Terapi Hiperosmolar dalam Tata Laksana Cedera Otak Traumatis
DOI:
https://doi.org/10.55175/cdk.v49i8.288Keywords:
Cedera otak traumatis, manitol, saline hipertonis, tekanan intrakranial, TIKAbstract
Latar Belakang: Cedera otak traumatis merupakan salah satu penyebab kematian dan kecacatan tertinggi di dunia. Angka mortalitas pasien cedera kepala dengan tekanan intrakranial di bawah 20 mmHg adalah 18,4%, sedangkan angka mortalitas setinggi 55,6% dilaporkan pada pasien dengan tekanan intrakranial melebihi 40 mmHg. Terapi hiperosmolar dengan manitol atau saline hipertonis merupakan tata laksana medis utama untuk menangani peningkatan intrakranial akibat cedera otak traumatis. Tinjauan sistematis ini bertujuan membandingkan efektivitas kedua terapi hiperosmolar tersebut dalam tata laksana cedera otak traumatis. Metode: Penelitian ekstensif dilakukan pada database PubMed, DOAJ, dan Cochrane dengan kriteria inklusi publikasi dalam dua puluh tahun terakhir. Artikel penelitian dalam bentuk meta-analisis, uji klinis, dan uji acak terkontrol lebih diutamakan. Kriteria eksklusi adalah pernyataan tidak jelas, korelasi yang tidak relevan dengan topik utama, atau fokus pada penyakit lain. Hasil: Sebelas penelitian menyimpulkan bahwa efektivitas saline hipertonis sebanding dengan manitol, enam penelitian menunjukkan bahwa saline hipertonis lebih unggul. Simpulan: Saline hipertonis layak dipertimbangkan sebagai alternatif untuk manitol, direkomendasikan untuk pasien dengan hipovolemia, hiponatremia, atau gagal ginjal. Penelitian lebih lanjut diperlukan untuk mendapatkan dosis terapi dan konsentrasi saline hipertonis yang optimal. Background: Traumatic brain injury is one of the leading causes of death and disability worldwide. Mortality rate of head injuries with intracranial pressure below 20 mmHg was reported 18.4%, whereas those with intracranial pressure more than 40 mmHg had a 55.6% mortality rate. Hyperosmolar therapy with mannitol or hypertonic saline is the mainstay of medical management for treating elevated intracranial pressure in traumatic brain injury. This systematic review aimed to compare the effectiveness of these two hyperosmolar therapies in the management of traumatic brain injury. Methods: The PubMed, DOAJ, and Cochrane databases were used to perform extensive study, with the inclusion criteria of publications in the last twenty years. Meta-analyses, clinical trials, and randomized controlled trials were included. Unclear statements, irrelevant correlation with the main topic, or focusing more on other diseases were the exclusion criteria. Results: Eleven researches stated that the effectiveness of mannitol and hypertonic saline are comparable, six researches showed that hypertonic saline was better. Conclusion: Hypertonic saline should be considered as a preferable alternative to mannitol, recommended for patients with hypovolemia, hyponatremia, or renal failure. Further studies are required to find the optimal therapeutic dose and concentration of hypertonic saline.
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