Terapi Hipotermi setelah Cedera Otak Traumatik

Dewi Yulianti Bisri, Tatang Bisri

Abstract


Mekanisme proteksi otak hipotermi adalah mengurangi kebutuhan metabolik, cerebral metabolic rate for oxygen (CMRO2), eksitotoksisitas, menurunkan pelepasan glutamat, menurunkan pembentukan radikal bebas, mengurangi pembentukan edema, stabilisasi membran, memelihara adenosine triphosphate (ATP), menurunkan influx Ca, dan tekanan intrakranial. Sedangkan komplikasi hipotermi berat adalah pneumonia, sepsis, disritmia jantung, hipotensi, masalah perdarahan dan menggigil. Temperatur ideal untuk hipotermia terapeutik adalah 35 0C. Pertanyaan untuk terapi hipotermik (HT) adalah bagaimana mekanisme terapi hipotermi sebagai protektor otak? Berapa derajat C penurunan suhu tubuhnya? Bagaimana cara melakukan penurunan suhu? Berapa cepat hipotermia harus dicapai? Berapa lama hipotermi dipertahankan? Bagaimana memulihkan ke normotermi (rewarming)? Bagaimana hasilnya? Apakah ada penelitian yang sedang berlangsung? Untuk menggunakan hipotermia sebagai neuroprotektor, diperlukan mencapai keadaan hipotermi secepat mungkin setelah cedera dan pertahankan pada level aman. Metode hipotermi terapeutik adalah pendinginan permukaan tubuh, pendinginan endovaskuler, pendinginan kepala. Selama penghangatan kembali pasien dengan hipertensi intrakranial telah diketahui bisa terjadi peningkatan tekanan intrakranial selama pemanasan yang cepat. Dianjurkan pemanasan lambat lebih dari 12 jam dengan kecepatan 0,1 0C/jam. Sebagai simpulan, hipotermi terapeutik masih kontroversi, tapi dalam situasi klinik pertahankan suhu pasien 35 0C dan harus dihindari temperatur lebih dari 37 0C. Untuk mencapai suhu inti 35 0C dianjurkan digunakan metode pendinginan permukaan tubuh.

 

Hypothermia Therapy after Traumatic Brain Injury

The mechanism of hypothermia as neuro protector are by reducing metabolic demand of the brain, cerebral metabolic rate of oxygen (CMRO2), excitotoxicity, decrease the glutamate release, reduction of free radical formation, edema formation, membrane stabilization, maintains adenosine triphosphate (ATP), decrease in Ca influx, and intracranial pressure. In the order hand, complication of deep hypothermia are pneumonia, sepsis, cardiac dysrrhythmia, hypotension, bleeding problem and shivering. The ideal temperature for therapeutic hypothermia is 35 0C. Question arised for hypothermic therapy (HT) are what is the therapeutic mechanism of HT as neuroprotective? What is the proper degree for hypothermia? What can we do to induce hypothermia? How soon should we do the HT? How long hypothermia should be maintain? How to restore normothermia (rewarming)? What is the result? Is there any ongoing research?. For the use hypothermia as one of neuroprotective therapy, it is necessary to implement it as soon as possible after the insult and to maintain it at the lowest safe level. Methods of therapeutic hypothermia are surface cooling, endovascular cooling, as well as selective head cooling. During rewarming, patients with intracranial hypertension are known to have reflex that would increase ICP during rapid rewarming. Slow rewarming over a period of 12 hrs at the rate of 0.1 0C/hr is desirable. As conclusion, therapeutic hypothermia still controversial, but in clinical situation keep the patient 35 0C is desirable and temperature more than 37 0C should be avoided. To reach core temperature 35 0C, surface cooling is recommended.


Keywords


Cedera otak traumatik; terapi hipotermia; proteksi otak; resusitasi otakbrain protection; brain resuscitation; hypothermia therapy; traumatic brain injury

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DOI: https://doi.org/10.24244/jni.vol3i3.148

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