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"Latar belakang: Luka bakar adalah keadaan gawat darurat medis yang membutuhkan penanganan komprehensif sesuai dengan penyebab dan tingkat keparahan. Terapi resusitasi cairan sangat penting untuk mencegah atau mengatasi syok hipovolemik. Prinsipnya adalah memberikan cairan secara konservatif untuk mencapai tujuan resusitasi tanpa menyebabkan ekstravasasi cairan, yang dapat meningkatkan tekanan intraabdomen (TIA). TIA yang tinggi dan persisten dapat menyebabkan hipertensi intraabdomen (HIA) dan sindrom kompartemen abdomen (SKA). Formula Parkland tetap menjadi standar untuk resusitasi cairan, dengan menggunakan produksi urine (UO) sebagai penilaian kecukupan resusitasi.Metode: Subjek dalam penelitian ini adalah pasien luka bakar yang mendapatkan resusitasi cairan di ULB RSCM dan memenuhi kriteria inklusi dan eksklusi. Penelitian ini menggunakan desain studi cross sectional untuk mengetahui korelasi antara TIA dan UO dan bersumber dari data primer. Pengambilan data dilakukan selama fase resusitasi cairan 24 jam pertama. Pengukuran TIA dilakukan setiap 6 jam, sedangkan pengukuran UO dilakukan setiap 1 jam.Hasil: 12 pasien terinklusi dalam penelitian ini. Korelasi antara TIA dan UO 6 jam pertama bernilai lemah positif (r =0,225), pada 6 jam kedua korelasi lemah negatif (r = -0,226), pada 6 jam ketiga korelasi sedang negatif (r = -0,524), pada 6 jam keempat tidak terdapat korelasi (r = -0,120), pada korelasi secara keseluruhan selama 24 jam didapatkan korelasi lemah negatif (r = -0,208) tanpa adanya signifikansi secara keseluruhan (p > 0,05). Lebih lanjut, ditemukan korelasi antara %TBSA dengan jumlah cairan resusitasi selama 24 jam tergolong sangat kuat (r = 0,890) dan signifikan, korelasi antara %TBSA dengan rerata TIA selama 24 jam tergolong lemah positif (r = 0,226, p > 0,05), dan korelasi antara jumlah cairan resusitasi dan TIA rerata tergolong sedang positif (r = 0,467, p > 0.05).Kesimpulan: Tidak terdapat korelasi secara signifikan (p > 0.05) antara tekanan intraabdomen terhadap urine output pada pasien luka bakar selama fase 24 jam resusitasi cairan pertama di ULB RSCM.

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Introduction: Burns are urgent medical emergencies requiring comprehensive management based on etiology and severity. Fluid resuscitation therapy is crucial to prevent or manage hypovolemic shock. The principle is to administer fluid conservatively to achieve resuscitation goals without causing fluid extravasation, which can lead to intra-abdominal pressure (IAP) elevation. Persistent high IAP can result in intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). The Parkland formula remains standard for fluid resuscitation, utilizing urine output (UO) to assess adequacy.

Methods: Subjects in this study were burn patients who received fluid resuscitation at ULB RSCM and met the inclusion and exclusion criteria. This research uses a cross-sectional study design to determine the correlation between TIA and UO and is sourced from primary data. Data collection was carried out during the first 24 hours of fluid resuscitation phase. IAP measurements are carried out every 6 hours, while UO measurements are carried out every 1 hour.

Result: 12 patients were included in this study. The correlation between IAP and UO in the first 6 hours was weakly positive (r = 0.225), in the second 6 hours the correlation was weakly negative (r = -0.226), in the third 6 hours the correlation was moderately negative (r = -0.524), in the fourth 6 hours it was not there is a correlation (r = -0.120), in the overall correlation for 24 hours there is a weak negative correlation (r = -0.208) with no overall significance (p > 0.05). Furthermore, it was found that the correlation between %TBSA and the amount of resuscitation fluid for 24 hours was classified as very strong (r = 0.890) and significant, the correlation between %TBSA and average IAP for 24 hours was classified as weakly positive (r = 0.226, p > 0.05), and the correlation between the amount of resuscitation fluid and average IAP was moderately positive (r = 0.467, p > 0.05).

Conclusion: There is no significant correlation (p>0.05) between intra-abdominal pressure and urine output in burn patients during the first 24hour phase of fluid resuscitation at ULB RSCM."

"Tingginya angka mortalitas syok anak dapat dicegah dengan deteksi dini dan terapi adekuat. Parameter hemodinamik digunakan sebagai dasar tatalaksana syok. Tujuan penelitian ini adalah mengetahui perubahan parameter hemodinamik pada pasien syok anak pasca resusitasi cairan dan obat-obatan vasoaktif. Penelitian deskriptif ini dilakukan di instalasi gawat darurat dan rawat intensif RSUPN dr. Cipto Mangunkusumo Jakarta, Januari 2013-September 2014, pada seluruh anak yang mengalami syok. Pengukuran hemodinamik dengan USCOM dilakukan pada jam I dan VI. Sebagian besar pasien mengalami syok hipodinamik dan refrakter cairan pasca resusitasi. Pasca pemberian obat-obatan vasoaktif, terjadi peningkatan inotropy pada sebagian besar kasus, namun diikuti oleh peningkatan afterload.

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The high mortality rate in pediatric shock can be prevented by early detection and adequate management. Hemodynamic parameters is useful for guiding shock management. The aim of study was describing hemodynamic parameters in pediatric shock after fluid resuscitation and vasoactive drugs therapy. This descriptive study was conducted at emergency room and intensive care unit, Cipto Mangunkusumo Hospital, Jakarta, in January 2013 ? September 2014, including all shock children. The hemodynamic was measured by USCOM in 1st and 6th hour. Most patients suffered from hypodynamic and fluid-refractory shock after fluid resuscitation. Post-administration of vasoactive drugs, inotropy and afterload increased in most cases."

"yok kardiogenik yang terjadi pada seseorang dapat disebabkan oleh penurunan kinerja miokard yang parah dan mengakibatkan penurunan curah jantung hingga hipoperfusi organ akhir. Pemberian resusitasi cairan pada manajemen awal syok kardiogenik menjadi tantangan klinis karena seringkali sulit dinilai dan dapat bervariasi dari waktu ke waktu. Sehingga, salah satu cara untuk mengetahui efektivitas resusitasi cairan dengan syok kardiogenik adalah dengan pemantauan hemodinamik pasien menggunakan tekanan arteri rata-rata/mean arterial pressure (MAP). Metode dalam karya ilmiah ini dengan case study pada praktik klinik keperawatan kegawatdaruratan di RSUI. Pasien kelolaan adalah Tn. A berusia 74 tahun dengan diagnosis syok kombinasi kardiogenik dan intervensi utama yaitu pemantauan status sirkulasi menggunakan tekanan darah arteri rata-rata (MAP) untuk mengukur efektivitas resusitasi cairan. Hasil implementasi pemantauan MAP menunjukkan MAP dapat menjadi pengukuran efektivitas resusitasi cairan pada status sirkulasi pasien dengan syok kardiogenik. Perawat dapat menggunakan pemantauan status sirkulasi menggunakan tekanan darah arteri rata-rata (MAP) sebagai salah satu pengukuran efektivitas resusitasi cairan.

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Cardiogenic shock that occurs in a person can be caused by a severe decrease in myocardial performance and result in a decrease in cardiac output to end organ hypoperfusion. Providing fluid resuscitation in the initial management of cardiogenic shock is a clinical challenge because it is often difficult to assess and can vary over time. Thus, one way to determine the effectiveness of fluid resuscitation in cardiogenic shock is to monitor the patient's hemodynamics using the mean arterial pressure (MAP). The method in this scientific work is a case study in clinical of emergency nursing at RSUI. The patient being managed is Mr. A is 74 years old with a diagnosis of combined cardiogenic shock and the main intervention is monitoring of circulation status using mean arterial blood pressure (MAP) to measure the effectiveness of fluid resuscitation. The results of implementing MAP monitoring show that MAP can be a measure of the effectiveness of fluid resuscitation on the circulation status of patients with cardiogenic shock. Nurses can use monitoring of circulation status using mean arterial blood pressure (MAP) as one measure of the effectiveness of fluid resuscitation."

"Panduan resusitasi anak umumnya menganjurkan pemberian cairan dalam jumlah besar. Beberapa penelitian memperlihatkan bahwa penggunaan cairan yang agresif meningkatkan mortalitas. Penelitian pada hewan menunjukkan tekanan vena sentral yang tinggi memicu pelepasan atrial natriuretic peptide ANP , sementara penelitian invitro memperlihatkan ANP meluruhkan glycocalyx endotel vaskular dan meningkatkan permeabilitas endotel. ANP juga memicu vasodilatasi. Hemodilusi berpotensi menurunkan pasokan oksigen tubuh DO2 . Penelitian bertujuan untuk melihat pengaruh resusitasi cairan terhadap kadar ANP serum, peluruhan glycocalyx endotel vaskular, extravascular lung water index ELWI , mean arterial pressure MAP , kadar hemoglobin dan pasokan oksigen. Hewan model renjatan adalah 11 ekor Sus scrofa jantan, usia 6-10 minggu. Renjatan dilakukan dengan metode fixed pressure hemorrhage. Resusitasi pertama dilakukan dengan jumlah cairan sesuai darah yang dikeluarkan resusitasi normovolemik , dilanjutkan dengan 40 mL/kg resusitasi hipervolemik . Pengukuran hemodinamik dilakukan dengan PICCO. Serum ANP dan Syndecan-1, petanda peluruhan glycocalyx, dilakukan dengan teknik ELISA. Hasil penelitian menunjukkan terjadinya peningkatan ANP pasca resusitasi normovolemik p = 0,043 , yang kemudian menurun kembali dalam 30 menit. Peluruhan glycocalyx tidak terjadi. Perbedaan ELWI pada 60 menit pasca resusitasi secara statistik bermakna, dengan perbedaan 0,93 mL/kg 95 IK:0,19 -3,62 . Terdapat korelasi kuat antara SVRI dan CI pasca resusitasi hipervolemik r = -0,587 . Tidak ada perbedaan MAP pasca resusitasi normovolemik dan hipervolemik. Kadar hemoglobin pasca resusitasi hipervolemik lebih rendah daripada pasca resusitasi normovolemik p = 0,009 . Pasokan oksigen tubuh pasca resusitasi hipervolemik lebih tinggi daripada pasca resusitasi normovolemik p = 0,012 . Simpulan: Resusitasi cairan pada renjatan akibat perdarahan tidak mengakibatkan peluruhan glycocalyx endotel vaskular. Peningkatan ELWI amat terbatas. SVRI berkorelasi terbalik dengan CI. Tidak ada perbedaan MAP antara resusitasi normovolemik dan hipervolemik. Resusitasi hipervolemik menyebabkan hemodilusi yang diimbangi dengan peningkatan curah jantung.

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Many pediatric guidelines recommend liberal fluid resuscitation, but recent studies showed that aggressive fluid resuscitation might increase mortality. Animal studies showed that high central venous pressure induced ANP secretion. Invitro studies showed convincing evidence that ANP induced glycocalyx shedding. ANP also induced vasodilatation through cGMP signal transduction pathways. Hemodilution due to a large amount of resuscitation fluid potentially decreasing oxygen delivery.The objectives of this study were investigating the effect of fluid resuscitation, in the animal model, with special concern on serum ANP, glycocalyx shedding indicate by serum Syndecan-1 , changes in extravascular lung water, systemic vascular resirtance and mean arterial pressure, hemoglobin level and oxygen delivery DO2 . The animal models were 11 male domestic pigs, 6 -10 weeks old. The shock was induced with fixed pressure hemorrhage method. Fluid resuscitation was done in 2 phases. On the first attempt, we replaced total numbers of blood that withdrawn normovolemic resuscitation . On the second attempt, we gave 40 mL/kg resuscitation fluids hypervolemic resuscitation . The hemodynamic measurements were done with PICCO. Serum ANP and Syndecan-1 were measure with ELISA method.We found that serum ANP increased after normovolemic resuscitation p = 0.043 and immediately back to base level in 30 minutes. Glycocalyx shedding did not occur. Extravascular lung water index minimally increased. There was a strong correlation between SVRI and CI at hypervolemic resuscitation r = -0.587 . There was no difference in mean arterial pressure between normovolemic and hypervolemic resuscitation. Hemoglobin level after hypervolemic resuscitation was lower than after normovolemic resuscitation p = 0.009 . Oxygen delivery was higher after hypervolemic resuscitation p = 0.012 .Conclusions: Hypervolemic resuscitation in this hemorrhagic shock model did not induce glycocalyx shedding, extravascular lung water index minimally increased. Systemic vascular resistance index negatively correlated to cardiac index. Fluid resuscitation may induce hemodilution, but oxygen delivery can be compensated by increasing cardiac output. "