged 1 month to 18 years diagnosed with septic shock who were given epinephrine at doses of 0.1 to 0.3 mg/kgBW. The hemodynamic assessment was performed with USCOM, and the parameters assessed were SV, CI, SVI, SVRI, SMII, and use Masimo Radical-7 to monitor perfusion index. Based on the study analysis of 42 subjects, sepsis shock can be distinguished based on SMII and SVRI values, with 57.1% 22 subjects having low SMII and normal SVRI. Post epinephrine administration, shock was resolved in 30 subjects with 70% subjects in the low SMII normal or high SVRI group. An increase in SV was obtained in 23 subjects and a decrease in TAC in 26 subjects after epinephrine administration. CI and SMII values are expected to be used as clues to start epinephrine administration. Conclusion: Epinephrine administration led to clear changes in SV, CI, SVRI, SMII values in children with fluid-resistant septic shock. The use of IP and TAC is not effective for monitoring haemodynamics in sepsis shock in children. Keywords: epinephrine; septic shock; stroke volume; total arterial complianceSeptic shock remains one of the leading causes of hospital stays, morbidity, and mortality in children worldwide. The SSC 2020, haemodynamic monitoring in sepsis shock is essential for assessing cardiac and vascular function. This helps to determine the initiation, increase and decrease of inotropic and vasopressor doses. Ifcardiovascular function is compromised, administration of epinephrine is recommended. If the patient who will respond to inotropic medications can be identified in the early stages of shock after fluid administration, the use of inotropics will be more effective in their management. stroke volume (SV), cardiac index (CI), systemic vascular resistance index (SVRI) and SmithMadigan inotropy index (SMII) are used to monitor the response to therapy in sepsis shock. This study aims to determine the changes in the stroke volume and total arterial compliance (TAC) of fluid-refractory paediatric sepsis shock patients receiving epinephrine.. This study utilizes an analytical observational design conducted at RSUPN Cipto Mangunkusumo from January to April 2025. Study subjects are children aged 1 month to 18 years diagnosed with septic shock who were given epinephrine at doses of 0.1 to 0.3 mg/kgBW. The hemodynamic assessment was performed with USCOM, and the parameters assessed were SV, CI, SVI, SVRI, SMII, and use Masimo Radical-7 to monitor perfusion index. Based on the study analysis of 42 subjects, sepsis shock can be distinguished based on SMII and SVRI values, with 57.1% 22 subjects having low SMII and normal SVRI. Post epinephrine administration, shock was resolved in 30 subjects with 70% subjects in the low SMII normal or high SVRI group. An increase in SV was obtained in 23 subjects and a decrease in TAC in 26 subjects after epinephrine administration. CI and SMII values are expected to be used as clues to start epinephrine administration. Conclusion: Epinephrine administration led to clear changes in SV, CI, SVRI, SMII values in children with fluid-resistant septic shock. The use of IP and TAC is not effective for monitoring haemodynamics in sepsis shock in children.
Keywords: epinephrine; septic shock; stroke volume; total arterial compliance