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

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