Innovative Study of Fluid Therapy Management in Sepsis Patients Leads I Wayan Aryabiantara to Obtain a Doctor of Medical Science Degree

Innovative Study of Fluid Therapy Management in Sepsis Patients Leads I Wayan Aryabiantara to Obtain a Doctor of Medical Science Degree

 

Located in the Postgraduate Program Building, Fl. III Denpasar Campus Hall Room, the Doctoral Promotion exam took place with the promovendus candidate, dr. I Wayan Aryabiantara, SpAn-TI, Subsp-TI(K)., with the dissertation title "Comparison of Non-Invasive Dynamic Controlled Restrictive Fluid Therapy Management with Static Standard Management in Sepsis Patients in the Intensive Care Room: Study of Syndecan-1, VCAM-Levels 1, Serum Lactate and SOFA Score Improvement." (12/22/2023)

 

Fluid therapy and hemodynamic monitoring in sepsis patients are still problems. Giving excessive fluids to septic patients can cause transudation of fluid into the interstitial tissue which will cause tissue perfusion disorders resulting in increased lactate. Apart from that, it is also accompanied by increased levels of Syndecan-1 (SDC-1) and Vascular Cell Adhesion Molecule-1 (VCAM-1), which are biomarkers for damage to the endothelial glycocalyx. This study aims to assess the comparison of non-invasive dynamic controlled restrictive fluid therapy management with standard static management, by measuring changes in SDC-1, VCAM-1 and serum lactate levels and assessing the progression of changes in SOFA scores in sepsis patients treated in the Intensive Care Room.

 

The research design was Randomized Pre and Post Test Control Group Design with research samples of sepsis patients aged between 17-65 years who were treated in the Intensive Care Room taken by consecutive sampling from June 2023 to August 2023. The research sample was divided into 2 groups, namely the intervention group which received non-invasive controlled restrictive fluid therapy management and the control group which was treated using standard static fluid therapy management. Serial blood sampling was carried out at 0, 6 and 24 hours. Data were analyzed using SPSS. The analysis carried out was descriptive analysis and bivariate analysis. Bivariate analysis used the Mann-Whitney test, independent T-test and Pearson Chi-Square test. The p value was considered significant if < 0.05.

 

The results of this study showed that there was a decrease in the mean levels of SDC-1 and VCAM-1 in the intervention group. The decrease in SDC-1 levels between the intervention group and the control group was significant in comparison at all three collection times (p< 0.05). Apart from that, the difference in the pattern of decrease in mean VCAM-1 levels at the three collection times was also statistically significant (6th hour vs. 0th hour: p=0.003; 24th hour vs. 6th hour: p=0.002). The difference in mean reduction in lactate levels was not significant between the two groups (p=0.416). Apart from that, the comparison of the decrease in SOFA scores between the two groups was also not statistically significant (p=0.447; p>0.05). Thus, the results of this study can be used as a reference in choosing management or fluid therapy methods in sepsis patients in line with the marker results shown in this study.

 

The exam was led by the Dean of FK Unud, Prof. Dr. Dr. Komang Januartha Putra Pinatih. M. Kes. with the testing team:

1. Prof. Dr. Dr. I Made Wiryana, Sp.An-KIC (Promoter)

2. Prof. Dr. Dr. Tjok Gde Agung Senapathi, Sp.An., KAR (Copromotor I)

3. Prof.Dr.dr.Komang Januartha Putra Pinatih, M.Kes (Copromotor II)

4. Prof. Dr. Dr. I Made Bakta, Sp.PD-KHOM

5. Prof. Dr. Dr. I Made Jawi, M. Kes

6. Prof. Dr. Dr. I Ketut Suyasa, Sp.B., Sp.OT(K)

7. Prof. Dr. Dr. Tjokorda Gde Bagus Mahadewa, M.Kes.,Sp.BS (K)Spinal,FICS.FINSS

8. Prof. Dr. Dr. I Wayan Putu Sutirta Yasa, M.Sc

9. Prof. Dr. I Made Ady Wirawan, S.Ked, MPH., Ph.D

10. Prof. Dr. Dr. A.A.Wiradewi Lestari, Sp.PK(K)

Meanwhile, academic invitations are:

1.Dr. Dr. I Putu Pramana Suarjaya, Sp.An, M.Kes, KMN, KNA, FIPM

2.Dr. Dr. I Made Gede Widnyana, Sp.An. KAR

3.Dr. Dr. I Wayan Suranadi, Sp.An.KIC

4.Dr. Dr. I Wayan Eka Sutyawan, Sp. M(K)

5.Dr. Dr. I Gusti Agung Utara Hartawan, Sp.An, MARS, SH

 

In this exam, Dr. Dr. I Wayan Aryabiantara, SpAn-TI, Subsp-TI(K)., was declared to have graduated as the 402nd Doctoral Graduate of the Medical Science Doctoral Degree Study Program, Faculty of Medicine, Udayana University with the title of Very Satisfactory