MANAJEMEN PASIEN DENGAN SYOK SEPSIS, CONGESTIVE HEART FAILURE, CORONARY ARTERIAL DISEASE, CHRONIC KIDNEY DISEASE POST FISTULEKTOMI DI ICU
DOI:
https://doi.org/10.31004/jkt.v6i2.45876Keywords:
chronic kidney disease, congestive heart failure, fistelektomi, sepsis, syok sepsisAbstract
Sepsis merupakan kondisi disregulasi sistem imun akibat infeksi dengan angka mortalitas tinggi yang dapat mencapai 26%. Komplikasi seperti Acute Kidney Injury dapat meningkatkan risiko kematian hingga 50%. Masalah utama dalam manajemen sepsis adalah kompleksitas penanganan pasien dengan komorbid multipel seperti gagal jantung kongestif (CHF) dan chronic kidney disease (CKD). Tujuan penelitian ini adalah mengevaluasi manajemen dan luaran klinis pasien dengan syok sepsis disertai komorbid CHF dan CKD post fistelektomi di ruang intensif. Kasus: Pasien menjalani fistelektomi drainase dan dirawat di ICU dengan dukungan ventilasi mekanik, vasopresor (norepinefrin, dobutamin, epinefrin), dan antibiotik spektrum luas (meropenem). Pemeriksaan laboratorium menunjukkan leukositosis signifikan, anemia, hipoalbuminemia, serta gangguan fungsi hati dan ginjal. Setelah empat hari perawatan intensif dengan monitoring hemodinamik ketat, pasien menunjukkan perbaikan klinis, berhasil diekstubasi, dan direncanakan pindah ke ruang perawatan biasa. Simpulan: Manajemen pasien dengan syok sepsis disertai komorbid CHF dan CKD memerlukan pendekatan multidisiplin yang komprehensif. Kontrol sumber infeksi melalui pembedahan, terapi sepsis sistematis, dan pemantauan ketat di ruang intensif berperan penting dalam meningkatkan luaran klinis dan survival pasien.References
Abou Dagher, G., Hajjar, K., Khoury, C., El Hajj, N., Kanso, M., Makki, M., Mailhac, A., & Bou Chebl, R. (2018). Outcomes of patients with systolic heart failure presenting with sepsis to the emergency department of a tertiary hospital: a retrospective chart review study from Lebanon. BMJ Open, 8(7), e022185. https://doi.org/10.1136/bmjopen-2018-022185
Acharya, R., Patel, A., Schultz, E., Bourgeois, M., Kandinata, N., Paswan, R., Kafle, S., Sedhai, Y. R., & Younus, U. (2021). Fluid resuscitation and outcomes in heart failure patients with severe sepsis or septic shock: A retrospective case-control study. PloS One, 16(8), e0256368. https://doi.org/10.1371/journal.pone.0256368
Bagshaw, S. M., George, C., & Bellomo, R. (2008). Early acute kidney injury and sepsis: a multicentre evaluation. Critical Care (London, England), 12(2), R47. https://doi.org/10.1186/cc6863
Charalampopoulos, A., Bagias, G., Perdicaris, M., Latsonas, P., Papagrigoriadis, S., & Papaconstantinou, D. (2022). Perineal sepsis and successful surgical treatment in supralevator and ischiorectal fossa abscess: a case report. Journal of Surgical Case Reports, 2022(6), rjac287. https://doi.org/10.1093/jscr/rjac287
Chen, Y., Wang, X., Lin, G., & Xiao, R. (2018). Successful treatment following early recognition of a case of Fournier’s scrotal gangrene after a perianal abscess debridement: a case report. Journal of Medical Case Reports, 12(1), 193. https://doi.org/10.1186/s13256-018-1697-9
de Sousa, A. G., Fernandes, C. J. J., Santos, G. de P. D., Silva, E., Akamine, N., & Lisboa, L. F. (2007). Mortality rate reduction associated with a severe sepsis management protocol implementation. In Critical Care (Vol. 11, Nomor Suppl 3, hal. P30). https://doi.org/10.1186/cc5817
Dong, N., Gao, N., Hu, W., Mu, Y., & Pang, L. (2022). Association of Fluid Management With Mortality of Sepsis Patients With Congestive Heart Failure: A Retrospective Cohort Study. Frontiers in Medicine, 9, 714384. https://doi.org/10.3389/fmed.2022.714384
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., Schorr, C., Simpson, S., Joost Wiersinga, W., Alshamsi, F., Angus, D. C., Arabi, Y., Azevedo, L., Beale, R., Beilman, G., … Levy, M. (2021). Executive Summary: Surviving Sepsis Campaign: International Guidelines for the Management of Sepsis and Septic Shock 2021. Critical Care Medicine, 49(11), 1974–1982. https://doi.org/10.1097/CCM.0000000000005357
He, L., Wei, Q., Liu, J., Yi, M., Liu, Y., Liu, H., Sun, L., Peng, Y., Liu, F., Venkatachalam, M. A., & Dong, Z. (2017). AKI on CKD: heightened injury, suppressed repair, and the underlying mechanisms. Kidney International, 92(5), 1071–1083. https://doi.org/10.1016/j.kint.2017.06.030
Lorencio Cárdenas, C., Yébenes, J. C., Vela, E., Clèries, M., Sirvent, J. M., Fuster-Bertolín, C., Reina, C., Rodríguez, A., Ruiz-Rodríguez, J. C., Trenado, J., & Esteban Torné, E. (2022). Trends in mortality in septic patients according to the different organ failure during 15 years. Critical Care (London, England), 26(1), 302. https://doi.org/10.1186/s13054-022-04176-w
Mansur, A., Mulwande, E., Steinau, M., Bergmann, I., Popov, A. F., Ghadimi, M., Beissbarth, T., Bauer, M., & Hinz, J. (2015). Chronic kidney disease is associated with a higher 90-day mortality than other chronic medical conditions in patients with sepsis. Scientific Reports, 5, 10539. https://doi.org/10.1038/srep10539
Marik, P. E. (2011). Surviving sepsis: going beyond the guidelines. Annals of Intensive Care, 1(1), 17. https://doi.org/10.1186/2110-5820-1-17
Martin-Loeches, I., Nunnally, M. E., Hellman, J., Lat, I., Martin, G. S., Jog, S., Kesecioglu, J., De Backer, D., & Coopersmith, C. M. (2021). Surviving Sepsis Campaign: Research Opportunities for Infection and Blood Purification Therapies. Critical Care Explorations, 3(9), e0511. https://doi.org/10.1097/CCE.0000000000000511
Ou, S.-M., Lee, K.-H., Tsai, M.-T., Tseng, W.-C., Chu, Y.-C., & Tarng, D.-C. (2022). Sepsis and the Risks of Long-Term Renal Adverse Outcomes in Patients With Chronic Kidney Disease. Frontiers in Medicine, 9, 809292. https://doi.org/10.3389/fmed.2022.809292
Oud, L. (2019). Time-Sensitive Therapeutic Interventions at Diagnosis of Sepsis: Should Guidelines Be Confined to High-Level Evidence? Journal of Clinical Medicine Research, 11(7), 539–541. https://doi.org/10.14740/jocmr3866
Reichert, M., Eckerth, L., Fritzenwanker, M., Imirzalioglu, C., Amati, A.-L., Askevold, I., Padberg, W., Hecker, A., Liese, J., & Bender, F. (2023). New Perianal Sepsis Risk Score Predicts Outcome of Elderly Patients with Perianal Abscesses. Journal of Clinical Medicine, 12(16). https://doi.org/10.3390/jcm12165219
Sakr, Y., Jaschinski, U., Wittebole, X., Szakmany, T., Lipman, J., Ñamendys-Silva, S. A., Martin-Loeches, I., Leone, M., Lupu, M.-N., & Vincent, J.-L. (2018). Sepsis in Intensive Care Unit Patients: Worldwide Data From the Intensive Care over Nations Audit. Open Forum Infectious Diseases, 5(12), ofy313. https://doi.org/10.1093/ofid/ofy313
Schinkel, M., Holleman, F., Vleghels, R., Brugman, K., Ridderikhof, M. L., Dzelili, M., Nanayakkara, P. W. B., & Wiersinga, W. J. (2023). The impact of a sepsis performance improvement program in the emergency department: a before-after intervention study. Infection, 51(4), 945–954. https://doi.org/10.1007/s15010-022-01957-x
Slade, E., Tamber, P. S., & Vincent, J.-L. (2003). The Surviving Sepsis Campaign: raising awareness to reduce mortality. In Critical care (London, England) (Vol. 7, Nomor 1, hal. 1–2). https://doi.org/10.1186/cc1876
Song, J., Fang, X., Zhou, K., Bao, H., & Li, L. (2023). Sepsis‑induced cardiac dysfunction and pathogenetic mechanisms (Review). Molecular Medicine Reports, 28(6). https://doi.org/10.3892/mmr.2023.13114
Taylor, G. M., & Erlich, A. H. (2019). Perianal abscess in a 2-year-old presenting with a febrile seizure and swelling of the perineum. Oxford Medical Case Reports, 2019(1), omy116. https://doi.org/10.1093/omcr/omy116
Wang, D.-H., Zhao, J.-C., Xi, X.-M., Zheng, Y., & Li, W.-X. (2024). Attributable mortality of acute kidney injury among critically ill patients with sepsis: a multicenter, retrospective cohort study. BMC Nephrology, 25(1), 125. https://doi.org/10.1186/s12882-024-03551-9
Weng, L., Xu, Y., Yin, P., Wang, Y., Chen, Y., Liu, W., Li, S., Peng, J.-M., Dong, R., Hu, X.-Y., Jiang, W., Wang, C.-Y., Gao, P., Zhou, M.-G., & Du, B. (2023). National incidence and mortality of hospitalized sepsis in China. Critical Care (London, England), 27(1), 84. https://doi.org/10.1186/s13054-023-04385-x
Yuniar, I., Karyanti, M. R., Kurniati, N., & Handayani, D. (2023). The clinical and biomarker approach to predict sepsis mortality in pediatric patients. Paediatrica Indonesiana, 63(1 SE-Emergency & Pediatric Intensive Care), 37–44. https://doi.org/10.14238/pi63.1.2023.37-44
Zhu, M.-Y., Tang, X.-K., Gao, Y., Xu, J.-J., & Gong, Y.-Q. (2023). Impact of heart failure on outcomes in patients with sepsis: A systematic review and meta-analysis. World Journal of Clinical Cases, 11(15), 3511–3521. https://doi.org/10.12998/wjcc.v11.i15.3511
Downloads
Published
Issue
Section
License
Copyright (c) 2025 andryadi wijaya, Akhmad Yun Jufan, Erlangga Prasamya
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work’s authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal’s published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
