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"Infeksi nosokomial atau infeksi yang berkenaan atau berasal dari rumah sakit masih menjadi masalah di rumah sakit di Indonesia dan dunia. Lebih dari 20% infeksi nosokomial terjadi di ICU. Infeksi nosokomial akan meningkatkan angka kematian, waktu perawatan pasien serta biaya. Resistensi terhadap antibiotik kini juga menjadi masalah dalam mengatasi infeksi nosokomial. Pengetahuan mengenai pola bakteri di ICU RSUPNCM beserta pola resistensi penting diketahui sebagai pertimbangan dalam penatalaksanaan infeksi nosokomial. Penelitian ini menggunakan metode potong lintang dan data sekunder isolat yang berasal di ICU RSUPNCM pada tahun 2003-2006 yang didapat dari LMK FKUI. Data dibagi dua berdasarkan kurun waktu 2003-2004 dan 2005-2006. Didapatkan 142 isolat dalam kurun waktu 2003-2006, 91 isolat dalam kurun waktu 2003-2004 serta 51 isolat pada 2005-2006. Dari data didapatkan lima bakteri terbanyak yaitu Pseudomonas aeruginosa(31), Klebsiella pneumoniae(29), cinetobacter anitratus(21), Staphylococcus aureus(19) dan Enterobacter aerogenes(18). Pada kedua kurun waktu didapatkan lima besar bakteri yang sama namun dalam urutan yang berbeda. Pola resistensi terhadap antibiotik menunjukkan persentase resistensi yang meningkat pada Pseudomonas aeruginosa terhadap tikarsilin, Klebsiella pneumoniae, Acinetobacter anitratus, dan Enterobacter aerogenes terhadap sefepim, Staphylococcus aureus terhadap eritromisin, lainnya turun atau menetap. Berdasarkan perbandingan dengan hasil uji resistensi di negara-negara lain ditemukan beberapa perbedaan. Perbedaan ini dapat terjadi karena berbagai hal dan dipengaruhi berbagai faktor. Harus dilakukan upaya-upaya pengendalian infeksi nosokomial dan pencegahan resistensi dengan berbagai strategi.

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Nosocomial infection or infection associated with or derived from hospital is still a problem in Indonesia and around the world. More than 20% nosocomial infection occurred in the ICU. Nosocomial infection will increase cost, mortality rate, length of stay and cost. Resistance against antibiotics has also become a problem in controlling nosocomial infection. Knowledge about bacterial pattern in ICU of Cipto Mangunkusumo national General Hospital and its resistance pattern will help in determining the appropriate treatment for nosocomial infection. The study design is cross-sectional and using secondary data obtained from bacteria isolated from ICU of Cipto Mangunkusumo national General Hospital during 2003-2006. The data is then divided into two periods, 2003-2004 and 2005-2006. The highest numbers of microbes found were Pseudomonas aeruginosa(31), Klebsiella pneumoniae(29), Acinetobacter anitratus(21), Staphylococcus aureus(19) and Enterobacter aerogenes(18). In both period the big five bacterias are the same, but in a different order. Increased percentage of resistance is shown in Pseudomonas aeruginosa against ticarcillin, Klebsiella pneumoniae, Acinetobacter anitratus and Enterobacter aerogenes against cefepime, and Staphylococcus aureus against erythromycin, other shows decreased or constant percentage. Comparison of the resistance pattern with study in other countries show some differences. There are various reasons and factors that may affect this outcome. Efforts must be made on controlling nosocomial infection and prevent resistance againsts antibiotics through various strategies."

"Resistensi bakteri terhadap antibiotik sudah menjadi masalah di rumah sakit Indonesia dan dunia. Banyaknya penggunaan antibiotik dengan dosis yang tidak adekuat, dan pemakaian antibiotik dalam jangka waktu lama memberikan andil besar pada peningkatan resistensi antibiotik. Bangsal Bedah RSUPN CM merupakan salah satu unit kesehatan yang memiliki insiden tinggi terjadinya infeksi. Pola bakteri beserta pola resistensi penting diketahui sebagai pertimbangan dalam penatalaksanaan infeksi. Penelitian ini bertujuan untuk mengetahui pola resistensi bakteri yang diisolasi dari bangsal bedah. Penelitian ini menggunakan metode potong lintang; data merupakan data sekunder hasil uji kepekaan bakteri yang diisolasi dari bangsal bedah RSUPN CM pada tahun 2003-2006 yang didapat dari Laboratorium Mikrobiologi Klinik FKUI. Data dibagi dua berdasarkan kurun waktu 2003-2004 dan 2005-2006. Dari data didapatkan tujuh bakteri terbanyak yaitu Staphylococcus aureus, Escherichia coli, Staphylococcus epidermidis, Klebsiella pneumoniae, Proteus mirabilis, dan Streptococcus viridans. Staphylococcus aureus mempunyai nilai resistensi terbesar pada Chloramphenicol. Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, dan Pseudomonas aeruginosa mempunyai nilai resistensi yang besar pada Amoxicillin dan Trimethoprim-Sulfamethoxazole. Escherichia coli dan Klebsiella pneumoniae juga mempunyai nilai resistensi besar pada Ciprofloxacin. Terjadi peningkatan persentase resistensi beberapa antibiotik uji pada 2003-2004 ke 2005-2006. Namun ada pula uji yang menurun atau menetap. Perbedaan ini dapat terjadi karena berbagai hal dan dipengaruhi bebagai faktor. Harus dilakukan upaya-upaya pengendalian dalam penggunaan antibiotika dan pencegahan resistensi dengan berbagai strategi.

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Bacterial resistance to antibiotics has been an issue in hospitals in Indonesia as well as around the world. Inappropriate usage of antibiotics for a long period and errors in prescribing inadequate antibiotics dosages have been the main cause of the resistance. Due of its nature, The Surgery ward of RSUPNCM is one of the medical units that has high infection occurrence rates. The knowledge of bacterial resistence patterns must be studied and understood to successfully execute the right antibiotic for a certain infection. The purpose of this study is to evaluate bacterial resistance patterns which were isolated from the surgical ward of Cipto Mangunkusumo Hospital in 2003-2006. During the study, secondary data of bacterial isolation report from Clinical Microbiology Laboratory FKUI in 2003-2006 are also used. The data are divided into two time spans, 2003-2004 and 2005-2006. From the data gathered, we have found the top seven bacteria quantity wise; they are Staphylococcus aureus, Escherichia coli, Staphylococcus epidermidis, Klebsiella pneumoniae, Proteus mirabilis, and Streptococcus viridans. Staphylococcus aureus has the highest resistance to Chloramphenicol. Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa have the highest resistance to Amoxicillin and Trimethoprim-Sulfamethoxazole. Escherichia coli and Klebsiella pneumoniae also have the highest resistance to Ciprofloxacin. The Antibiotics resistance tests show an increasing trend of the isolated bacteria resistance to antibiotics in the comparative study of the two years time spans. Nonetheless, we did also find some of the resistances that are decreasing in trend or stayed constant. These alterations are caused by many factors. Correct procedural usage of antibiotics and, management of infection preventions and treatments for controlling the bacterial resistance growth are essentials."

"Latar belakang : Pembedahan abdomen secara laparotomi menyebabkan penurunan kadar albumin. Kadar albumin di bawah 3,00 g/dL berperan dalam terjadinya mortalitas dan morbiditas pasca-operasi.Tujuan: Mengetahui hubungan antara kadar albumin pre-operasi dan pasca-operasi terhadap luaran klinis pasca-operasi laparotomi.Metode : Penelitian ini dengan desain kohort retrospektif menggunakan data rekam medis Departemen Ilmu Kesehatan Anak tahun 2015-2017. Total sampling pada pasien pasca-laparotomi di PICU dengan rentang usia 1 bulan hingga 18 tahun, dikelompokan ke dalam dua kategori, yaitu: albumin ≤ 3,0 g/dL dan > 3,00 g/dL. Subyek diambil data luaran klinis pasca-operasi seperti sepsis pasca-operasi, infeksi luka operasi, dehisens, relaparotomi, dan lama rawat di PICU.Hasil : Dua ratus satu subyek pasca-laparotomi diikutsertakan dalam penelitian ini. Kadar albumin pre-operasi ≤ 3,0 g/dL meningkatkan risiko terjadinya sepsis pasca-operasi (RR 3,40(95%IK: 1,54-7,51), relaparotomi (RR 3,84(95%IK: 1,28-11,49), dan lama rawat PICU 2 kali lebih lama daripada normoalbuminemia. Kadar albumin pasca-operasi ≤ 3,0 g/dL meningkatkan risiko terjadinya sepsis pasca-operasi (RR 2,55(95%IK: 1,40-4,63) dan lama rawat PICU 1 hari lebih lama daripada normoalbuminemia. Mortalitas pada kelompok hipoalbuminemia sebesar 19,2% dengan RR 3,44(95%IK: 1,07-11,07).Simpulan : Hipoalbuminemia pre-operatif atau pasca-operatif meningkatkan risiko kejadian sepsis pasca-operatif. Hipoalbuminemia pre-operatif atau pasca-operatif tidak berhubungan dengan infeksi luka operasi. Hipoalbuminemia pre-operatif atau pasca-operatif tidak berhubungan dengan risiko kejadian dehisens. Hipoalbuminemia pre-operatif meningkatkan risiko untuk menjalani relaparotomi. Hipoalbuminemia pre-operatif atau pasca-operatif memperpanjang lama rawat di PICU. Hipoalbuminemia pre-operatif meningkatkan angka mortalitas.

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Backgrounds : Laparotomy abdominal surgery decreasing serum albumin. Serum albumin concentration below 3,00 g/dL associated with postoperative morbidity and mortality.

Aim: To determine the relationship between serum albumin (preoperative and postoperative) and postoperative clinical course.

Methods : Retrospesctive observational study in pediatric patients undergoing laparotomy and hospitalized in Pediatric Intensive Care Unit during January 2015- December 2017. Post-laparotomy patients over the age range 1 month to 18 years, classified according to serum albumin concentration: ≤ 3,0 g/dL and > 3,00 g/dL. Postoperative outcome measured by postoperative sepsis, surgical site infection, dehiscence, relaparotomy, PICU length of stay, and mortality.

Results : Two hundred and one subjects undergone laparotomy participated. Preoperative serum albumin ≤ 3,0 g/dL increase risk of postoperative sepsis (RR 3,40 (95%CI: 1,54-7,51)), relaparotomy (RR 3,84 (95%CI: 1,28-11,49)), and twice longer in Pediatric Intensive Care Unit length of stay. Postoperative albumin ≤ 3,0 g/dL increase risk of postoperative sepsis (RR 2,55(95%CI: 1,40-4,63)) and Pediatric Intensive Care Unit length of stay. Mortality rate in hypoalbuminemic group is 19,2% with RR 3,44(95%CI: 1,07-11,07).

Conclusions : Preoperative and postoperative hypoalbuminemia increase risk of postoperative sepsis. Preoperative and postoperative hypoalbuminemia not associated with risk of surgical site infection and wound dehiscense. Preoperative hypoalbuminemia increase risk of relaparotomy. Preoperative and postoperative albumin concentration inversely related with Pediatric Intensive Care Unit length of stay. Preoperative hypoalbuminemia increase mortality rate."

"Latar Belakang: Resusitasi cairan merupakan terapi yang sering diberikan pada ruang rawat intensif untuk mengembalikan perfusi jaringan. Namun, seringkali terapi resusitasi cairan menyebabkan kelebihan cairan yang memiliki efek buruk terhadap pasien termasuk kematian. Tujuan: Penelitian retrospektif ini bertujuan untuk mengetahui hubungan antara mortalitas dengan durasi kelebihan cairan di Rumah Sakit Ciptomangunkusumo. Metode: Sebanyak 194 pasien yang mengalami kelebihan cairan dan berada di ruang rawat intensif selama 7 hari atau lebih, diperoleh melalui teknik consecutive sampling, dievaluasi. Durasi kelebihan cairan dan kematian 28 hari dicatat. Sampel yang diperoleh dibagi menjadi dua kelompok, yaitu pasien yang mengalami kelebihan cairan kurang dari sama dengan 4 hari dan pasien yang mengalami kelebihan cairan lebih dari 4 hari. Sampel kemudian dianalisis menggunakan uji bivariat Chi square untuk diketahui hubungannya dengan kematian. Hasil: Terdapat hubungan antara kematian dengan durasi kelebihan cairan dengan nilai P.

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Background: Fluid resuscitation is a common therapy given at the Intensive Care Unit ICU to maintain tissue perfusions. However, this therapy usually results in fluid overload that has adverse outcome including death.

Objective: This retrospective study aimed to assess the association between mortality and fluid overload duration in Dr. Cipto Mangunkusumo National General Hospital's.

Methods: A total of 194 ICU patients with fluid overload and stayed for 7 days or more that obtained by consecutive sampling, were evaluated. Fluid overload duration and 28 days mortality were recorded. Samples were divided into two groups, patients with fluid overload less than or equal to 4 days and patients with fluid overload more than 4 days. A bivariate analysis Chi square were perform to assess the association of mortality and fluid overload duration.

Results: Mortality and fluid overload duration were significantly associated P."

"Indonesia merupakan negara dengan tingkat resistensi antibiotik yang tinggi. Tingkat resistensi yang tinggi ini terutama didapatkan pada bakteri batang Gramnegatif famili Enterobacteriaceae. Tujuan penelitian ini adalah untuk mengetahui proporsi dan karakteristik Enterobacteriaceae patogen penghasil AmpC di Unit Perawatan Intensif RS Cipto Mangunkusumo Jakarta. Spesimen berasal dari pasien dewasa yang didiagnosis mengalami infeksi organ atau sistem tertentu. Spesimen berupa darah, sekret saluran pernafasan bawah, urin, swab dasar luka, aspirat abses, dan jaringan luka operasi. Identifikasi dilakukan menggunakan VITEK® 2. Pola kepekaan ditentukan dengan VITEK® 2 dan metode difusi cakram sesuai kriteria CLSI tahun 2014. Deteksi AmpC dan ESBL dilakukan menggunakan metode double disc synergy test. Famili gen pengkode AmpC ditentukan dengan metode PCR multipleks. Enterobacteriaceae patogen yang berhasil dikumpulkan berjumlah 45 isolat, terdiri dari Klebsiella pneumoniae (n=32), Escherichia coli (n=6), Enterobacter cloacae (n=5), dan Enterobacter aerogenes (n=2). Proporsi Enterobacteriaceae penghasil AmpC adalah 9 isolat di antara 45 isolat, terdiri dari 4 isolat penghasil AmpC dan 5 isolat penghasil AmpC dan ESBL. Gen pengkode AmpC ditemukan pada 7 isolat, yang terbanyak adalah DHA (n=4) diikuti EBC (n=2) dan CIT (n=1). Secara in vitro, Enterobacteriaceae penghasil AmpC menunjukkan kepekaan yang baik terhadap gentamisin, tobramisin, amikasin, sefepim, meropenem, siprofloksasin, levofloksasin, tetrasiklin, dan kotrimoksasol sementara penghasil AmpC dan ESBL hanya terhadap amikasin.

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Antibiotic resistance has become a problem in Indonesia, in which the high resistance has been found mainly in Gram-negative bacilli Enterobacteriaceae. This study aimed to find out the proportion and characteristics of pathogenic AmpC-producing Enterobacteriaceae in the ICU of Cipto Mangunkusumo Hospital Jakarta. Spesimens collected were blood, lower respiratory tract secretions, urine, wound swab, abscess aspirate, and soft tissue taken from adult patients with infection. Identification were conducted using VITEK® 2. Susceptibility tests were conducted using VITEK® 2 and diffusion technique according to CLSI 2014 guidelines. Double disc synergy test method were employed to detect AmpC activity. The presence of ampC genes were detected using multiplex PCR. Forty five isolates were collected. Klebsiella pneumoniae was predominant, followed by Escherichia coli, Enterobacter cloacae, and Enterobacter aerogenes. AmpC activity was detectable in nine isolates. Five of the 9 isolates produced both AmpC and ESBL. In vitro, AmpC-producing Enterobacteriaceae showed good susceptibility to gentamicin, tobramycin, amikacin, cefepime, meropenem, ciprofloxacin, levofloxacin, tetracycline, and cotrimoxazole. While the AmpC and ESBL-producing only to amikacin. ampC genes were detected in seven isolates and the most prevalent gene family was DHA (n=4) followed by EBC (n=2) and CIT (n=1)."

"Latar belakang: Cedera gastrointestinal akut kerap terjadi pada pasien dengan sakit kritis. Fungsi saluran menjadi salah satu pertimbangan dalam pemberian nutrisi pasien. Komplikasi pada saluran cerna dapat menghambat pemberian nutrisi enteral yang lebih direkomendasikan. Oleh karena itu, penelitian ini bertujuan untuk melihat hubungan derajat cedera gastrointestinal akut dengan capaian nutrisi enteral pada pasien anak sakit kritis. Metode: Penelitian ini memiliki desain studi potong lintang menggunakan data sekunder dari rekam medis pasien anak sakit kritis yang dirawat di PICU RSCM dari September 2019 sampai Agustus 2020. Cedera gastrointestinal akut dikelompokkan berdasarkan klasifikasi WGAP ESICM. Asupan nutrisi diambil dari data rekam medis pasien. Data dianalisis menggunakan Uji Saphiro-Wilk dilanjutkan Uji Kruskal-Wallis untuk mengetahui hubungan derajat cedera gastrointestinal akut dengan capian nutrisi enteral pasien. Data diolah menggunakan aplikasi IBM SPSS for windows versi 20.Hasil: Sampel penelitian berjumlah 26 pasien. Median presentase capaian nutrisi enteral hari ketiga (% laju metabolik basal) setiap derajat yaitu derajat satu 40,08 (0-144,39); dua 0,00 (0-219); tiga 19,10 (0,00-38,20); dan empat 0,00 (0,00-130,30) dengan hasil uji Kruskal-Wallis (p=0,904). Tidak terdapat hubungan bermakna antara lama capaian 25% nutrisi enteral dengan derajat cedera gastrointestinal akut (Kruskal-Wallis, p=0,556). Pada penelitian, faktor lain seperti status gizi (p=0,952), penggunaan ventilator mekanik (p=0,408), dan riwayat pascaoperasi (p=0,423) tidak mempengaruhi presentase nutrisi enteral hari ketiga. Kesimpulan: Pada pasien anak kritis, tidak terdapat hubungan yang bermakna antara derajat cedera gastrointestinal akut dengan capaian nutrisi enteral.

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Background: Acute gastrointestinal injury (AGI) is usually found in critically ill patients. Gastrointestinal function can determine the route od nutritional therapy. Gastrointestinal abnormalities may delay enteral nutrition therapy in patients. Therefore, this study aims to determine the association between the association between acute gastrointestinal injury and enteral nutrition outcome in critically ill children.

Methods: This study had a cross-sectional study design using the medical records of critically ill children in PICU RSCM from September 2019 until August 2020. AGI patients was classified based on WGAP ESIM grading system. Nutritional outcomes were assessed using data from medical record. Data were analyzed the Kruskal-Wallis test to determine the association between acute gastrointestinal injury and enteral nutrition outcomes. The Data were analysed using SPSS for windows version 20.

Results: The study sample was 26 patients. The medians of day three enteral nutrition percentage were grade one 40,08 (0-144,39); grade two 0,00 (0-219); grade three 19,10 (0,00-38,20); dan grade four 0,00 (0,00-130,30) with Kruskall-walis test result (p=0,904). There was no significant association between AGI and the duration of 25% basal metabolic rate (Kruskal-Wallis, p=0,556). In this study, Other factors such as nutritional status (p=0,952), ventilator usage (p=0,408), and post-operative history (p=0,423) did not associate with day three enteral nutrition percentage.

Conclusion: In critically ill children, there was no significant association between the acute gastrointestinal injury and the outcome of enteral nutrition."

"PendahuluanPasien anak, termasuk di Pediatric Intensive Care Unit (PICU), tergolong rentan menerima peresepan obat off-label, yang berpotensi menimbulkan kejadian efek samping obat. Penelitian ini bertujuan mengevaluasi penggunaan obat off-label pada pasien anak di PICU RSCM, yang belum pernah diteliti.MetodeSampel merupakan peresepan yang diambil dari rekam medis secara consecutive sampling. Perhitungan jumlah sampel menggunakan proporsi tunggal dan beda dua proporsi. Kriteria inklusi adalah pasien anak <18 tahun yang dirawat di PICU RSCM tahun 2018. Kriteria eksklusi adalah pasien dengan data pengobatan yang sulit dibaca atau tidak lengkap, obat luar, elektrolit, dan suplemen. Data ditabulasi berdasarkan nama obat, jenis kelamin, usia, status off-label obat berdasarkan usia pasien, dan klasifikasi Anatomical Therapeutic Chemical (ATC). Uji Chi-Square dipakai untuk mengetahui beda proporsi penggunaan obat off-label antar kelompok.HasilDari 400 peresepan yang dievaluasi, 23,8% tergolong off-label kategori usia. Berdasarkan klasifikasi ATC, peresepan di PICU didominasi oleh obat kardiovaskular (25,25%). Obat muskuloskeletal paling sering diresepkan secara off-label (84,6%). Tidak ada perbedaan signifikan proporsi penggunaan obat off-label pada kelompok laki-laki (21%) dan perempuan (26,5%) (p = 0,196,). Proporsi off-label pada kelompok usia bayi (0-2 tahun) 33,8%, anak (2-12 tahun) 18,6%, dan remaja (12-18 tahun) 14,3%. Peresepan off-label pada bayi lebih tinggi secara signifikan dibandingkan anak (p = 0,002) dan remaja (p = 0,001)KesimpulanSebanyak 23,8% peresepan pada pasien PICU diberikan secara off-label berdasarkan usia, dan yang tersering adalah obat muskuloskeletal. Perbedaan proporsi obat off-label antar jenis kelamin tidak signifikan, sedangkan antar kelompok usia signifikan.

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Introduction

Pediatric patients, including Pediatric Intensive Care Unit (PICU) patients, are prone to off-label drug prescriptions, which potentially lead to adverse drug reactions. This study aimed to assess the use of off-label drugs on PICU patients at RSCM, which has never been studied before.

Methods

Samples were prescriptions taken from medical records connsecutively. Sample size were calculated using single proportion and difference between two proportions. The inclusion criteria were <18 years old PICU patients at RSCM admitted in 2018. The exclusion criteria were patients with unclear or incomplete data, external drugs, electrolytes, and supplements. Data were tabulated by drug name, sex, age, off-label drug status based on patient age, and Anatomical Therapeutic Chemical (ATC) classification. Difference in proportions between groups were tested using Chi-Square.

Results

Of the 400 prescriptions evaluated, 23.8% were off-label by age. Based on the ATC classification, PICU prescription was dominated by cardiovascular drugs (25.25%). Musculoskeletal drugs were most often prescribed off-label (84.6%). There was no significant difference in off-label prescription between males (21%) and females (26.5%) (p = 0.196). The proportion of off-label in the infant age group (0-2 years) was 33.8%, in children (2-12 years) 18.6%, and in adolescents (12-18 years) 14.3%. Infants were given off-label drugs significantly higher than children (p = 0.002) and adolescents (p = 0.001)

Conclusion

Off-label prescription in PICU patients is 23.8%. Musculoskeletal drugs are most often prescribed off-label. The difference in the proportion of off-label drugs between sexes was not significant, whereas between age groups was significant"

"ABSTRAKPendahuluan: Pasien pascaoperasi berisiko mengalami perubahan suhu tubuh. Upaya tubuh untuk mengembalikan suhu tubuh ke dalam rentang normal akan meningkatkan kebutuhan tubuh akan oksigen. Pada pasien kritis, kadar laktat >2 mmol/L merupakan prediktor morbiditas dan mortalitas. Kadar laktat dapat meningkat ketika terdapat gangguan perfusi jaringan. Hipoperfusi jaringan dapat terjadi karena hipotermia. Berdasarkan hal tersebut, penelitian ini dilakukan untuk membuktikan hipotesisnya yaitu adanya hubungan antara suhu tubuh dengan kadar laktat pada pasien dewasa pascaoperasi. Metode: Penelitian ini bersifat analitik observasional dengan desain potong lintang. Data diperoleh dari 194 rekam medis pasien pascaoperasi di ICU Rumah Sakit Cipto Mangunkusumo, Jakarta. Data yang dianalisa adalah suhu tubuh dan kadar laktat saat pasien masuk ICU. Uji yang dilakukan adalah uji korelasi Spearman menggunakan perangkat lunak SPSS versi 20. Hasil: Dari 194 pasien dewasa pascaoperasi di ICU Rumah Sakit Cipto Mangunkusumo, didapatkan rerata suhu tubuh 36.3°C dan rerata kadar laktat adalah 1,7 mmol/L. Korelasi antara suhu tubuh dan kadar laktat dianalisis dengan uji korelasi Spearman dan menghasilkan korelasi positif lemah yang bermakna secara statistik dengan nilai r=0,2 (p=0,005). Kesimpulan: Terdapat hubungan berupa korelasi positif antara suhu tubuh dengan kadar laktat pasien dewasa pascaoperasi di ICU.

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ABSTRACT

Introduction: Postoperative patients are at risk of experiencing changes in body temperature. The bodys effort to restore body temperature to its normal range will increase the bodys need for oxygen. In critical patients, lactate levels >2 mmol/L is a predictor of morbidity and mortality. Lactate levels might increase when there is tissue perfusion impairment. Tissue hypoperfusion can occur due to hypothermia. Based on that, this study was conducted to prove its hypothesis that there is a relationship between body temperature and lactate levels in postoperative adult patients. Method: This study is an observational analytic study with a cross-sectional design. Data was collected from 194 medical records of postoperative patients in the ICU of Cipto Mangunkusumo Hospital, Jakarta. The analyzed data was body temperature and lactate level at the time patients moved into ICU. The applied test was Spearman correlation test using SPSS version 20 software. Results: Obtained from 194 postoperative adult patients in the ICU of Cipto Mangunkusumo Hospital, the average body temperature was 36.3°C and the average lactate level was 1,7 mmol/L. Correlations between body temperature and lactate levels were analyzed by the Spearman correlation test and resulted in a statistically significant positive weak correlation with a value of r=0,2 (p=0,005). Conclusion: There is a relationship in the form of a weak positive correlation between body temperature with lactate level of postoperative adult patients in ICU."

"ABSTRAK

Latar Belakang. Terdapat gangguan sistem imun pada sepsis. Fase awal ditandai

dengan hiperinflamasi, sedangkan fase lanjut ditandai dengan imunosupresi.

Kematian kumulatif lebih banyak pada fase lanjut. Saat ini belum terdapat

penelitian yang secara khusus meneliti faktor prognostik mortalitas sepsis fase

lanjut dan mengembangkan model prediksi mortalitasnya.

Tujuan. Mengetahui faktor prognostik mortalitas sepsis berat fase lanjut di ICU

dan mengembangkan sistem skor untuk memprediksi mortalitas.

Metode. Penelitian kohort retrospektif dilakukan pada pasien dewasa yang

mengalami sepsis berat di ICU RSCM pada periode Oktober 2011 – November

2012 dan masih bertahan setelah > 72 jam diagnosis sepsis ditegakkan di ICU.

Tujuh faktor prognostik diidentifikasi saat diagnosis sepsis berat ditegakkan di

ICU. Prediktor independen diidentifikasi dengan analisis Cox’s proportional

hazard. Prediktor yang bermakna secara statistik dikuantifikasi dalam model

prediksi. Kalibrasi model dinilai dengan uji Hosmer-Lemeshow dan kemampuan

diskriminasi dinilai dari area under curve (AUC) dari receiver operating curve.

Hasil. Subjek penelitian terdiri atas 220 pasien. Mortalitas 28 hari sepsis berat

fase lanjut adalah 40%. Faktor prognostik yang bermakna adalah alasan masuk

ICU (medis (HR 2,75; IK95%:1,56-4,84), pembedahan emergensi (HR 1,96;

IK95%:0,99 – 3,90), indeks komorbiditas Charlson > 2 (HR 2,07; IK95%:1,32-

3,23), dan skor MSOFA > 4 (HR 2,84; IK95%:1,54-5,24). Model prediksi

memiliki kemampuan diskriminasi yang baik (AUC 0,844) dan kalibrasi yang

baik (uji Hosmer-Lemeshow p 0,674). Berdasarkan model tersebut risiko

mortalitas dapat dibagi menjadi rendah (skor 0, mortalitas 5,4%), sedang (skor 1 –

2,5, mortalitas 20,6%), dan tinggi (skor > 2,5, mortalitas 73,6%).

Simpulan. Alasan masuk medis dan pembedahan emergensi, indeks komorbiditas

Charlson > 2, dan skor MSOFA > 4 merupakan faktor prognostik mortalitas

sepsis berat fase lanjut di ICU RSCM. Sebuah model telah dikembangkan untuk

memprediksi dan mengklasifikasikan risiko mortalitas.

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ABSTRACT

Background. Immune system derrangement occurs during the course of sepsis,

characterized by hyperinflamation in early phase and hypoinflamation and

immunosupression in late phase. The number of patient die during late phase is

larger than early phase. Until now, there is no study specifically addressing

prognostic factors of mortality from late sepsis and developing a mortality

prediction model.

Aim. To determine prognostic factors of mortality from late phase of severe

sepsis in ICU and to develop scoring system to predict mortality.

Method. A retrospective cohort study was conducted to identify prognostic

factors associated with mortality. Adult patients admitted to ICU during

November 2011 until October 2012 who developed severe sepsis and still alive

for minimum 72 hours were included in this study. Seven predefined prognostic

factors were indentified at the onset of severe sepsis in ICU. Cox’s proportional

hazard ratio was used to identify independent prognostic factors. Each

independent factors was quantified to develop a prediction model. Calibration of

the model was tested by Hosmer-Lemeshow, and its discrimination ability was

calculated from area under receiver operating curve.

Result. Subjects consist of 220 patients. Twenty eight-day mortality was 40%.

Significant prognostic factors indentified were admission source (medical (HR

2.75; CI95%: 1.56 – 4.84), emergency surgery (HR 1.96; CI95%:0.99 – 3.90),

Charlson comorbidity index > 2(HR 2.07; CI95%:1.32 – 3.23), and MSOFA score

> 4 (HR 2.84; CI95% : 1.54 – 5.24). Prediction model developed has good

discrimination ability (AUC 0.844) and good calibration (Hosmer-Lemeshow test

p 0.674). Based on the model mortality risk can be classified as low (score 0,

mortality 5.4%), moderate (score 1 – 2.5, mortality 20.6%), and high (score > 2.5,

mortality 73.6%).

Conclusion. Medical and emergency surgery admission, Charlson comorbidity

index > 2, and MSOFA score > 4 were prognostic factors of mortality from late

phase of severe sepsis in ICU at Dr.Cipto Mangunkusumo general hospital. A

model has been developed to predict and classify mortality risk."

"Latar Belakang : Kejadian AKI di unit perawatan intensif berhubungan dengan peningkatan mortalitas, morbiditas pasca AKI dan biaya perawatan tinggi. Penelitian mengenai faktor-faktor yang berhubungan dengan mortalitas pasien AKI di unit perawatan intensif di Indonesia khususnya RSUPN dr. Cipto Mangungkusumo belum pernah dilakukan.Tujuan: Mengetahui prevalensi AKI, angka mortalitas pasien AKI, dan faktor- faktor yang berhubungan dengan peningkatan mortalitas pasien AKI di unit perawatan intensif di ICU RSUPN dr. Cipto Mangunkusumo.Metode : Penelitian kohort retrospektif terhadap seluruh AKI di unit perawatan intensif di RSUPN Cipto Mangunkusumo periode Januari 2015 ndash; Desember 2016. Dilakukan analisis hubungan bivariat saampai dengan multvariat dengan STATA Statistics 15.0 antara faktor usia >60 tahun, sepsis, ventilator, durasi ventilator, dialisis, oligoanuria, dan skor APACHE II saat admisi dengan mortalitas. Hasil : Prevalensi pasien AKI di unit perawatan intensif didapatkan 12,25 675 dari 5511 subjek dan sebanyak 220 subjek 32,59 dari 675 subjek yang dianalisis meninggal di unit perawatan intensif. Faktor-faktor yang berhubungan dengan peningkatan mortalitas pada analisis multivariat adalah sepsis OR 6,174; IK95 3,116-12,233 , oligoanuria OR 4,173; IK95 2,104-8,274 , ventilator OR 3,085; IK95 1,348-7,057 , skor APACHE II saat admisi 1/2 [OR 1,597; IK95 1,154-2,209], dan durasi ventilator OR 1,062; IK95 1,012-1,114 . Simpulan : Prevalensi pasien AKI dan angka mortalitasnya di unit perawatan intensif RSUPN dr. Cipto Mangunkusumo didapatkan sebesar 12,25 dan 32,59 . Sepsis, oligoanuria, ventilator, skor APACHE II saat admisi 1/2, dan durasi ventilator merupakan faktor-faktor yang berhubungan bermakna dengan peningkatan mortalitas pasien AKI di unit perawatan intensif. Kata Kunci : Acute Kidney Injury, Faktor Risiko, Mortalitas, Unit Perawatan Intensif

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Background Acute kidney Injury AKI in ICU associated with increased mortality rate, morbidity post AKI, and high health care cost. There is no previous study about factors associated with mortality of AKI patients in ICU in Indonesia, especially at dr. Cipto Mangunkusumo National Central General Hospital.Aim To identify prevalence, mortality rate, and factors associated with mortality of AKI patients in ICU.Method This is a retrospective cohort study. Data were obtained from all of medical records of AKI patients period January 2015 until December 2016 in ICU at Cipto Mangunkusumo hospital. Association of risk factors age 60 years old, sepsis, ventilator, duration of ventilator, oligoanuria, and APACHE II score at admission and mortality will be analyzed using STATA Statistics 15.0. Results AKI prevalence in ICU was 12,25 675 subjects from total 5511 subjects . A total of 220 subjects out of 675 subjects AKI died at ICU. Sepsis OR 6,174 95 CI 3,116 12,233 , oligoanuria OR 4,173 95 CI 2,104 8,274 , ventilator OR 3,085 95 CI 1,348 7,057 , APACHE II score at admission 1 2 OR 1,597 95 CI 1,154 2,209 , and duration of ventilator OR 1,062 95 CI 1,012 1,114 . were significant factors associated with mortality of AKI patients in ICU. Conclusion AKI prevalence and mortality rate in ICU at dr. Cipto Mangunkusumo National Central General Hospital were 12,25 and 32,59 . Sepsis, oligoanuria, ventilator, APACHE II score at admission 1 2, and duration of ventilator were significant factors associated with mortality of AKI patients in ICU. Keywords Acute Kidney Injury, Intensive Care Unit, Mortality, Risk Factor "