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"Latar belakang. Delirium adalah komplikasi neuropsikiatri yang serius dan kerap terjadi pada pasien anak sakit kritis yang dirawat di unit rawat intensif anak (URIA). Diagnosis delirium sulit ditegakkan karena manifestasi klinis yang tidak khas. Kurangnya pengetahuan dokter anak mengenai faktor risiko dan diagnosis delirium menyebabkan terjadinya underdiagnosed atau misdiagnosed sehingga pasien tidak mendapat tata laksana yang adekuat. Hal ini menyebabkan morbiditas dan mortalitas pada pasien sehingga penting melakukan penapisan delirium dan identifikasi faktor risiko sehingga dapat dilakukan tindakan pencegahan dan tata laksana yang cepat. Implementasi penapisan dengan menggunakan Cornell Assessment of Pediatric Delirium (CAP-D) dan tata laksana yang adekuat terhadap delirium pada anak sakit kritis termasuk pengaturan dalam pemberian sedasi tertuang dalam pediatric intensive care unit (PICU) liberation bundle. Saat ini data mengenai prevalens dan faktor risiko kejadian delirium pada anak sakit kritis di Indonesia belum ada. Dibutuhkan data tersebut untuk dapat melakukan implementasi PICU Liberation Bundle di Indonesia, terutama Rumah Sakit Cipto Mangunkusumo (RSCM).Tujuan. Mengetahui prevalens dan faktor risiko delirium pada anak sakit kritis.Metode. Studi deskriptif observasional menggunakan desain potong lintang yang dilakukan pada 87 pasien anak sakit kritis yang dirawat di URIA Departemen Ilmu Kesehatan Anak (IKA), URIA Instalasi Gawat Darurat (IGD), dan URIA Unit Luka Bakar (ULB), URIA Pelayanan Jantung Terpadu (PJT) RSCM.Hasil. Sebanyak 4 (4,6%) anak sakit kritis memenuhi kriteria delirium berdasarkan DSM IV-TR/ICD-10. Dua subjek mengalami delirium tipe campuran, satu subjek mengalami delirium tipe hipoaktif, dan satu subjek mengalami delirium tipe hiperaktif. Tiga subjek tidak mendapatkan sedasi tetapi salah satu subjek mendapatkan sedasi dengan kombinasi yang banyak, jumlah yang besar, dan waktu yang lama. Dua dari keempat subjek mengalami keterlambatan perkembangan. Satu dari empat subjek dengan delirium yang menggunakan ventilasi mekanik.Kesimpulan. Prevalens delirium pada anak sakit kritis di RSCM adalah 4,6%. Penggunaan midazolam, opioid, dan deksmedetomidin infus kontinu di URIA sebagai faktor risiko delirium pada anak sakit kritis belum memiliki data yang cukup untuk dapat disimpulkan karena data prevalens delirium pada penelitian ini yang rendah meskipun dengan minimal besar sampel telah terpenuhi.

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Background. Delirium is a serious neuropsychiatric complication that occurs frequently in critically ill pediatric patients who admitted to the pediatric intensive care unit (PICU). The diagnosis of delirium is difficult to establish because of the atypical clinical manifestations. The lack of knowledge from pediatricians regarding risk factors and the diagnosis of delirium causes underdiagnosed or misdiagnosed of it so that patients do not receive adequate management. This causes morbidity and mortality in patients making it important to screen delirium and identify supporting factors so the preventive action and fast management can be carried out. Implementation of screening using Cornell Assessment of Pediatric Delirium (CAP-D) and management of delirium in critically ill children, including arrangements for administering sedation, is contained in PICU liberation bundle. Currently there is no data regarding prevalence and risk factors for delirium in critically ill children in Indonesia. This data is needed to be able to implement the PICU Liberation Bundle in Indonesia, especially Cipto Mangunkusumo Hospital (RSCM).

Objectives. Knowing the prevalence and risk factors for delirium in critically ill children.

Methods. Observational descriptive study using a cross-sectional design conducted on 87 critically ill pediatric patients treated at PICU Department of Pediatrics, PICU of Emergency Room, PICU of Burn Unit, and Cardiac Intensive Care Unit RSCM.

Results. A total of 4 (4.6%) critically ill children met the criteria for delirium based on DSM IV-TR/ICD-10. Two subjects had a mixed type of delirium, one subject had a hypoactive type of delirium, and one subject had a hyperactive type of delirium. Three subjects did not get sedation but one subject got sedation with a lot of combinations, large amounts, and long duration. Two of the four subjects experienced developmental delays. One in four subjects with delirium is on mechanical ventilation.

Conclusion. The prevalence of delirium in critically ill children at RSCM is 4.6%. The use of midazolam, opioids, and continuous infusion of dexmedetomidine in PICU as a risk factor for delirium in critically ill children does not yet have sufficient data to be conclusive because the data on the prevalence of delirium in this study was low even though the minimum sample size was met."

"Malnutrisi pada anak sakit kritis dalam perawatan intensif menjadi masalah dalam beberapa dekade terakhir dan berhubungan erat dengan morbiditas dan mortalitas. Hingga kini, Rumah Sakit Cipto Mangunkusumo (RSCM) belum memiliki panduan baku mengenai dukungan nutrisi anak sakit kritis. Penelitian bertujuan untuk mengetahui profil pemberian nutrisi enteral (NE) dan waktu pencapaian resting energy expenditure (REE) di Pediatric Intensive Care Unit (PICU) RSCM dan faktor-faktor yang memengaruhi. Penelitian dilakukan secara retrospektif dengan menggunakan data rekam medis anak sakit kritis yang dirawat di PICU RSCM pada tahun 2017-2018. Waktu inisiasi pemberian NE dan pencapaian REE serta faktor-faktor yang memengaruhi pemberian tersebut dicatat dan dilakukan analisis multivariat untuk mencari faktor risiko yang bermakna. Terdapat 203 pasien yang memenuhi kriteria inklusi. Terdapat 120 subyek berjenis kelamin lelaki (59,1%), dengan median usia adalah 35 bulan (rentang usia 1-209 bulan). Kasus bedah terdapat pada 125 subyek (61,6%) dan status gizi normal terdapat pada 87 subyek (42,9%). Prevalensi pemberian NE dini adalah 63,1%, dan pencapaian kalori REE ≤72 jam adalah 67,5%, dengan median 48 jam. Faktor risiko yang menghambat pemberian NE dini adalah pasca-bedah abdomen, penggunaan inotropik, penggunaan ventilator, gejala gastrointestinal sebelum inisiasi, dan status gizi tidak normal dengan odds ratio (OR) 10,89 (IK 95% 4,31-27,50; p=0,009), 4,60 (IK 95% 1,78-11,90; p=0,002), 4,18 (IK 95% 1,56-11,17; p=0,004), 3,40 (IK 95% 1,59-7,29; p=0,002), 2,49 (IK 95% 1,09-5,72; p=0,031). Faktor risiko yang menghambat pencapaian kalori REE ≤72 jam adalah pemberian NE lambat, intoleransi pemberian enteral berupa gejala gastrointestinal dan skor PELOD-2 ≥7 dengan OR 20,62 (IK 95% 6,48-65,65; p=0,000), 14,77 (IK 95% 4,40-49,60; p=0,000), 3,98 (IK 95% 1,01-15,66; p=0,048). Prevalensi pemberian NE dini pada anak sakit kritis di PICU RSCM cukup baik dengan waktu pencapaian REE sesuai dengan target. Faktor terbanyak penghambat pemberian NE dini adalah kondisi pasca-bedah abdomen, sedangkan faktor penghambat pencapaian REE ≤ 72 jam terbanyak adalah pemberian NE lambat.

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Malnutrition of critically ill children remains a major problem that is closely related to high morbidity and mortality in pediatric intensive care unit (PICU) during the last decades. The protocol of nutritional support for critically ill children in Cipto Mangunkusumo Hospital (CMH) has not yet been developed. The study is aimed to evaluate the enteral nutrition (EN) profile, the duration to achieve resting energy expenditure (REE) and number of influencing factors associated with the late EN administration and late REE achievement. The data were collected retrospectively from medical records during the year 2017 to 2018 in PICU CMH. We assessed the timing of EN given and the duration of REE achieved from EN. We performed multivariate analysis to determined significant factors associated with late EN and late REE achievement. Two hundred three subjects were included. One hundred twenty subjects (59%) were boys, with median age of 35 (1-209) months old. One hundred twenty five subjects (61.6%) were post-surgical period and 87 subjects (42.9%) were in good nutritional status. The prevalence of early EN was 63.1%, and REE ≤72 hours was achieved in 67.5% subjects, with the median time was 48 hours. Significant factors inhibit early EN administration were post-abdominal surgery, ventilator use, inotropic use, gastrointestinal symptoms before initiation, and abnormal nutritional status; with OR 10.89 (95% CI 4.31 to 27.50; p=0.009), 4.60 (95% CI 1.78 to 11.90; p=0.002), 4.18 (95% CI 1.56 to 11.17; p=0.004), 3.40 (95% CI 1.59 to 7.29; p=0.002), 2.49, 95% CI 1.09 to 5.72; p=0.031), respectively. While factors inhibit the achievement of REE ≤72 hours were the late EN initiation, enteral intolerance, and PELOD-2 score ≥7 with OR 20.62 (95% CI 6.48 to 65.65; p=0.000), 14.77 (95% CI 4.40 to 49.60; p=0.000), 3.98 (95% CI 1.01 to 15.66; p=0.048), respectively. The prevalence of early EN administration with the duration to achieve REE among critically ill children in the PICU CMH was quite satisfying. The most influencing factor inhibit early EN administration was post-abdominal surgery, while the most significant factor inhibit the achievement of REE ≤72 hours was the late NE administration."

"Latar belakang: Penentuan kebutuhan nutrisi secara tepat pada anak sakit kritis perludilakukan untuk menghindari underfeeding dan overfeeding. Rumus estimasi menjadidasar perkiraan kebutuhan energi jika kalorimetri indirek sebagai baku emas tidaktersedia. Akurasi rumus pada studi terdahulu sangat bervariasi dan dipengaruhi olehkarakteristik populasi setempat, sehingga akurasinya perlu diuji pada populasi Indonesia.Tujuan: Mengevaluasi akurasi rumus Schofield WH, Schofield W, dan WHOdibandingkan kalorimetri indirek, serta mengevaluasi dampak penambahan faktor stresterhadap akurasi.Metode: Penelitian deskriptif analitik potong lintang ini mengikutsertakan pasien anakyang menggunakan ventilasi mekanik Mei sampai Juli 2019. Analisis kesesuaiandilakukan dengan membandingkan perhitungan rumus Schofield WH, Schofield W, danWHO, dengan dan tanpa faktor stres terhadap pengukuran kalorimetri indirek.Hasil: Penelitian mengikutsertakan 52 subjek pada hari perawatan 1-5 di PICU denganmedian usia 5 tahun (1 bulan 10 hari hingga 17 tahun 9 bulan). Kebutuhan energi yangdiukur kalorimetri indirek adalah 60,7 ± 23,5 Kkal/kg/hari. Estimasi rumus SchofieldWH, Schofield W, dan WHO lebih rendah dari hasil pengukuran tersebut dengan %biasberturut-turut -13 ± 19, -15 ± 20, dan -16 ± 21. Nilai estimasi dan hasil pengukurankalorimetri indirek berkorelasi kuat (intraclass correlation coefficient r > 0,9) namuninterval kesesuaian (limit of agreement) dari %bias sangat lebar. Hanya 12 (23%) subjekyang memiliki nilai estimasi akurat sesuai dengan kalorimetri indirek. Pada populasipenelitian ini faktor stres meningkatkan akurasi rumus estimasi.Simpulan: Rumus Schofield WH, Schofield W, dan WHO tidak akurat sebagai estimasikebutuhan energi anak sakit kritis. Hasil prediksi rumus tersebut lebih rendah darikebutuhan aktual jika faktor stres tidak digunakan.

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Background: Accurate estimation of energy expenditure in critically ill children isimportant to avoid underfeeding and overfeeding. Prediction formula helps to estimateenergy expenditure when the gold standard indirect calorimetry is not available. Previousstudy on estimation accuracy yielded variable result in different populationcharacteristics, therefore the accuracy of prediction formula in Indonesian populationneeds to be evaluated.Objective: To assess the accuracy of Schofield WH, Schofield W, and WHO formulacompared to indirect calorimetry. To evaluate the impact of additional stress factor on theaccuracy of prediction formula.Methods: This is a descriptive analytic cross-sectional study on mechanically ventilatedcritically ill children held in May-July 2019. We analyze the agreement of measuredenergy expenditure using indirect calorimetry and estimated energy expenditurecalculated by Schofield WH, Schofield W, and WHO formula, with and withoutadditional stress factor.Results: This study included 52 subjects with median age 5 years old (1 month 10 days -17 years 9 months) on day 0-5 after they were admitted to PICU. Mean measuredenergy expenditure was 60,7 ± 23,5 Kcal/kg/day. All estimated energy expenditure bySchofield WH, Schofield W, and WHO were lower than measured energy expenditurewith % bias of -13 ± 19, -15 ± 20, and -16 ± 21, respectively. Estimated and measuredvalue have strong correlation (intraclass correlation coefficient r > 0.9) but the limit ofagreement interval is too wide. Only 12 (23%) subjects have accurate estimation ofenergy expenditure. In this population stress factor improves the accuracy of predictionformulas.Conclusion: Schofield WH, Schofield W, and WHO formula have poor accuracy inestimating energy expenditure in critically ill children. Without additional stress factor,the estimated value were lower than actual/measured energy expenditure"

"Anak dengan kolestasis kronik memiliki risiko tinggi mengalami malnutrisi yang memengaruhi pertumbuhan dan perkembangan. Berbagai faktor risiko penyebab malnutrisi pada kolestasis kronik penting untuk diidentifikasi agar penanganan malnutrisi lebih terarah. Tujuan studi ini untuk mengetahui prevalens, profil dan faktor risiko yang memengaruhi malnutrisi pada anak dengan kolestasis kronik. Penelitian ini menggunakan desain potong lintang pada anak kolestasis kronik berusia 3 bulan – 5 tahun di klinik rawat jalan gastrohepatologi RSCM. Dilakukan pemeriksaan antropometri, status gizi, pola asupan nutrisi makronutrien dan mikronutrien dan identifikasi faktor risiko malnutrisi. Kemudian dinilai hubungan antara faktor risiko tersebut dengan status gizi. Dari 94 subyek didapatkan prevalens malnutrisi 53,3%, prevalens stunting 59,6%, prevalens mikrosefali 59,6%. Persentase subyek dengan riwayat rawat inap 71,1%, riwayat puasa 44,7%, asites sedang-masif 38,3% dan perdarahan saluran cerna 11,7%. Jumlah subyek dengan kekurangan asupan makronutrien: asupan kalori 67,1%, asupan karbohidrat 53,2%, asupan protein 13,8%, asupan lemak 77,7% dan asupan MCT 76,6%. Jumlah subyek dengan kekurangan asupan mikronutrien: vitamin A 56,4%, vitamin D 55,3%, vitamin E 21,3%, vitamin K 24,5%, vitamin B₁ 21,3%, vitamin B₂ 13,8%, vitamin B₆ 24,5%, vitamin B₁₂ 2,1%, vitamin C15,8%, zat besi 69,1%, seng 87,2%, fosfor 3,2% dan magnesium 66%. Faktor risiko yang memiliki hubungan bermakna dengan malnutrisi pada anak kolestasis kronik adalah perdarahan saluran cerna dan asites sedang-masif  dengan nilai p  0,001 dan 0,025. Tidak terdapat hubungan yang bermakna antara asupan makronutrien, riwayat durasi rawat inap, riwayat durasi puasa dengan malnutrisi pada anak kolestasis kronik. Prevalens dan penyebab malnutrisi pada anak kolestasis kronik cukup tinggi dan bervariasi, dibutuhkan evaluasi status gizi berkala pada anak kolestasis kronik untuk mengatasi dan mencegah malnutrisi. Perdarahan saluran cerna dan asites sedang- masif sebagai faktor risiko yang berpengaruh terhadap malnutrisi harus mendapat penanganan yang komprehensif agar pemberian asupan nutrisi tidak terhambat.

Kata kunci: kolestasis kronik, status gizi, makronutrien, mikronutrien, ascites, perdarahan saluran cerna.

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Abstract

Children with chronic cholestasis have a higher risk of malnutrition that affect growth and development in life. There are several risk factors that should be identified and managed to reduce the risk of malnutrition. In this study we want to know the prevalence of malnutrition, the profile and risk factors that are related to malnutrition in children with chronic cholestasis. This cross-sectional study involved children age 3 months to 5 years old at pediatrics gastro-hepatology clinic RSUPN Dr. Cipto Mangunkusumo. Methods include standard anthropometric examination, evaluation of nutritional status, pattern of intake nutrition and identification risk factors that are related to malnutrition. Out of 94 subjects, the prevalence of malnutrition is 53.3%, prevalence of stunting is 59.6% and prevalence of microcephaly is 59.6%. 71.1% had history of hospitalization, 44.7% had history of fasting, 38.3% had moderate and massive ascites, and 11.7% had gastro-intestinal bleeding. Insufficient daily macronutrient intake are as follows: calorie 67.1%, carbohydrate 53.2%, protein 13.8%, lipid 77.7% and MCT 76.6%. Insufficient daily micronutrient intake are as follows: vitamin A 56.4%, vitamin D 55.3%, vitamin E 21,3%, vitamin K 24,5%, vitamin B₁ 21,3%, vitamin B₂ 13.8%, vitamin B₆ 24.5%, vitamin B₁₂ 2.1%, vitamin C 15.8% Fe 69.1%, zinc 87.2 %, P 3.2% and Mg 66%. There were significant relationships between gastro-intestinal bleeding (p value of 0.001) and moderate-massive ascites (p value of 0.025) in nutrition status in children with chronic cholestasis. No relationships were observed among insufficient macronutrient intake, duration of hospitalization and duration of fasting with nutrition status in children with chronic cholestasis. The high prevalence of malnutrition in children with chronic cholestasis and the causes of malnutrition are varied. Although some causes have no specific treatment, all children with chronic cholestasis should have periodic nutritional evaluation to optimized macronutrient and vitamin intake. Comprehensive management moderate – massive ascites and gastro-intestinal bleeding are important to prevent malnutrition in children with chronic cholestasis."

"Malnutrisi pada anak sakit kritis dalam perawatan intensif menjadi masalah dalam beberapa dekade terakhir dan berhubungan erat dengan morbiditas dan mortalitas. Hingga kini, Rumah Sakit Cipto Mangunkusumo (RSCM) belum memiliki panduan baku mengenai dukungan nutrisi anak sakit kritis. Penelitian bertujuan untuk mengetahui profil pemberian nutrisi enteral (NE) dan waktu pencapaian resting energy expenditure (REE) di Pediatric Intensive Care Unit (PICU) RSCM dan faktor-faktor yang memengaruhi. Penelitian dilakukan secara retrospektif dengan menggunakan data rekam medis anak sakit kritis yang dirawat di PICU RSCM pada tahun 2017-2018. Waktu inisiasi pemberian NE dan pencapaian REE serta faktor-faktor yang memengaruhi pemberian tersebut dicatat dan dilakukan analisis multivariat untuk mencari faktor risiko yang bermakna. Terdapat 203 pasien yang memenuhi kriteria inklusi. Terdapat 120 subyek berjenis kelamin lelaki (59,1%), dengan median usia adalah 35 bulan (rentang usia 1-209 bulan). Kasus bedah terdapat pada 125 subyek (61,6%) dan status gizi normal terdapat pada 87 subyek (42,9%). Prevalensi pemberian NE dini adalah 63,1%, dan pencapaian kalori REE ≤72 jam adalah 67,5%, dengan median 48 jam. Faktor risiko yang menghambat pemberian NE dini adalah pasca-bedah abdomen, penggunaan inotropik, penggunaan ventilator, gejala gastrointestinal sebelum inisiasi, dan status gizi tidak normal dengan odds ratio (OR) 10,89 (IK 95% 4,31-27,50; p=0,009), 4,60 (IK 95% 1,78-11,90; p=0,002), 4,18 (IK 95% 1,56-11,17; p=0,004), 3,40 (IK 95% 1,59-7,29; p=0,002), 2,49 (IK 95% 1,09-5,72; p=0,031). Faktor risiko yang menghambat pencapaian kalori REE ≤72 jam adalah pemberian NE lambat, intoleransi pemberian enteral berupa gejala gastrointestinal dan skor PELOD-2 ≥7 dengan OR 20,62 (IK 95% 6,48-65,65; p=0,000), 14,77 (IK 95% 4,40-49,60; p=0,000), 3,98 (IK 95% 1,01-15,66; p=0,048). Prevalensi pemberian NE dini pada anak sakit kritis di PICU RSCM cukup baik dengan waktu pencapaian REE sesuai dengan target. Faktor terbanyak penghambat pemberian NE dini adalah kondisi pasca-bedah abdomen, sedangkan faktor penghambat pencapaian REE ≤ 72 jam terbanyak adalah pemberian NE lambat.

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Malnutrition of critically ill children remains a major problem that is closely related to high morbidity and mortality in pediatric intensive care unit (PICU) during the last decades. The protocol of nutritional support for critically ill children in Cipto Mangunkusumo Hospital (CMH) has not yet been developed. The study is aimed to evaluate the enteral nutrition (EN) profile, the duration to achieve resting energy expenditure (REE) and number of influencing factors associated with the late EN administration and late REE achievement. The data were collected retrospectively from medical records during the year 2017 to 2018 in PICU CMH. We assessed the timing of EN given and the duration of REE achieved from EN. We performed multivariate analysis to determined significant factors associated with late EN and late REE achievement. Two hundred three subjects were included. One hundred twenty subjects (59%) were boys, with median age of 35 (1-209) months old. One hundred twenty five subjects (61.6%) were post-surgical period and 87 subjects (42.9%) were in good nutritional status. The prevalence of early EN was 63.1%, and REE ≤72 hours was achieved in 67.5% subjects, with the median time was 48 hours. Significant factors inhibit early EN administration were post-abdominal surgery, ventilator use, inotropic use, gastrointestinal symptoms before initiation, and abnormal nutritional status; with OR 10.89 (95% CI 4.31 to 27.50; p=0.009), 4.60 (95% CI 1.78 to 11.90; p=0.002), 4.18 (95% CI 1.56 to 11.17; p=0.004), 3.40 (95% CI 1.59 to 7.29; p=0.002), 2.49, 95% CI 1.09 to 5.72; p=0.031), respectively. While factors inhibit the achievement of REE ≤72 hours were the late EN initiation, enteral intolerance, and PELOD-2 score ≥7 with OR 20.62 (95% CI 6.48 to 65.65; p=0.000), 14.77 (95% CI 4.40 to 49.60; p=0.000), 3.98 (95% CI 1.01 to 15.66; p=0.048), respectively. The prevalence of early EN administration with the duration to achieve REE among critically ill children in the PICU CMH was quite satisfying. The most influencing factor inhibit early EN administration was post-abdominal surgery, while the most significant factor inhibit the achievement of REE ≤72 hours was the late NE administration."

"Latar belakang: Hiperglikemia dan AKI merupakan komorbiditas yang sering dijumpai pada anak sakit kritis. Keduanya berhubungan dengan peningkatan morbiditas dan mortalitas. Hubungan antara hiperglikemia dan AKI pada anak sakit kritis belum banyak diketahui.Tujuan: Diketahuinya perbedaan proporsi AKI pada kelompok anak sakit kritis dengan hiperglikemia dan nonhiperglikemia. Diketahuinya perbedaan rerata kadar gula darah admisi, kadar gula darah puncak, dan durasi hiperglikemia pada kelompok anak sakit kritis dengan AKI dan tanpa AKI.Metode: Penelitian kohort prospektif dilakukan pada anak sakit kritis usia 1 bulan-18 tahun di ruang resusitasi IGD dan perawatan intensif anak RSCM selama bulan Agustus-Desember 2016. Pemeriksaan kadar gula darah, kreatinin serum, dan kadar NGAL urine dilakukan pada saat admisi. Pemantauan kadar gula darah dilakukan dengan interval 2 jam pada kelompok hiperglikemia. Seluruh subyek diikuti sampai keluar ruang perawatan intensif.Hasil: Proporsi subyek anak sakit kritis yang mengalami hiperglikemia adalah 46,5 IK 95 36,8-56,2 . Proporsi subyek dengan hiperglikemia yang mengalami AKI menurut kriteria AKIN adalah 30,7 IK 95 21,8 ndash;39,6 , sedangkan proporsi subyek dengan hiperglikemia yang memiliki kadar NGAL urine >135 ng/mL adalah 21,8 IK 95 13,8 ndash;29,8 . Acute kidney injury menurut kriteria AKIN maupun kadar NGAL urine lebih banyak dijumpai pada subyek dengan hiperglikemia, namun perbedaan proporsi tersebut tidak bermakna secara statistik kriteria AKIN: RR 2,08; IK 95 0,93-4,67; P 0,072; NGAL urine >135 ng/mL: RR 1,34; IK 95 0,81-2,1; P 0,243 . Paparan hiperglikemia pada perawatan intensif dengan durasi ge;4 jam risiko AKI meningkat sebesar 2,38 kali IK 95 1,25 ndash;4,56.Simpulan: Acute kidney injury banyak dijumpai pada anak sakit kritis yang mengalami hiperglikemia. Paparan hiperglikemia ge;4 jam pada perawatan intensif berkaitan dengan peningkatan risiko AKI pada anak sakit kritis.

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Background Hyperglycemia and AKI are common in critically ill children. Both conditions are associated with increasing mortality and morbidity. The association of hyperglycemia and AKI in critically ill children is still not well understood.

Objective To evaluate the difference in proportion of AKI between critically ill children with and without hyperglycemia. To evaluate the mean difference of initial blood glucose, peak blood glucose, and the duration of hyperglycemia between critically ill children with and without AKI.

Method A prospective cohort study was conducted in critically ill children aged 1 month to 18 years at the emergency unit and the pediatric intensive care unit at Cipto Mangunkusumo Hospital between August December 2016. Blood glucose, creatinine serum, and urine NGAL was examined at admission. Blood glucose was monitored every 2 hours in hyperglycemic subjects. All of the subjects were followed until time of discharge from the intensive care unit.

Result Hyperglycemia in critically ill children was found in 46.5 subject 95 CI 36.8 56.2. Acute kidney injury based on the AKIN criteria was found in 30.7 hyperglycemic subjects 95 CI 21,8 ndash 39,6, and hyperglycemia with an increased urine NGAL level 135 ng mL was found in 21.8 subjects 95 CI 13.8 ndash 29.8. Acute kidney injury and an increased urine NGAL were more frequently found in subjects with hyperglycemia, however, the difference in the proportion was statistically insignificant AKIN criteria RR 2,08 95 CI 0,93 4,67 P 0,072 urine NGAL level 135 ng mL RR 1,34 95 CI 0,81 2,1 P 0,243 . The duration of hyperglycemia ge 4 hours at the intensive care unit increases the risk of AKI up to 2.38 times CI 95 1.25 ndash 4.56.

Conclusion Acute kidney injury are frequently seen in hyperglycemic critically ill children. A duration of hyperglycemia of ge 4 hours in intensive care unit is associated with an increased risk of AKI in critically ill children."

"Bayi yang dirawat di unit perawatan intensif sangat mudah terpengaruh oleh lingkungan yang asing dan gangguan terhadap rutinitas harian normal mereka. Bahkan setelah tidak dirawatpun bayi-bayi ini akan menghadapi tantangan baru selama berbulan-bulan bahkan bertahun-tahun setelahnya. Baby liberation merupakan hasil adaptasi dari PICU liberation dan telah diidentifikasi sebagai strategi utama untuk mengurangi morbiditas dan meningkatkan hasil jangka panjang bagi para penyintas PICU. Teori Henderson bersifat fundamental memenuhi 14 kebutuhan dasar individu yang holistik dan komprehensif, teori ini sudah banyak dipakai di berbagai populasi individu namun belum pada ruang perawatan intensif anak. Tujuan penulisan karya ilmiah ini untuk memberikan gambaran aplikasi teori kebutuhan Henderson dalam asuhan keperawatan pada bayi sakit kritis sekaligus melihat efektivitas penerapan Baby Liberation Bundles Care untuk mendukung status fungsional bayi sakit kritis di ruang perawatan intensif anak. Terdapat lima kasus bayi yang mengalami masalah pada pemenuhan kebutuhan dasar dan diberikan asuhan keperawatan melalui pendekatan teori kebutuhan Henderson. Aplikasi teori kebutuhan Henderson cocok digunakan di PICU karena teori ini bersifat holistik dan komprehensif yang terdiri dari sembilan kebutuhan dasar fungsional tubuh dan lima kebutuhan dasar kenyamanan meliputi psikologis, sosial dan spiritual. Penerapan Baby Liberation Bundles Care efektif untuk mendukung status fungsional bayi sakit kritis dan diharapkan intervensi ini dapat diaplikasikan oleh perawat ruangan.

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Babies treated in intensive care units are easily affected by unfamiliar environments and disruptions to their daily normal routines. Even after not being cared for, these babies will face new challenges for months or even years afterward. Baby liberation is an adaptation of PICU liberation and has been identified as a key strategy to reduce morbidity and improve long-term outcomes for PICU survivors. Henderson's theory is fundamental in fulfilling 14 basic individual needs in a holistic and comprehensive manner, this theory has been widely used in various individual populations but not in pediatric intensive care unit yet. The purpose of writing this scientific work is to provide an overview of the application of Henderson's theory of needs in the care of critically ill babies and see the effectiveness of implementing Baby Liberation Bundles Care to support the functional status of critically ill babies in the Pediatric Intensive Care Unit. There were five cases of babies who experienced problems in providing basic needs and were given nursing care using Henderson's needs theory approach. The application of Henderson's needs theory is suitable for use in the PICU because this theory is holistic and comprehensive, consisting of nine basic functional body needs and five basic comfort needs including psychological, social and spiritual. The implementation of Baby Liberation Bundles Care is effective in supporting the functional status of critical babies and it is hoped that this intervention can be implemented by nursing staff."

"Kadar kalium merupakan salah satu biomarker prognostik yang banyak digunakan untuk memprediksi luaran klinis berbagai penyakit. Kadar kalium yang rendah atau hipokalemia berhubungan dengan perlunya pemasangan ventilasi mekanik pada pasien sakit kritis. Berbagai kondisi seperti status nutrisi dan komorbid dapat menyebabkan hipokalemia. Hipokalemia dapat memengaruhi fungsi otot respirasi dan memengaruhi durasi penggunaan ventilasi mekanik. Penelitian ini bertujuan untuk melihat hubungan antara status kalium terhadap kejadian sulit weaning ventilasi mekanik pada pasien sakit kritis di ICU RSCM dan RSUI. Penelitian ini menggunakan desain kohort retrospektif pada subjek berusia ≥18 tahun yang dirawat di ICU RSCM dan RSUI. Diperoleh 52 subjek dengan kelompok yang hipokalemia sebanyak 26 subjek dan kelompok yang normokalemia sebanyak 26 subjek. Rerata usia subjek 49,3±15,1 tahun, jenis kelamin laki-laki 65,4%, status nutrisi berdasarkan indeks massa tubuh (IMT) berat badan normal 34,6%, dan komorbid penyakit keganasan 36,5%. Tidak terdapat hubungan bermakna antara status kalium dengan kejadian sulit weaning ventilasi mekanik selama perawatan di ICU. Sebagian besar subjek yang mengalami hipokalemia tidak mengalami sulit weaning ventilasi mekanik. Penelitian lanjutan diperlukan dengan menggunakan subjek yang lebih banyak dan menganalisis faktor-faktor lain yang dapat memengaruhi kejadian sulit weaning ventilasi mekanik dan status kalium pada pasien sakit kritis yang dirawat di ICU.

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Potassium levels are one of the prognostic biomarkers that are widely used to predict clinical outcomes of various diseases. Low potassium levels or hypokalemia are associated with the need for mechanical ventilation in critically ill patients. Various conditions such as nutritional status and comorbidities can cause hypokalemia. Hypokalemia can affect respiratory muscle function and influence the duration of mechanical ventilation. This study aims to examine the relationship between potassium status and the incidence of mechanical ventilation weaning difficulty in critically ill patients in the ICU at RSCM and RSUI. This study used a retrospective cohort design on subjects aged ≥18 years who were treated in the ICU at RSCM and RSUI. Total 52 subjects obtained, with 26 subjects in the hypokalemia group and 26 subjects in the normokalemia group. The mean age of the subjects was 49.3±15.1 years old, male gender 65.4%, nutritional status based on body mass index (BMI) of normal weight 34.6%, and comorbid of malignant disease 36.5%. There was no significant relationship between potassium status and the incidence of mechanical ventilation weaning difficulty during treatment in the ICU. Most subjects who experienced hypokalemia did not experience mechanical ventilation weaning difficulty. Further research is needed using more subjects and analyzing other factors that may influence the incidence of mechanical ventilation weaning difficulty and potassium status in critically ill patients treated in the ICU."

"Latar belakang : Skor PELOD-2 digunakan untuk mengetahui prognosis disfungsi organ pada anak sakit kritis. Hasil skor PELOD-2 terkadang tidak berbanding lurus dengan luaran perawatan sehingga tidak selalu dapat digunakan sebagai prediktor luaran pasien yang dirawat di PICU. Tujuan : Mengetahui profil dan luaran pasien sakit kritis yang dirawat di PICU RSCM berdasar skor PELOD-2. Metode : Penelitian retrospektif dengan mengambil data rekam medis pasien rawat di PICU RSCM, periode Januari-Desember 2018 secara total sampling. Penilaian skor PELOD-2 pada 24 jam pertama perawatan, komorbid dan luaran subjek dicatat dalam rekam medis. Hasil : Diperoleh 477 subjek yang memenuhi kriteria. Pasien sakit kritis yang dirawat di PICU RSCM sebagian besar berjenis kelamin laki (56,4%) dan berusia <1 tahun (27,9%), dengan bedah sebagai diagnosis terbanyak (65%). Sebagian besar pasien memiliki penyakit kronik (70,4%). Nilai median skor PELOD-2 2 untuk pasien hidup dan median skor 8 untuk pasien meninggal. Angka mortalitas adalah 10,7%. Sebagian besar subjek memiliki lama rawat <7 hari (75,5%). Subjek dengan lama rawat >14 hari memiliki median skor PELOD-2 tiga kali lipat dari subjek dengan lama rawat <7 hari. Subjek meninggal memiliki median skor PELOD-2 empat kali lipat lebih tinggi dari subjek hidup. Adanya luaran mortalitas dan lama rawat subjek yang tidak sesuai dengan skor PELOD-2 kemungkinan dipengaruhi oleh status nutrisi dan status imun. Titik potong mortalitas skor PELOD-2 pada penelitian ini adalah >5, dan titik potong mortalitas skor PELOD-2 pasien sepsis >7. Simpulan : Skor PELOD-2 dapat digunakan untuk memprediksi prognosis disfungsi organ yang mengancam kehidupan pada anak tanpa imunosupresi, semakin tinggi skor PELOD-2 akan diikuti peningkatan lama rawat dan mortalitas.

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Background: PELOD-2 score is stated can be used to discover prognosis of organ dysfunction in critically ill child. Sometimes PELOD-2 score does not always directly proportional to critically ill child s outcome, therefore sometimes can not be used as outcome and mortality predictor. Objective: To describe critically ill patient s profile and outcome of based on PELOD-2 score. Methods: This descriptive study was retrospective, conducted from January to December 2018 in PICU RSCM by total sampling. Evaluation of PELOD-2 score were performed in the first 24 hours. Subjects comorbid and outcome were stated in medical record. Results: There were 477 subjects that fulfilled the criteria. Most of the subjects were boys (56,4%) and under 1 year of age (27,9%) with surgical were the most common diagnosis (65%). Most of the subject have chronic illness as comorbid (70,4%). Median of PELOD-2 score were 2 for subjects that lived and 8 for subjects that died. Mortality rate is 10,7%. Most of the subjects were stayed in PICU for < 7 days (75,5%). Subjects with length of stay >14 days had median PELOD-2 score 3 times higher than the subjects with length of stay <7 days. Died subjects had median PELOD-2 score 4 times higher than the subjects that lived. The subjects mortality and length of stay that not in accordance with the PELOD-2 score may be influenced by subjects nutritional and immunity status. Mortality cut off point for PELOD-2 score in this study is >5. Mortality cut off point for PELOD-2 for subjects with sepsis is >7 Conclusion: PELOD-2 score is feasible to be used to predict life threatening organ dysfunction in critically ill children without immunosuppression, the higher the PELOD-2 score is equal to higher mortality and longer length of stay."

"Ventilator mekanik adalah salah satu alat bantuan hidup yang paling sering digunakan oleh pasien kritis, namun terdapat banyak komplikasi apabila digunakan dengan durasi yang memanjang yaitu lebih dari 14 hari (prolonged mechanical ventilation, PMV), dan dikatakan hanya 50% pasien dengan Ventilator mekanik adalah salah satu alat bantuan hidup yang paling sering digunakan oleh pasien kritis, namun terdapat banyak komplikasi apabila digunakan dengan durasi yang memanjang yaitu lebih dari 14 hari (prolonged mechanical ventilation, PMV), dan dikatakan hanya 50% pasien dengan PMV yang dapat dilakukan ekstubasi. Peningkatan durasi pemakaian ventilator dan lama rawat pada pasien ICU disebabkan antara lain karena berkurangnya sintesis protein dan meningkatnya pemecahan protein otot, sehingga asupan protein dalam jumlah yang tepat dan diberikan sesuai dengan waktu rawat dapat mengurangi waktu lama rawat, durasi pemakaian ventilator dan angka kematian pada pasien kritis. Namun, saat ini prevalensi obesitas meningkat pada sakit kritis dan memengaruhi pemanjangan durasi pemakaian ventilator. Penelitian ini menggunakan desain kohort prospektif pada subjek dengan indeks massa tubuh ≥25 kg/m2, berusia 18-70 tahun, menggunakan ventilator mekanik ≥72 jam, dan dirawat di ICU RSCM dan RSUI. Diperoleh 23 subjek dengan proporsi 65,2% laki-laki dan 34,8% perempuan, dengan rerata usia 51 tahun. Mayoritas subjek penelitian memiliki IMT obesitas derajat 1 (91,3%) dan EOSS kelas 2 (56,5%). Berdasarkan diagnosis awal admisi ICU didominasi oleh sepsis dan pasca pembedahan (14,3%). Subjek penelitian sebagian besar belum dapat memenuhi kebutuhan energi berdasarkan rekomendasi (17,52±5,99 kkal/kgBB/hari). Rerata asupan protein pada penelitian ini masih kurang dari rekomendasi (0,833±0,264 g/kgBB/hari) dan rerata durasi pemakaian ventilator pada penelitian ini cukup panjang (245,35±125,16 jam). Hasil penelitian ini tidak didapatkan hubungan antara rerata asupan protein dengan durasi pemakaian ventilator mekanik. Penelitian lanjutan diperlukan dengan kriteria subjek pada variabel dependen dan independen yang lebih bervariasi dan dengan mempertimbangkan analisis faktor perancu lain yang dapat memengaruhi durasi pemakaian ventilator mekanik.

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Mechanical ventilators are one of the most frequent life-support used in critically ill patients. However, prolonged mechanical ventilation (more than 14 days) can lead to many complications and only 50% of PMV patients being able to be extubated. The increased duration of ventilator and length of ICU stay in patients is partly due to decreased protein synthesis and increased muscle protein breakdown. Therefore, adequate protein intake may reduce length of ICU stay, duration of ventilation, and mortality in critically ill patients. However, the prevalence of obesity in critically ill patients has been increasing and affecting the longer duration of ventilation. This study employed a prospective cohort design on subjects with a body mass index (BMI) of ≥25 kg/m², aged 18-70 years, who used mechanical ventilators for ≥72 hours, and were treated in the ICUs of Dr. Cipto Mangunkusumo Hospital (RSCM) and University of Indonesia Hospital (RSUI). A total of 23 subjects were included, with 65.2% male and 34.8% female, and an average age of 51 years. The majority of study subjects had a BMI obesity grade 1 (91.3%) and EOSS class 2 (56.5%). The initial diagnosis at ICU admission was dominated by sepsis and post-surgery conditions (14.3%). Most subjects in the study could not meet their energy needs (17.52±5.99 kcal/kgBW/day). The average protein intake in this study was still below the recommendation (0.833±0.264 g/kgBW/day) and the average duration of mechanical ventilation was quite long (245.35±125.16 hours). The study did not find a relationship between protein intake and duration of mechanical ventilation. Further research is needed with more varied subject criteria fpr dependent and independent variables, while considering the analysis of other confounding factors that may influence the duration of mechanical ventilator use."