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"Latar belakang: Sindrom curah jantung rendah (low cardiac output syndrome, LCOS) merupakan salah satu morbiditas yang terjadi pascaoperasi jantung terbuka. Angka kejadian LCOS pada pasien pascaoperasi sebanyak 25–65%, sehingga diperlukannya suatu penanda biologis praoperatif untuk menilai keadaan pembedahan yang optimal. NT-proBNP merupakan suatu biomarker yang berpotensi digunakan dalam diagnosis, tata laksana dan prognosis pada populasi pediatrik. Penelitian ini bertujuan untuk mengevaluasi peran NT-proBNP sebagai faktor prediktor terhadap kejadian LCOS pascabedah jantung terbuka.Metode: Studi longitudinal dilakukan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita dalam periode November 2018 hingga Maret 2020 dengan merekrut subjek di bawah usia 18 tahun yang menjalani operasi korektif kelainan jantung bawaan. Kadar NT-proBNP prabedah diambil dan dianalisis terhadap kejadian LCOS pascaoperasi.Hasil: Terdapat 159 subjek dilibatkan sebagai subjek penelitian. Angka kejadian LCOS pascaoperasi sebanyak 23,9%. Median NT-proBNP prabedah berbeda bermakna antara pasien yang mengalami LCOS dengan pasien yang tidak mengalami LCOS (1592 pg/mL vs. 227 pg/mL; p = 0,001). Nilai cut-off NT-proBNP prabedah terhadap kejadian LCOS pascaoperasi adalah 400 pg/mL, dengan sensitivitas 78,95%, spesifisitas 64,46%, positive predictive value 41,10%, negative predictive value 90,70% dan diagnostic accuracy 67,92%.Simpulan: NT-proBNP prabedah dapat dijadikan faktor prediktor terhadap kejadian LCOS pascaoperasi jantung terbuka. Nilai cut-off NT-proBNP prabedah terhadap luaran LCOS pascaoperasi adalah 400 pg/mL.

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Background: Low cardiac output syndrome (LCOS) is a common morbidity following open heart surgery in pediatric population. The incidence of postoperative LCOS range from 25 to 65%, indicating the needs for preoperative tool to evaluate optimum condition prior to surgery. NT-proBNP is a biomarker that has potential in diagnosis, management, and prognosis in pediatric population. This study aims to evaluate the role of NT-proBNP as predictive factor for LCOS following cardiac surgery.

Methods: A longitudinal study was conducted in Harapan Kita National Heart Center between November 2018 and March 2020. We recruited subjects below 18 years old who underwent corrective cardiac surgery. NT-proBNP was obtained preoperatively and analyzed for postoperative LCOS.

Results: A total of 159 subjects were enrolled. The incidence of postoperative LCOS was 23.9%. The median of preoperative NT-proBNP was found to be significantly higher in patients experiencing LCOS compared to that of patients without LCOS (1592 pg/mL vs. 227 pg/mL; p = 0.001). The cut-off value for preoperative NT-proBNP to determine postoperative LCOS was 400 pg/mL with sensitivity of 78.95%, specificity of 64.46%, positive predictive value of 41.10%, negative predictive value of 90.70% and diagnostic accuracy of 67.92%.

Conclusions: Preoperative NT-proBNP can be used as predictor for postoperative LCOS following cardiac surgery. The cut-off value of preoperative NT-proBNP in determining postoperative LCOS was found to be 400 pg/mL."

"Latar Belakang: Aktifitas dan lingkungan penyelaman yang dilakukan penyelam Kopaska memiliki bahaya potensial baik fisik, kimia maupun biologi. Teori adatatif Guritno mengatakan bahwa lingkungan penyelaman merupakan stressor yang menyebabkan manusia melakukan penyesuain, dimana dalam melakukan adaptasinya mengalami strain yang mempengaruhi beberapa organ tubuh manusia. Penelitian ini bertujuan membuktikan pengaruh kerja jantung : isi sekuncup, frekuensi denyut jantung dan curah jantung dengan kerja fisik submaksimal menggunakan media napas oksigen 100% dan udara kompresi di kedalaman 5 meter pada penyelam Kopaska. Metode: Penelitian ini merupakan studi eksperimental dengan cross over design. Subyek penelitin 22 orang penyelam Kopaska, dibagi dua kelompok, yaitu oksigen 100% (intervensi) dengan udara kompresi (kontrol). Kerja fisik submaksimal menggunakan sepeda ergocycle dengan metode Astrand modifikasi Guritno. Hasil: Perbandingan respon kardiovaskuler antara media napas oksigen 100% dengan udara kompresi kondisi hiperbarik saat istirahat, respon isi sekuncup dengan nilai value-p p = 0.655, frekuensi denyut jantung p = 0.512 dan curah jantung p = 0.769 (p > 0.05). Dalam kondisi hiperbarik saat pembebanan fisik submaksimal 2 Kp, respon isi sekuncup dengan nilai value-p p = 0.655, frekuensi denyut jantung p = 0.512 dan curah jantung p = 0.769 (p > 0.05). Kesimpulan: Tidak terdapat perbedaan bermakna pada sistem kardiovaskuler berupa respon isi sekuncup, frekuensi denyut jantung dan curah jantung antara media napas oksigen 100% dengan udara kompresi di kedalaman 5 meter baik saat istirahat maupun saat pembebanan fisik submaksimal 2 Kp.

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Background: activities and environmental dives conducted frogmen divers have good potential danger of physical, chemical and biological. "Guritno adatatif Theory" says that the dive environment is a stressor that causes people to do adjustment, which in doing adaptation subjected to strain that affects several organs of the human body. This study aims to prove the influence of the heart: stroke volume, heart rate and cardiac output with submaximal physical work using the media breathing 100% oxygen and compressed air at a depth of 5 meters at divers frogmen. Methods: This study is an experimental study with cross-over design. The subjects of the research is conducted 22 divers frogmen, divided into two groups, namely oxygen 100% (intervention) with compressed air (control). Submaximal exercise using a bicycle Ergocycle Astrand method "Guritno modification". Results: Comparison of cardiovascular responses between the media breathing oxygen 100% (hyperbaric hyperoxia) with compressed air (hyperbaric ?hyperoxia air?) conditions hyperbaricat rest, stroke volume response with value-p of p = 0.655, heart rate p = 0.512 and cardiac output p = 0.769 (p> 0.05). In conditions hyperbaric submaximal exercise 2 Kp, stroke volume response with value-p of p = 0.226, heart rate p = 0.647 and cardiac output p = 0.195 (p> 0.05). Conclusions: There were no significant differences in the response of the cardiovascular system such as stroke volume, heart rate and cardiac output between the media breathing oxygen 100% with compressed air at a depth of 5 meters both at rest and during submaximal exercise 2 Kp."

"Posisi tubuh semi fowler 30° lateral kanan yang dianggap upaya proteksi mandiri yang memiliki efek positif terhadap hemodinamik pada pasien gagal jantung, namun belum diketahui dampaknya terhadap curah jantung. Penelitian ini bertujuan untuk mengetahui pengaruh posisi semi fowler 30 lateral kanan terhadap curah jantung. Uji klinis crossover pada 20 subjek gagal jantung akut dengan teknik non randomisasi berdasarkan riwayat gagal jantung. Parameter hemodinamik diukur menggunakan alat LiDCO CNAP. Analisa dilakukan untuk menilai efek residual dan efektifitasnya menggunakan SPSS 26 & NCSS. Rentang usia subjek adalah 26-72 tahun. 75% tidak memiliki riwayat gagal jantung. 85% memiliki penurunan fraksi ejeksi ventrikel kiri <40%. Durasi washout 30 menit tidak menimbulkan efek residual dan tidak bermakna secara statistik (p>0.05). Perbedaan rerata stroke volume (p<0.05), variasi stroke volume 20.1±7.6 vs 43.3±19. Rerata curah jantung 4.88 sedangkan semi fowler 4.20, tidak signifikan secara statistik (p>0.05). Semi fowler 30 lateral kanan menurunkan variasi stroke volume dan meningkatkan rerata curah jantung. Dipertimbangkan sebagai strategi optimalisasi beban awal pada pasien gagal jantung preload dependent.

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The right lateral semi fowler 30° body position is considered a self-protective measure that has a positive effect on hemodynamics in heart failure patients, but the impact on cardiac output is not yet known. This study aimed to determine the effect of positioning the right lateral 30 semi fowler on cardiac output. A non randomized Crossover clinical trial on 20 acute heart failure subjects based on history of heart failure. Hemodynamic parameters were measured using the LiDCO CNAP. Statistical analysis was performed to assess the residual effect and assess its effectiveness using SPSS 26 & NCSS software. The age range of subjects is 26-72 years. 75% had no history of heart failure. 85% of subjects had a decrease in left ventricular ejection fraction <40%. The washout duration of 30 minutes caused no residual effect and was not statistically significant (p>0.05). The average stroke volume differs significantly, stroke volume variation in SF30RL was 20.1±7.6 vs 43.3±19 in SF group. The mean cardiac output SF30RL was 4.88 while the semi fowler was 4.20 but not statistically significant (p>0.05). The right lateral 30 semi fowler can increase cardiac output values. Considered as a volume optimization strategy in a preload dependentt patients."