HEMODINAMIC

MONITORING
IN SEPSIS
HENRY SAKTIANA, S.KEP., NS
HIPERCCI JAWA TENGAH

MY PROFILS
 Nama : Henry saktiana, S.Kep., Ns
 Tempat tanggal lahir : Batang, 01 januari 1981
 Status : Menikah
 Institusi : IRIN - RSUP Dr.Kariadi Semarang
 Pendidikan :
1. D3-Keperawatan : Poltekkes Semarang Prodi Keperawatan Pekalongan (2002)
2. S1/Ners : Universitas Diponegoro Semarang (2015)
 Pelatihan :
1. TOT BPTTK Gombong (2016)
2. ICU-CCU RSUP Dr. Kariadi Semarang (2016)
3. BTLS-BCLS Pro-Emergency Cibinong (2015)

MY FAMILY .

Come On .

PREVIEW MANAGEMENT SEPSIS PENEGAKAN PENATALAKSANAAN MONITORING DIAGNOSIS qSOFA Sepsis hemodinamik SOFA Score BUNDLE .

memantau. mengamati. . atau mengecek dengan cermat. terutama untuk tujuan khusus. (kamus besar bahasa indonesia)  Hemodinamic : Performance of cardiovasculer system.DEFINISION OF HEMODINAMIC MONITORING  Monitoring (me-monitor) : mengawasi.

THE GOALS OF MONITORING HEMODINAMIC Tujuan monitoring hemodinamik adalah? • Untuk mempertahankan / memastikan PERFUSI JARINGAN ADEQUAT. .

PARAMETER HEMODINAMIK .

 VERY VIEW randomized controlled trial. .PRINCIPLES OF MONITORING HEMODINAMIC  Monitoring is NOT therapy.  Clinicians MUST KNOW how to interpret the data.

 Perfusi organ di tentukan oleh perbedaan antara tekan arteri dan tekanan vena dibagi resistensi (FLOW).PERFUSI ORGAN  HIPOPERFUSI ORGAN vital dapat menyebabkan terjadinya DISFUNGSI SISTEM ORGAN MULTIPEL dan KEMATIAN.  FLOW = (P arterial – P vena) : RESISTENSI  Flow ≈ MAP (mean arterial pressure) .

TANDA-TANDA HIPOPERFUSI JARINGAN .

diastolic volume PERFORMANCE (pressure) PRELOAD CVP = RVEDV PAOP = LVDF Afterload = 2. DETERMINANT OF Estimated end CARDIAC 1. CONTRACTILITY muscle to contract . SVR AFTERLOAD Ability heart 3.

METHODS OF HEMODINAMIC MONITORING .

4)  Mean arterial pressure (MAP) ≥ 65 mm Hg  Central venous pressure (CVP) 8-12 mm Hg (12-15 mm Hg in patients receiving mechanical ventilation or with known preexisting decreased ventricular compliance)  Urine output ≥ 0.5 mL/kg/hr  Central venous oxygen saturation (ScVO₂ : from the superior vena cava) ≥ 70%. . or mixed venous oxygen saturation (SVO₂ : from a pulmonary artery catheter) ≥ 65%.THE GOALS DURING THE FIRST 6 HOURS OF SEPSIS RESUSCITATION SHOULD BE (GRADE 1C): (LIT.

(LIT 3) .BLOOD PRESSURE RECOMENDED TARGET OF MAP FOR SEPSIS > 65 MMHG (GRADE 1C).

(ProCESS & ARISE study) .(LIT 3)  CVP : a) reflect RIGHT VENTRICLE FEELING PRESSURE.  ScVO₂ 1) Is ONE OF USEFUL INDEX OF TISSUE HIPOPERFUSION. b) ESTIMATION of intravasculer volume status. 2) however.CENTRAL VENOUS PRESSURE (CVP) AND ScVO₂. THE EFFECTIVENESS as single goal of sepsis treatment is QUESTIONABLE. c) LIMITED BY respiratory variation and PEEP.

3) .(LIT.

LACTATE SERUM (GRADE 2.C). 3. (LIT. . Lactate has been suggested as an ALTERNATIVE GOAL AND MONITORING INDEX FOR RESUSCITATION in severe sepsis or septic shock.3)  PROCESS dan ARISE study : 1. Serial measurement of lactate is expected TO BE USED AS AN ALTERNATIVE TO SCVO2 IF CENTRAL VENOUS INSERTION IS NOT AVAILABLE. 2. lactate normalization within 6 hours was THE STRONGEST PREDICTOR OF SURVIVAL in severe sepsis.

7 Hipotension only 30.3 .7 Lactate > 2 mmol only 25. (LIT.2) IN HOSPITAL MORTALITY (%) No hipotension and lactat < 2 mmol 18.LACTATE AS PREDICTOR MORTALLITY.1 Hipotension and lactate > 2 42.

HAMBATAN MONITORING HEMODINAMIK PASIEN SEPSIS Tidak ada fasilitas yang memadai • CVC • Laboratorium : laktat .

2010  Boom C. kardiak anestesi .pdf  Abdul Hakeem Al Hashim . 2010 .egdt. MD.2013. 2015Refrensi Monitoring hemodinamik\lit 3. Update of Sepsis Recent Evidences about.pdf  Cho W.fluid resusitation. update of sepsis : recent evidences about Early goal directed therapy .pdf  pullCCM : Surviving Sepsis Guidelines: Early Goal Directed Therapy. Initial Fluid Resuscitation : 2013Refrensi Monitoring hemodinamik\lit 4.H . sepsis-3 : 2016seminar hipercci nop 2016 journals\lit 2.E .docx  Orlando health . the third international consensus definitions for sepsis and septic shock (sepsis-3) : 2016seminar hipercci nop 2016 journals\lit 1. Sepsis-3 Abdul Hakeem Al Hashim.REFERENSI  JAMA . fundamentals hemodinamic monitoring . FRCPC. consensus definition of sepsis and syock septik (sepsis-3). Surviving Sepsis Guidelines.