Background Corrective cardiac surgery is the standard management for complex congenital heart disease. Cardiopulmonary bypass surgery and post-surgical intensive care may lead to low cardiac output syndrome (LCOS), as a major complication after open heart surgery. To diagnose early LCOS, lactate level, pCO2 gap, and mixed venous oxygen saturation (SvO2) are parameters reported to have correlations with decreased cardiac output, morbidity, and post-cardiac surgery mortality. Objective To determine the usefulness of lactate level, pCO2 gap (arterial-vein), and SvO2 for early detection of LCOS in children post-open heart surgery. Methods This prospective cohort study was done from August to October 2017 in the ICU of the Integrated Cardiac Center, Dr. Cipto Mangunkusumo Hospital, Jakarta. Subjects were pediatric patients who underwent cardiac surgery. After surgery, patients underwent monitoring in the ICU for clinical signs of LCOS and examinations for lactate levels, pCO2 gap, and SvO2 at 15 minutes, 4 hours and 8 hours. Results Thirty-three open heart surgery patients were the subjects. Lactate level at 4 hours and 8 hours post-operative were significantly higher in the LCOS group compared to non-LCOS group. For the pCO2 gap, only the 4-hour post-operative results were significantly higher in LCOS group compared to non-LCOS groups. In addition, only SvO2 at 4 hours after surgery was significantly lower in LCOS group compared to non-LCOS group. Conclusion Elevated lactate, high pCO2 gap, as well as decreased SvO2 at 4 hours post-operatively are the most reliable markers of LCOS after pediatric open heart surgery.
Latar belakang. Diare akut masih menjadi penyebab morbiditas dan mortalitas, terutama di negara berkembang. Probiotik sebagai mikroorganisme hidup jika dikonsumsi dalam jumlah cukup akan memberikan manfaat terhadap tubuh pejamu. Namun masih terdapat masalah teknologi probiotik yang sulit diatasi, yaitu hilangnya dosis dan aktivitas yang tidak dapat diprediksi karena kualitas penyimpanan sediaan yang beragam. Heat-killed probiotic sudah mengalami tindalisasi menawarkan sediaan farmasi yang lebih stabil dengan aktivitas yang sama.Tujuan. Menilai efektifitas heat-killed probiotic dibandingkan dengan live probiotic terhadap anak yang menderita diare akut nondisentri.Metode. Uji klinis acak tersamar buta ganda terhadap pasien diare akut nondisentri usia 6-24 bulan dengan atau tanpa dehidrasi ringan-sedang di RS Hasan Sadikin, RSUD Ujung Berung dan RSUD Cibabat pada periode bulan April-Mei 2008. Setiap subjek mendapat satu bungkus berisi 3 x 1010 probiotic atau 107 live probiotic, kemudian dilanjutkan dengan interval 8 sampai 12 jam per hari selama lima hari. Durasi dan frekuensi defekasi dicatat secara kuantitatif. Analisis statistik dihitung dengan menggunakan uji t.Hasil. Didapatkan 52 anak (25 heat-killed probiotic, 27 live probiotic) masuk ke dalam penelitian. Rata-rata durasi diare menurun secara bermakna pada pasien yang diberi heat-killed probiotic (50,2 jam SB 28,6) dibandingkan dengan live probiotic (74,8 jam SB 28,8) (p=0,003). Rata-rata frekuensi defekasi juga lebih rendah secara bermakna pada kelompok heat-killed probiotic dibandingkan dengan kelompok live probiotic (8,3;SB 7,4 vs 10,7;SB6,4).Kesimpulan. Heat-killed probiotic lebih baik dalam mengurangi lama diare dan frekuensi defekasi daripada live probiotic pada anak pasien diare akut nondisentri.
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