Pemanjangan Ventilasi Mekanik di Intensive Care Unit (ICU) pada Pasien dengan Tumor Glioma Batang Otak yang menjalani Kraniotomi Pengangkatan Tumor

Abstract

Kekerapan glioma batang otak mencapai 10–20% dari semua tumor primer sistem saraf pusat dan biasanya terdiagnosa pada usia muda. Pada penanganan perioperatif perlu dipertimbangkan cara pengangkatan tumornya, pemakaian steroid perioperatif, perencanaan ventilasi mekanik pascabedah dan fisioterapi. Seorang anak berumur 11 tahun dengan diagnosa tumor batang otak, mengeluh tidak dapat berdiri, penglihatan ganda, afasia, gangguan menelan. Pasien telah menggunakan kortikosteroid dalam waktu yang lama. Dilakukan operasi pengangkatan massa tumor otak dengan lama operasi 10 jam. Pascabedah terjadi pemanjangan ventilasi mekanik, Ventilator Associated Pneumonia (VAP) pada hari ke-4 dan perdarahan lambung pada hari ke-6 di ICU. Teknik operasi sulit karena tumor berada di daerah yang sangat dekat dengan pusat pernapasan dan hemodinamik. Diperlukan perencanaan yang matang mengenai penilaian kondisi pasien saat preoperatif, pemantauan hemodinamik dan tekanan intrakranial, strategi perlindungan terhadap lambung, perencanaan ventilasi mekanik, penilaian cepat perlunya trakheostomi, pemberian antibiotik untuk meningkatkan keluaran yang lebih baik.

Prolonged Mechanical Ventilation on Postcraniotomy Tumor Removal on Brainstem Glioma in the Intensive Care Unit

Brain stem glioma makes 10–20% of primary central nervous system tumor and is diagnosed primarily in children. In perioperative management, approach of tumor removal, steroid usage, mechanical ventilation planning, good nursing care, and physioterapy, should be considered. The aim of this case report is to discuss complications that may occur with prolonged mechanical ventilation after surgery. An 11-year old boy, diagnosed with brain tumor, was admitted to hospital due to inability to stand, double-vision, aphasia, swallowing disorder, with long–term corticosteroid treatment. He underwent a brain tumor removal surgery. Surgery was conducted within 10 hours. After the surgery, he had prolonged mechanical ventilation in ICU. On the fourth day, he suffered from ventilator associated pneumonia (VAP) and gastrointestinal bleeding on the sixth day care in ICU. Patient presented to hospital with late onset symptoms of his condition. Operation technique was difficult as the tumor is located within close proximity to the breathing and haemodynamic centers. There are necessity for detailed perioperative assessment and planning, hemodynamic and intracranial pressure monitoring, gastric protection strategy, mechanichal ventilation planning, quick assessment of tracheostomy installment need and usage of proper antibiotic for a better outcome.