Supandji, Mia
Perdatin Pusat

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Mikrosirkulasi Supandji, Mia; Redjeki, Ike Sri
Majalah Anestesia dan Critical Care Vol 34 No 2 (2016): Juni
Publisher : Perdatin Pusat

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Mikrosirkulasi adalah suatu jaringan pembuluh darah yang sangat kecil dan tidak terlihat dengan mata telanjang. Mikrosirkulasi merupakan bagian dari sirkulasi yang berfungsi untuk transportasi oksigen, nutrisi ke jaringan sel dan produk pembuangan dari sel melalui pembuluh darah. Saat terjadinya suatu kondisi sepsis maka akan terjadi gangguan fungsi mikrosirkulasi disertai dengan gangguan fungsi endotel, mitokondria, degradasi, glycocalyx, kebocoran kapiler, hilangnya reaktivitas vaskular, autoregulasi dan mikrotrombosis. Hal tersebut akan menyebabkan terjadinya kondisi densitas vaskular yang heterogen disertai dengan kantung-kantung area hipoksia. Gangguan ini tidak dapat didiagnosis secara pasti menggunakan parameter hemodinamik global, namun mememrlukan advanced imaging techniques. Resusitasi dengan pemberian cairan, merupakan dasar dari resutitasi mikrosirkulasi selain terapi dengan mengguakan obat-obatan lainnya. Kata kunci: Mikrosirkulasi,oksigen, perfusi, resusitasi, sepsis MicrocirculationMicrocirculation is a network of small blood vessels that are too small to see with naked eyes; it is a very important part of the human circulation, for the transport of oxygen and nutrition to the cells and waste products form the cells to the blood vessels. In septic patient, there is an alteration of the microcirculation associated with endothelial dysfunction, mitochondria dysfunction, glycocalyx degradation, capillary leakage, loss of micro vascular reactivity and auto regulation and micro thrombosis. Moreover there are heterogeneity of vascular density associated with hypoxic pocket zones. These alterations can not be diagnosed definitely with global hemodynamic parameters,and therefore advanced imaging techniques arerequired. Fluid resuscitation is a fundamental therapy in restoring microcirculation beside a combination of agents. Key words: Microsirculation, oxygent, perfusion,resuscutation, sepsis
Resuscitative Strategies in Traumatic Hemorrhagic Shock Supandji, Mia; Budipratama, Dhany; Pradian, Erwin
Majalah Anestesia dan Critical Care Vol 33 No 3 (2015): Oktober
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Trauma and brain injury are common in young patients with a high incidence of mortality. The classic triadof death in a trauma involves hypothermia, acidosis and coagulopathy. This physiologic derangement plays animportant role in exsanguination and death of trauma patients, if it is not promptly diagnosed and aggressivelytreated. However, the optimal strategy is still debatable. Damage Control Resuscitation along with damage controlsurgery has been proven to increase patients survival. DCR is a management of patients with trauma startedfrom the emergency room up to the operating room and the intensive care unit (ICU). Five pillars of DCR are 1.Body rewarming, 2. Correction of acidosis, 3. Permissive hypotension, 4. Restrictive luids administration and 5.Hemostatic resuscitation. Early and aggressive transfusion of blood and blood products, with comparison of PRC,FFP and platelets of 1:1:1, if no whole blood available, can improve the outcome and survival of the patients.