Ventilasi Mekanik yang Memanjang pada Pasien Cedera Otak Traumatik Berat dengan Subdural Hematoma

Dini Handayani Putri, Iwan Abdul Rachman, Sri Rahardjo

Abstract


Cedera otak traumatik (COT) adalah suatu proses patologis pada otak yang berasal dari luar tubuh, yang dapat menyebabkan kerusakan permanen atau sementara dari fungsi otak. Salah satu perdarahan otak yang sering menyertai terjadinya COT berat adalah subdural hematoma (SDH). Pasien laki-laki 41 tahun, datang ke rumah sakit dengan penurunan kesadaran GCS E2M2V2 akibat kecelakaan. Pasien dilakukan tatalaksana dan diintubasi di IGD, hasil CT-Scan memperlihatkan SDH, dan edema serebri. Pasien dilakukan evakuasi hematom dengan anestesi umum, diinduksi dengan fentanil 100 μgr, propofol 20 mg dan atracurium 20 mg intravena. Pemeliharaan dengan sevofluran, propofol kontinyu, fentanil dan atracurium intermiten. Pascaoperasi pasien mengalami ventilator associated pneumonia (VAP), diberikan antibiotik sprektum luas untuk pemulihan paru, pada hari ke 10 pasien dilakukan trakeostomi. Pasien dapat disapih dari ventilator hari ke 21 dengan GCS E4M4Vtrach tanpa kontak, dengan skor GOS (Glasgow Outcome Scale) 3, direncanakan untuk homecare. COT berat membutuhkan tatalaksana pascaoperasi yang lebih kompleks, antisipasi penggunaan ventilasi mekanik yang memanjang, risiko VAP serta pertimbangan pemasangan trakeostomi secara cepat hingga pemberian antibiotik yang adekuat untuk mendapatkan hasil luaran terbaik.

 

Prolonged Mechanical Ventilation in Severe Traumatic Brain Injury Patients with Subdural Hematomas

Abstract

Traumatic brain injury (TBI) is a pathological process in the brain that originates from outside the body, which can lead to permanent or temporary damage to brain function. One of the brain hemorrhages that often accompanies severe TBI is subdural hematoma (SDH). Male patient 41 years old, was admitted to our hospital with decreased of consciusness with GCS E2M2V2 due to a motorcycle accident. The patient was intubated in the emergency room and then performed head CT scan examination which showed SDH and cerebral edema as the result. Patients then underwent hematoma evacuation under general anesthesia, induced with fentanyl 100 g, propofol 20 mg and atracurium 20 mg intravenously. Maintenance of anesthesia with sevoflurane, continuous propofol, fentanyl and intermittent atracurium. Postoperatively the patient experienced ventilator associated pneumonia (VAP) and given broad-spectrum antibiotics for lung recovery, then on the 10th day tracheostomy was performed. Patients can be weaned from the ventilator on day 21st with GCS E4M4Vtrach without contact, with a GOS (Glasgow Outcome Scale) score of 3, and was planned for homecare. Severe TBI requires more complex postoperative management, anticipation of prolonged use of mechanical ventilation, risk of VAP and consideration of rapid tracheostomy installation to adequate antibiotic administration to obtain the best outcome.


Keywords


COT berat; subdural hematoma; VAP; ventilasi mekanik memanjang; prolonged mechanical ventilation; severe TBI; subdural hematoma; VAP

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DOI: https://doi.org/10.24244/jni.v9i2.253

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DOI:  https://doi.org/10.24244/jni 

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