Management of Septic Shock with Complications of Acute Renal Failure in Patients with Secondary Peritonitis - Masriani Najamuddin; Haizah Nurdin; Faisal Muchtar (Faculty of Medicine, Universitas Padjadjaran, 2020)
Peritonitis akibat infeksi intraabdominal, khususnya peritonitis sekunder merupakan salah satu penyebab syok sepsis dengan tingkat morbiditas dan mortalitas yang tinggi. Perkembangan dalam pemahaman fisiologi, pemantauan, dan tunjangan sistem kardiopulmonal, serta penggunaan obat-obat baru secara rasional membuat mortalitas stabil pada kisaran 30%. Kasus ini mengenai seorang pasien perempuan usia 67 tahun masuk rumah sakit dengan diagnosis peritonitis generalisata karena suspek perforasi Hollow viscous. Setelah menjalani operasi laparatomi untuk source control, pasien dirawat di ICU selama 5 hari. Selama perawatan pasien mengalami edema paru, sepsis, anemia, hipokalemia, hipoalbuminemia, serta acute kidney injury (AKI). Pada pasien dilakukan tindakan ventilasi mekanik selama 4 hari yang diiringi dengan pemantauan analisis gas darah arteri dan furosemid untuk tata laksana edema paru dan fluid overload. Resusitasi dan pemeliharaan cairan sambil memantau hemodinamik konvensional dan melalui ICON, balance kumulatif, fluid overload, tekanan vena sentral, serta urine output. Terapi antimikrob diberikan berdasar atas pedoman terapi infeksi intraabdominal dan antibiogram ICU rumah sakit. Kondisi perfusi dipantau dengan kadar laktat dan SCVO2. Respons antibiotik dan perbaikan sepsis dipantau dengan pemeriksaan prokalsitonin dan leukosit. Perbaikan AKI dipantau dengan produksi urine serta kadar ureum dan kreatinin. Penatalaksanaan peritonitis sekunder dengan komplikasi sepsis dengan penyulit AKI telah berhasil dilakukan di ICU. Peritonitis sekunder memiliki tingkat mortalitas yang cukup tinggi, namun dengan source control yang adekuat dan manajemen di ICU yang agresif maka diperoleh hasil yang baik seperti pada kasus ini.Management of Septic Shock with Acute Renal Failure Complications in Secondary Peritonitis PatientsPeritonitis due to intraabdominal infection, especially secondary peritonitis is one of the major causes of septic shock with high morbidity and mortality. Developments in understanding the physiology, monitoring and supportive therapy for cardiopulmonary system and rational use of new drugs, make mortality stable at around 30%. A 67-year-old female patient was hospitalized with generalized peritonitis due to suspected Hollow Viscous perforation. After undergoing laparotomy for source control, the patient was treated in the ICU for five days. During treatment, the patient experiences pulmonary edema, sepsis, anemia, hypokalaemia, and hypoalbuminemia, and acute kidney injury (AKI). The patient received mechanical ventilation intervention for four days accompanied by monitoring of arterial blood gas analysis and furosemide administration for pulmonary edema and fluid overload management. Fluid resuscitation and maintenance are monitored by conventional hemodynamic monitoring and through ICON, and by cumulative balance calculation, fluid overload calculation, central venous pressure, and urine output. Antimicrobial therapy is given based on guidelines for intraabdominal infection therapy and antibiogram at the hospital ICU. The condition of perfusion is monitored by examination of lactate and SCVO2 levels. Antibiotic response and improvement in sepsis are monitored by examination of procalcitonin and leukocytes. AKI improvement is monitored by urine production, and urea and creatinine levels. Management of secondary peritonitis with complications of sepsis and AKI has been successfully carried out in the ICU. Secondary peritonitis has a fairly high mortality rate, but with adequate source control and aggressive management in the ICU, good results are obtained as in this case.