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MANAGEMENT SEPTIC SHOCK EC MENINGOENCEPHALITIS BACTERIALIS AND

POST TRACHEOSTOMY WITH INDICATION PROLONGED MECHANICAL


VENTILATION

Muhammad David Riandy*, Zulkifli**

*Resident, Department of Anesthesiology and Intensive Care, Faculty of Medicine Sriwijaya


University, Dr. Moh. Hoesin Hospital Palembang, Indonesia
**Intensivist Consultant, Department of Anesthesiology and Intensive Care, Faculty of Medicine
Sriwijaya University, Dr. Moh. Hoesin Hospital Palembang, Indonesia

Introduction

Meningoencephalitis is a disease of central nervous system caused by a microorganism


susch as bacteria, virus, fungus. Some bacteria or virus is invaded in the dura sheet,
which causes severe inflammation in dura. When the brain is inflamed, the patient is
diagnosed meningoencephalitis. Sepsis is defined as life-threatening organ dysfunction
caused by a dysregulated host response to infection.

Objective

To present management of septic shock ec meningoencephalitis bacterialis in Dr.


Mohammad Hoesin General Hospital Palembang

Case Report

A 36 years old man with headache, loss of consciousness, hyperpyrexia, tachypnea,


tachycardia, hypotension. Patient with GCS 5 (E1M3V1), vital sign patient with BP 88/40
mmHg (MAP 56 mmHg), heart rate 114 x/min, respiratory rate 32x/min with SpO2 96%.
This patient with septic shock because meningoencephalitis bacterialis. Then, patient was
intubated and fluid resuscitation with crystalloid 30 ml/kgBB

Discussion
The goals of management in acute pulmonary edema are to maintain adequate
oxygenation and ventilation, decrease left ventricle preload and fluid restriction. The
methods of oxygen delivery in pulmonary edema include the use of a face mask,
noninvasive ventilation and intubation with mechanical ventilation. Any kind of method
which is used depends on the presence of hypoxemia, acidosis and patient's level of
consciousness.

Conclusion

The use of NIV in acute pulmonary edema can be an option. It significantly decreases the
need of endotracheal intubation, thus improving the survival rate of patient.

References

1. Sibai BM, Mabie BC, Harvey CJ, et al. Pulmonary edema in severe preeclampsia-
eclampsia: analysis of thirty-seven consecutive cases. Am J
ObstetGynecol1987;156:1174-9.
2. Dunne C, Meriano A (2009) Acute Postpartum Pulmonary Lung Edema in a 23 year
old woman 5 days after caesarean delivery. CJEM 11 : 178-171
3. Anthony C, Scisione K, Thomas I, Marissa L (2003) Acute pulmonary edema in
pregnancy. ObstetGynecol 101: 511-515
4. Agarwal R, Aggarwal AN, Gupta D, Jindal SK (2005) Noninasive ventilation in acute
cardiogenic pulmonary edema. Postgrade Med J 81: 637-643

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