HEMODINAMIC

MONITORING
IN SEPSIS
HENRY SAKTIANA, S.KEP., NS
HIPERCCI JAWA TENGAH
MY PROFILS
Nama : Henry saktiana, S.Kep., Ns
Tempat tanggal lahir : Batang, 01 januari 1981
Status : Menikah
Institusi : IRIN - RSUP Dr.Kariadi Semarang
Pendidikan :
1. D3-Keperawatan : Poltekkes Semarang Prodi Keperawatan Pekalongan (2002)
2. S1/Ners : Universitas Diponegoro Semarang (2015)
Pelatihan :
1. TOT BPTTK Gombong (2016)
2. ICU-CCU RSUP Dr. Kariadi Semarang (2016)
3. BTLS-BCLS Pro-Emergency Cibinong (2015)
MY FAMILY
Come On
PREVIEW
MANAGEMENT SEPSIS

PENEGAKAN
PENATALAKSANAAN MONITORING
DIAGNOSIS

qSOFA Sepsis
hemodinamik
SOFA Score BUNDLE
DEFINISION OF HEMODINAMIC MONITORING

Monitoring (me-monitor) :
mengawasi, mengamati, atau mengecek
dengan cermat, terutama untuk tujuan
khusus; memantau.
(kamus besar bahasa indonesia)

Hemodinamic :
Performance of cardiovasculer system.
THE GOALS OF MONITORING HEMODINAMIC

Tujuan monitoring
hemodinamik adalah?
Untuk mempertahankan /
memastikan PERFUSI
JARINGAN ADEQUAT.
PARAMETER
HEMODINAMIK
PRINCIPLES OF MONITORING HEMODINAMIC

Monitoring is NOT therapy.

Clinicians MUST KNOW how to
interpret the data.
VERY VIEW randomized controlled trial.
PERFUSI ORGAN

HIPOPERFUSI ORGAN vital dapat menyebabkan terjadinya

DISFUNGSI SISTEM ORGAN MULTIPEL dan KEMATIAN.
Perfusi organ di tentukan oleh perbedaan antara tekan arteri
dan tekanan vena dibagi resistensi (FLOW).
FLOW = (P arterial P vena) : RESISTENSI
Flow MAP (mean arterial pressure)
TANDA-TANDA
HIPOPERFUSI JARINGAN
 DETERMINANT OF
Estimated end CARDIAC
1.
diastolic volume PERFORMANCE
(pressure)
PRELOAD
CVP = RVEDV
PAOP = LVDF

Afterload = 2.
SVR AFTERLOAD

Ability heart
3.
CONTRACTILITY muscle to
contract
METHODS OF HEMODINAMIC
MONITORING
THE GOALS DURING THE FIRST 6 HOURS OF SEPSIS RESUSCITATION
SHOULD BE (GRADE 1C): (LIT.4)

Mean arterial pressure (MAP) 65 mm Hg

Central venous pressure (CVP) 8-12 mm Hg (12-15 mm Hg in patients receiving
mechanical ventilation or with known preexisting decreased ventricular compliance)
Urine output 0.5 mL/kg/hr
Central venous oxygen saturation (ScVO : from the superior vena cava) 70%, or
mixed venous oxygen saturation (SVO : from a pulmonary artery catheter) 65%.
BLOOD PRESSURE
RECOMENDED TARGET OF MAP FOR SEPSIS > 65 MMHG (GRADE 1C). (LIT 3)
CENTRAL VENOUS PRESSURE (CVP) AND ScVO.(LIT 3)

CVP :
a) reflect RIGHT VENTRICLE FEELING PRESSURE.
b) ESTIMATION of intravasculer volume status.
c) LIMITED BY respiratory variation and PEEP.

ScVO
1) Is ONE OF USEFUL INDEX OF TISSUE HIPOPERFUSION.
2) however, THE EFFECTIVENESS as single goal of sepsis treatment
is QUESTIONABLE. (ProCESS & ARISE study)
(LIT. 3)
LACTATE SERUM (GRADE 2.C). (LIT.3)

PROCESS dan ARISE study :

1. Lactate has been suggested as an ALTERNATIVE GOAL AND MONITORING
INDEX FOR RESUSCITATION in severe sepsis or septic shock.
2. lactate normalization within 6 hours was THE STRONGEST PREDICTOR OF
SURVIVAL in severe sepsis.
3. Serial measurement of lactate is expected TO BE USED AS AN ALTERNATIVE TO
SCVO2 IF CENTRAL VENOUS INSERTION IS NOT AVAILABLE.
LACTATE AS PREDICTOR MORTALLITY. (LIT.2)

IN HOSPITAL MORTALITY (%)

No hipotension and lactat < 2 mmol 18.7

Lactate > 2 mmol only 25.7

Hipotension only 30.1

Hipotension and lactate > 2 42.3

HAMBATAN MONITORING HEMODINAMIK PASIEN SEPSIS

Tidak ada fasilitas

yang memadai
CVC
Laboratorium : laktat
REFERENSI

JAMA ; the third international consensus definitions for sepsis and septic shock (sepsis-3) : 2016seminar hipercci nop
2016 journals\lit 1. consensus definition of sepsis and syock septik (sepsis-3).pdf
Abdul Hakeem Al Hashim ; sepsis-3 : 2016seminar hipercci nop 2016 journals\lit 2. Sepsis-3 Abdul Hakeem Al
Hashim, MD, FRCPC.pdf
Cho W.H ; update of sepsis : recent evidences about Early goal directed therapy ; 2015Refrensi Monitoring
hemodinamik\lit 3. Update of Sepsis Recent Evidences about.pdf
pullCCM : Surviving Sepsis Guidelines: Early Goal Directed Therapy, Initial Fluid Resuscitation : 2013Refrensi Monitoring
hemodinamik\lit 4. Surviving Sepsis Guidelines.egdt.fluid resusitation.2013.docx
Orlando health ; fundamentals hemodinamic monitoring ; 2010
Boom C.E ; kardiak anestesi ; 2010