Tatalaksana Pasien Post Ventriculo Peritoneal (VP) Shunt et causa Meningitis disertai Aspirasi Pneumonia dan Gagal Napas di Ruang Rawat Intensif

Abstract

Ventriculo Peritoneal (VP) Shunt adalah tindakan operasi pemasangan kateter yang menghubungkan ventrikel otak dan rongga peritoneum. Tindakan VP Shunt bertujuan menurunkan tekanan intrakranial yang tinggi pada hidrosefalus. Pasien hidrosefalus akibat meningitis sering mengalami gagal napas akibat gangguan otak atau aspirasi pneumonia. Terapi ventilasi mekanik diperlukan sebelum, selama dan setelah operasi VP Shunt. Laporan kasus laki-laki 21 tahun datang ke rumah sakit karena gangguan kesadaran dan didiagnosis dengan meningitis. Pasien mengalami gagal napas akibat aspirasi pneumonia dan mendapat terapi ventilasi mekanik, kemudian menjalani operasi VP Shunt atas indikasi hidrosefalus komunikan. Induksi anestesi menggunakan fentanil dan propofol, pemeliharaan anestesi menggunakan sevofluran dan analgesi pascabedah menggunakan fentanil kontinyu. Berdasarkan pemeriksaan cairan serebrospinal pasien didiagnosis meningitis serosa akibat Tuberkulosis. Pasien mendapat terapi antibiotik empirik untuk aspirasi pneumonia dan antituberkulosis. Setelah kesadaran membaik dan weaning ventilator pasien dipindahkan dari ruang perawatan intensif.

Management Patient Post Ventriculo Peritoneal (VP) shunt et causa Meningitis with Pneumonia Aspiration and Respiratory Failure in ICU

Abstract

Ventriculo Peritoneal (VP) Shunt is a surgery that connects the brain ventricles and the peritoneal cavity with a catheter. VP Shunt aims to reduce high intracranial pressure in hydrocephalus. Hydrocephalus patients due to meningitis often experience respiratory failure from brain disorder or pneumonia aspiration. Mechanical ventilation therapy is needed before, during and after VP Shunt surgery. Case report of 21-year-old came to the hospital with decreased of conciousness and diagnosed with meningitis. The patient experienced respiratory failure and received mechanical ventilation therapy in the intensive care unit. The patient underwent VP Shunt surgery for indications of communicant hydrocephalus. Induction of anesthesia used fentanyl and propofol, maintenance of anesthesia used sevoflurane and postoperative analgesia used continuous fentanyl. Based on the results of the examination of cerebrospinal fluid, the diagnosis leads to serous meningitis due to Tuberculosis bacteria. Empiric antibiotics therapy for aspiration pneumonia and antituberculosis were given even if no bacteria was found in the blood or cerebrospinal fluid. After improvement in clinical condition and weaning from mechanical ventilator, the patient discharge from the ICU and sent to the ward.