Tugas Jurnal Anestesi

Coass :

Annisa Suliyani 012116331

Sanchia Janita C. 30101206798
Putri Kusuma W. 30101206816
Fierly Damayanti S. 30101206828
Siti Sofi Hadiyana 30101206846

Tugas :
1) Elevated mixed venous oxygen saturation (>70%)?
Saturasi oksigen vena (Sv O2) diukur untuk melihat berapa banyak mengkonsumsi
oksigen tubuh. Dalam perawatan klinis, Sv O2 di bawah 60%, menunjukkan bahwa tubuh
adalah dalam kekurangan oksigen, dan iskemik penyakit terjadi. Pengukuran ini sering
digunakan pengobatan dengan mesin jantung-paru (Extracorporeal Sirkulasi), dan dapat
memberikan gambaran tentang berapa banyak aliran darah pasien yang diperlukan agar
tetap sehat.

2) Cardiac index?
Cardiac index (CI) is a haemodynamic parameter that relates the cardiac output (CO)
from left ventricle in one minute to body surface area (BSA), thus relating heart
performance to the size of the individual. The unit of measurement is litres per minute per
square metre (L/min/m2).

Rumus :
CI = CO / BSA

CI : Cardiac Index (L/min/m2)

CO : Cardiac Output (L/menit)

BSA : Body Surface Area (m2)

3) Arterial hypoxemia?
Hypoxemia is an abnormally low level of oxygen in the blood. More specifically, it is
oxygen deficiency in arterial blood. Hypoxemiahas many causes, often respiratory
disorders, and can cause tissue hypoxia as the blood is not supplying enough oxygen to the
body.

4) Vital organ support?

Life support refers to a spectrum of techniques used to maintain life after the failure of one
or more vital organs.
Purpose ; A patient requires life support when one or more vital organs fail, due to causes
such as trauma, infection, cancer, heart attack, or chronic disease

5) Early goal direct theraphy?

Early Goal Direct Theraphy (EGDT) is comprised of early identification of high-risk
patients, appropriate cultures, source control, and administration of appropriate antibiotics.

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This is followed by early hemodynamic optimization of oxygen delivery, guided by

preload (central venous pressure (CVP) or surrogate targeting with fluids), afterload (mean
arterial pressure (MAP) targeted with vasopressors), arterial oxygen content (packed red
blood cells and/or oxygen supplementation), contractility (inotropic agents), and
decreasing oxygen consumption (mechanical ventilation and sedation), and guided by
ScvO2. These principles were essentially best practice recommendations for sepsis
management in the ICU setting

6) Fluid challenge?
 A fluid challenge is a method of identifying those patients likely to benefit from an
increase in intravenous volume in order to guide further volume resuscitation. It is a
dynamic test of the circulation. The use of a test that uses a small amount of fluid to
assess the volume responsiveness may reduce the risk of too liberal fluid strategy and
the possible consequences of fluid overload.
 A fluid challenge is used as a diagnostic and a therapeutic measure to assess and
optimise intravascular volume status of an individual patient.

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 Indications: Patients identified as requiring a fluid challenge who meet the

criteria specified in the section below: ‘Common issues prompting review for fluid
challenge’.  Patients in whom a clinical assessment reveals the following factors
that could suggest the need for fluid administration:
 Dynamic evaluation: This has greater specificity and is considered more
useful than static evaluation. Dynamic methods should be used as a guide during
administration of a fluid challenge.
• Respiratory variations in arterial pressure or stroke volume (during
mechanical ventilation in the absence of ventilatory dyssynchrony or
arrhythmias).
• Pulse pressure variation or stroke volume variation with the respiratory cycle
• Positive response to fluid challenge.
 Static Evaluation: This has limited sensitivity and specificity.
Signs of dehydration:
• Diminished skin turgor
• Thirst
• Dry mouth
• Hypernatraemia, hyperproteinaemia, elevated haemoglobin and haematocrit.
Circulatory signs of hypovolaemia:
• Tachycardia (refer to ‘goals to be achieved’ section below).
• Arterial hypotension (MAP ≤65mmHg)
• Increased serum lactate
• Decreased peripheral temperature
Decreased renal perfusion:
• Concentrated urine output < 0.5mL/kg/hr (refer to ‘goals to be achieved’
section below)
• Increased blood urea nitrogen relative to creatinine concentration. •
Persistent metabolic acidosis.

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7) Elevated cardiac filling pressures?

Preload is teh fillig pressure of the heart at the end of diastole. The left arterial pressure
(LAP) at the end of diastole will determine the preload.
Starling’s Law : heart will eject a greater stroke volume if it is filled to a greater volume at
the end of diastole. The volume of the heart at the end diastole is related to the filling
pressure of the heart (preload) which is determined by the left atrial pressure (LAP)
Afterload is the pressure against which the heart must work to eject blood during systole
(systolic pressure). The lower blood the heart will eject with each contraction.
If systolic pressure is higher, the heart will be unable to contract to as small a volume at
the end of systole and the stroke volume index will be decreased.

8) De-escalation?
 De-eskalasi antibiotik merupakan cara pengobatan dengan pemberian antibiotik awal
berspektrum luas dengan probabilitas tinggi mencakup semua patogen yang mungkin
kemudian dalam waktu 48-72 jam dilanjutkan dengan pengalihan antibiotik
berspektrum sempit berdasarkan data mikrobiologi yang dapat mencakup semua
kuman penyebab.
 Peran penting de-eskalasi adalah pada proses pengambilan keputusan dengan memilih
terapi spektrum laus secara empiris dan kebijakan menghentikan terapi antibiotik bila
hasil kultur putum mikroorganisme sudah negatif dan terdapat tanda-tanda awal
penyembuhan.
 Tujuan utama yaitu berusaha mengganti rejimen terapi empiris ombinasi menjadi
monoterapi untuk mencegah resistensi selama pengobatan.