MANAJEMEN PENCEGAHAN PENINGKATAN TEKANAN INTRAKRANIAL (TIK) PADA PASIEN PASCA KRANIOTOMI DI RUANG INTENSIVE CARE UNIT (ICU)

INTRACRANIAL PRESSURE MANAGEMENT OF POST CRANIOTOMY PATIENT IN INTENSIVE CARE UNIT (ICU)

  • Ahmat Pujianto 1Jurusan Keperawatan, Universitas Borneo Tarakan, Kota Tarakan, Kalimantan Utara, Indonesia
  • Hendy Lesmana 1Jurusan Keperawatan, Universitas Borneo Tarakan, Kota Tarakan, Kalimantan Utara, Indonesia
  • Maria Imaculata Ose 1Jurusan Keperawatan, Universitas Borneo Tarakan, Kota Tarakan, Kalimantan Utara, Indonesia
  • Bayu Purnomo Rumah Sakit Umum Daerah dr. H. Jusuf SK, Kota Tarakan, Kalimantan Utara, Indonesia
  • Aris Junaidi Jurusan Keperawatan, Universitas Borneo Tarakan, Kota Tarakan, Kalimantan Utara, Indonesi

Abstract

Kondisi pasien pasca kraniotomi relatif tidak stabil, dan berpotensi mengalami komplikasi intrakranial sehingga pasien harus mendapat pemantauan ketat di ruang perawatan intensif (Intensive Care Unit ((ICU). Penelitian ini bertujuan untuk mendapatkan gambaran manajemen pencegahan tekanan intrakranial (TIK) pada pasien pasca kraniotomi di ICU. Penelitian ini merupakan penelitian studi kasus yang melibatkan 12 responden pasien pasca kraniotomi sesuai kriteria inklusi dan eksklusi. Instrumen yang digunakan untuk mengumpulkan data adalah lembar observasi catatan medis pasien yang berisi karakteristik responden, status hemodinamik responden, manajemen TIK yang dilakukan, nilai pemeriksaan Glasgow Coma Scale-Pupil (GCS-P), nilai laboratorium untuk laktat, dan nilai elektrolit (natrium, kalium, dan klorida). Hasil penelitian menunjukkan bahwa pada hari ketiga perawatan, pengaruh sedasi sudah menurun dan 3 responden (8,3%) sudah dalam keadaan sadar dengan nilai GCS-P E4M6Vett-P 3/3. Semua responden diberikan posisi head up 15-30 derajat, sedangkan untuk mode ventilator mekanik, positive end expiratory pressure (PEEP), fraksi oksigen, obat sedasi, analgesik. Pada hari ketiga perawatan, sebagian besar responden sudah mengalami peningkatan ke arah perbaikan. Manajemen pencegahan peningkatan tekanan intrakranial pada pasien pasca kraniotomi akibat cedera otak traumatik pada pasien di ICU sesuai dengan pedoman Brain Trauma Foundation Guideline tahun 2016. Hanya saja untuk pengukuran tekanan intrakranial pada semua pasien belum dilakukan baik secara non-invasif maupun invasif.


Kata kunci: ICU, manajemen TIK, pasca kraniotomi


DOI : 10.35990/mk.v6n1.p44-55

References

1. Nidhi B. Panda, Mahajan S, Chauhan R. Management of Postoperative Neurosurgical Patients. J Neuroanaesth Crit Care. 2019;06(02):80–6.
2. Herrera I, Amosa M, Capilla E, Benassi JMG. The postoperative cranium , normal findings and complications. Eur Soc Radiol. 2013;1–25.
3. Sughrue ME, Bonney PA, Choi L, Teo C. Early Discharge after Surgery for Intra-Axial Brain Tumors. World Neurosurg [Internet]. 2015;84(2):505–10. Available from: http://dx.doi.org/10.1016/j.wneu.2015.04.019
4. Wong JM, Panchmatia JR, Ziewacz JE, Bader AM, Dunn IF, Laws ER, et al. Patterns in neurosurgical adverse events: Intracranial neoplasm surgery. Neurosurg Focus. 2012;33(5):1–3.
5. Florman JE, Cushing D, Keller LA, Rughani AI. A protocol for postoperative admission of elective craniotomy patients to a non-ICU or step-down setting. J Neurosurg. 2017;127(6):1392–7.
6. Ragland J, Lee K. Critical Care Management and Monitoring of Intracranial Pressure. J Neurocritical Care. 2016;9(2):105–12.
7. Livesay S, Moser H. Evidence-based nursing review of craniectomy care. Stroke. 2014;45(11):e217–9.
8. Lee SB, Oh JH, Park JH, Choi SP, Wee JH. Differences in youngest-old, middle-old, and oldest-old patients who visit the emergency department. Clin Exp Emerg Med. 2018 Dec 1;5(4):249–55.
9. Ambardekar N. Chloride Blood Test & Chloride Levels: Purpose, Procedure, Results [Internet]. 2019 [cited 2021 Mar 26]. Available from: https://www.webmd.com/a-to-z-guides/what-is-a-chloride-test
10. Rangel-Castillo L, Gopinath S, Robertson CS. Management of Intracranial Hypertension. Neurol Clin. 2008;26(2):521–41.
11. Dhar R, Sandler RH, Manwaring K, Kostick N, Mansy HA. Noninvasive detection of elevated ICP using spontaneous tympanic membrane pulsation. Sci Reports | [Internet]. 123AD;11:21957. Available from: https://doi.org/10.1038/s41598-021-01079-8
12. Kramer N, Lebowitz D, Walsh M, Ganti L. Rapid Sequence Intubation in Traumatic Brain-injured Adults. Cureus [Internet]. 2018 Apr 25 [cited 2022 Apr 13];10(4). Available from: /pmc/articles/PMC6017125/
13. Davis DP. Early ventilation in traumatic brain injury. Resuscitation. 2008;76(3):333–40.
14. Boone MD, Sayuri •, Jinadasa P, Mueller A, Shaefi S, Ekkehard •, et al. The Effect of Positive End-Expiratory Pressure on Intracranial Pressure and Cerebral Hemodynamics. 26.
15. Chen H, Zhou J, Lin YQ, Zhou JX, Yu RG. Intracranial pressure responsiveness to positive end-expiratory pressure in different respiratory mechanics: A preliminary experimental study in pigs. BMC Neurol [Internet]. 2018 Nov 5 [cited 2022 Apr 13];18(1):1–10. Available from: https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-018-1191-4
16. Altun Uǧraş G, Yüksel S, Temiz Z, Eroǧlu S, Şirin K, Turan Y. Effects of Different Head-of-Bed Elevations and Body Positions on Intracranial Pressure and Cerebral Perfusion Pressure in Neurosurgical Patients. J Neurosci Nurs [Internet]. 2018 Aug 1 [cited 2022 Apr 13];50(4):247–51. Available from: https://journals.lww.com/jnnonline/Fulltext/2018/08000/Effects_of_Different_Head_of_Bed_Elevations_and.13.aspx
17. Thibault M, Girard F, Moumdjian R, Chouinard P, Boudreault D, Ruel M. Craniotomy site influences postoperative pain following neurosurgical procedures: A retrospective study. Can J Anesth. 2007;54(7):544–8.
18. Watts CR, Kelley P. Sedation and Analgesia in Neurosurgery/ Neurocritical Care A BIWEEKLY PUBLICATION FOR CLINICAL NEUROSURGICAL CONTINUING MEDICAL EDUCATION. 2016 [cited 2022 Apr 13]; Available from: www.contempneurosurg.com
19. Girard F, Moumdjian R, Boudreault D, Chouinard P, Bouthilier A, Sauvageau É, et al. The effect of propofol sedation on the intracranial pressure of patients with an intracranial space-occupying lesion. Anesth Analg [Internet]. 2004 [cited 2022 Apr 13];99(2):573–7. Available from: https://journals.lww.com/anesthesia-analgesia/Fulltext/2004/08000/The_Effect_of_Propofol_Sedation_on_the.47.aspx
20. Schirmer-Mikalsen K, Vik A, Skogvoll E, Gøran Moen K, Solheim O, Klepstad P, et al. Intracranial Pressure During Pressure Control and Pressure-Regulated Volume Control Ventilation in Patients with Traumatic Brain Injury: A Randomized Crossover trial. Neurocrit Care. 2016;24:332–41.
Published
2023-03-31
How to Cite
PUJIANTO, Ahmat et al. MANAJEMEN PENCEGAHAN PENINGKATAN TEKANAN INTRAKRANIAL (TIK) PADA PASIEN PASCA KRANIOTOMI DI RUANG INTENSIVE CARE UNIT (ICU). Medika Kartika : Jurnal Kedokteran dan Kesehatan, [S.l.], v. 6, n. 1, p. 44-55, mar. 2023. ISSN 2655-6537. Available at: <http://medikakartika.unjani.ac.id/medikakartika/index.php/mk/article/view/374>. Date accessed: 29 may 2024.