Kesesuaian terhadap Prosedur Standar Resuscitation Bundle 6 Jam pada Pelaksanaan Penderita Sepsis Berat dan Syok Sepsis

Chevie Wirawan, Bachti Alisjahbana, Uun Sumardi

Abstract


Sepsis berat dan syok sepsis memiliki angka kematian tinggi. Resuscitation bundle 6 jam adalah panduan tata laksana sepsis berat dan syok sepsis yang terbukti menurunkan mortalitas. Kesesuaian penatalaksanaan sepsis berat dan syok sepsis dalam 6 jam pertama dengan prosedur standar resuscitation bundle diteliti. Penelitian observasional deskriptif ini dilaksanakan selama September–Desember 2015 terhadap penderita sepsis berat dan syok sepsis di SMF Ilmu Penyakit Dalam RSUP Dr. Hasan Sadikin Bandung. Data dikumpulkan adalah data umum penderita dan pelaksanaan prosedur 6 jam pertama sesuai standar: pemeriksaan laktat, kultur darah, pemberian antibiotik, resusitasi cairan, pemberian vasopresor, pengukuran CVP, dan pemeriksaan Scvo2/Svo2. Dari 80 subjek penelitian, 59 (74%) sepsis berat dan 21 (26%) syok sepsis. Pada sepsis berat dan syok sepsis, dalam 3 jam pertama pemeriksaan laktat dilakukan pada 2%  dan 14%, kultur darah sebelum antibiotik 17% dan 10%, pemberian antibiotik spektrum luas 32% dan 43%, serta  resusitasi cairan 30 mL/kgBB 2% dan 14%. Pada syok sepsis dalam 6 jam pertama pemberian vasopresor 62% dan pengukuran CVP 5%. Pemeriksaan Scvo2/Svo2 tidak dilakukan pada syok sepsis. Angka kematian sepsis berat 7% dan syok sepsis 19,1% dalam 6 jam pertama. Simpulan, kesesuaian penatalaksanaan 6 jam pertama penderita sepsis berat dan syok sepsis dengan prosedur standar masih kurang.

Kata kunci: Resuscitation bundle 6 jam, sepsis berat, syok sepsis 

 

Compliance to 6-Hour Resuscitation Bundle Standard in Severe Sepsis and Septic Shock Management

Severe sepsis and septic shock have a high mortality rate. Six-hour resuscitation bundle is a management standard for severe sepsis and septic shock that has been proven to reduce mortality rate. Compliance to the 6-hour resuscitation bundle standard was studied. This was a descriptive observational study on severe sepsis and septic shock patients in the Internal Medicine Department of Hasan Sadikin General Hospital Bandung in the period of September–December 2015. Data collected were patient’s general data and the implementation of the 6-hour management standard procedures that include lactate measurement, blood culture, broad spectrum antibiotics, fluid resuscitation, vasopressor use, CVP measurement, and Scvo2/Svo2 measurement. Of 80 subjects, 59 (74%) had severe sepsis and 21 (26%) had septic shock. In the first 3 hours, for severe sepsis and septic shock patients, lactate was examined in 2% and 14% respectively. For blood culture before antibiotics, broad spectrum antibiotic provision, and 30 mL/kgWt fluid resuscitation, the values were 17% and 10%, 32% and 43%; and 2% and 14%, respectively. In septic shock, in the 6 hours, vasopressor was given to 62% and CVP was measured in CVP 5%. Scvo2/Svo2 was not measured. The mortality rates in the first 6 hours for severe sepsis and septic shock were 7% and 19%. Compliance to first 6-hour standard procedure for severe sepsis and septic shock is still inadequate. 

Key words: Septic shock, severe sepsis, six hours resuscitation bundle


Keywords


Resuscitation bundle 6 jam; sepsis berat; syok sepsis

Full Text:

PDF

References


Mayr FB, Yende S, Angus DC. Epidemiology of severe sepsis. Virulence. 2014;5(1):4 –11.

Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, dkk. Surviving Sepsis Campaign international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580–637.

Levy MM, Rhodes A, Phillips GS, Townsend SR, Schorr CA, Beale R, dkk. Surviving sepsis campaign: association between performance metrics and outcomesin a 7.5-year study. Intensive Care Med. 2014;40(11):1623–33.

Silviana M. Keberhasilan tindakan early goal-directed therapy dan faktor pengganggu pada pasien sepsis berat di instalasi gawat darurat RSUP Dr. Hasan Sadikin Bandung yang akan menjalani pembedahan. JAP. 2014;3(2):131–8.

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, dkk. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801–10.

Phua J, Koh Y, Du B, Tang YQ, Divatia JV, Tan CC, dkk. Management of severe sepsis in patients admitted to Asian intensive care units: prospective cohort study. BMJ. 2011;2011(342):1–11.

Na S, Kuan WS, Mahadevan M, Li C, Shrikhande P, Ray S, dkk. Implementation of early goal-directed therapy and the surviving sepsis campaign resuscitation bundle in Asia. Int J Qual Health Care. 2012;24(5):452–62.

Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F, dkk. A randomized trial of protocol-based care for early septic shock. NEJM. 2014;370(18):1683–93.

Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD, dkk. Trial of early, goal-directed resuscitation for septic shock. NEJM. 2015;372(14):1301–11.

Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cooper J, dkk. Goal-directed resuscitation for patients with early septic shock. NEJM. 2014;371(16):1496–506.

McGregor C. Improving time to antibiotics and implementing the “Sepsis 6”. BMJ Qual Improv Report. 2014;2(2):1–3.

Kafle S, Nath N. Improving management of severe sepsis and uptake of sepsis resuscitationbundle in an acute setting. BMJ Qual Improv Report. 2014;3(1):1–4.

Jones AE, Shapiro NI, Roshon M. Implementing early goal-directed therapy in the emergency setting: the challenges and experiences of translating research innovations into clinical reality in academic and community settings. Acad Emerg Med. 2007;14(11):1072–8.




DOI: http://dx.doi.org/10.15395/mkb.v50n1.1157

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


 

This Journal indexed by

             


Creative Commons License
MKB is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

 


View My Stats