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"Latar Belakang: Anak sakit kritis berisiko mengalami kelebihan cairan akibat terapi cairan inadekuat. Venous excess ultrasound (VExUS), suatu point of care ultrasound (POCUS), dapat digunakan pada kongesti sistemik akibat kelebihan cairan. Terdapat 5 kelas skor VExUS yaitu VExUS A, B, C, D, dan E. Kelebihan cairan pada organ paru dievaluasi dengan lung ultrasound (LUS). Kelebihan cairan sering dihubungkan dengan balans cairan positif. Tujuan: Mengetahui korelasi antara balans cairan positif dengan skor VExUS dan LUS. Metode: Penelitian potong lintang melibatkan anak sakit kritis berusia 1 bulan hingga 18 tahun, mengalami balans cairan positif pada perawatan 24 jam pertama di PICU RSUPN Dr. Cipto Mangunkusumo selama November hingga Desember 2024. Analisis korelasi dilakukan terhadap skor VExUS dan LUS dengan balans cairan positif serta tanda klinis. Hasil: Pada 40 anak sakit kritis, tidak terbukti ada korelasi antara skor VExUS dan LUS dengan balans cairan positif. Hasil tambahan penelitian menunjukkan korelasi antara VExUS A dengan ronki (r=0,367, p=0,020), VExUS B dengan ronki (r=0,367, p=0,020), dan VExUS D dengan edema (r = 0,328, p = 0,039). Simpulan: Skor VExUS dan LUS tidak terbukti berkorelasi dengan balans cairan positif. VExUS A, B, dan D berkorelasi dengan ronki dan edema pada anak sakit kritis dengan kelebihan cairan.

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Background: Critically ill children were at risk of fluid overload due to inadequate fluid therapy. Venous excess ultrasound (VExUS), a point of care ultrasound (POCUS), was used in systemic congestion due to fluid overload. There were 5 classes of VExUS scoring system (VExUS A, B, C, D, and E). Fluid overload in lung can be evaluated by lung ultrasound (LUS). Fluid overload was also referred to positive fluid balance. Objective: To obtain correlation between positive fluid balance with VExUS and LUS score. Methods: Cross section study on critically ill children aged 1 month to 18 years old, with positive fluid balance during first 24 hour admission to PICU RSUPN Dr. Cipto Mangunkusumo, in November to December 2024. Correlation analysis were done between VExUS and LUS score, as well as the clinical signs. Results: Among 40 critically ill children, there were no correlation between VExUS and LUS score with positive fluid balance. Positive correlations were obtained between VExUS A with ronchi (r=0.367, p=0.020), VExUS B with ronchi (r=0.367, p=0.020), VExUS D with edema (r = 0.347, p = 0.028). Conclusion: VExUS and LUS score was not correlated with positive fluid balance. VExUS A, B, dan D scoring system were correlated with ronchi and edema in critically ill children with fluid overload. "

"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."

"Pasien rawat inap ICU sering ditemui dengan keadaan balans cairan akumuatif positif. Hal ini dapat menjadi penanda biologis sekaligus faktor risiko perburukan gagal fungsi organ dan kematian. Untuk itu, koreksi balans cairan utamanya pada pasien dengan urin output berkurang diperlukan. Furosemid merupakan agen diuretik pilihan. Akan tetapi, furosemid dapat menyebabkan abnormalitas elektrolit. Atas dasar itu, dilakukan studi analisis komparatif antara perubahan kadar elektrolit dan pH serum terhadap penggunaan furosemid pada pasien balans cairan akumulatif positif di ICU. Dengan desain penelitian kohort retrospektif, diperoleh 222 sampel rekam medik RSCM melalui metode consecutive sampling. Data penggunaan furosemid dan perubahan kadar elektrolit dan pH serum dimasukkan dalam tabel kemudian dianalisis menggunakan uji T tidak berpasangan. Hasil menunjukkan tidak terdapat perbedaan bermakna pada perubahan kadar elektrolit dan pH serum dengan penggunaan furosemid pada pasien balans positif di ICU (p>0,05). Furosemid dapat menyebabkan penurunan kadar elektrolit dan fluktuasi pH pada pengukuran 0, 24, 48, dan 72 jam pasca pemberian. Hal ini dapat terjadi akibat adanya mekanisme kompensasi tubuh terhadap retensi Na+-K+-Cl- pada urin yang terjadi sebagai efek kerja dari furosemid. Hal ini kemudian dikompensasi dengan retensi H+ yang menyebabkan fluktuasi pada pH. Meskipun demikian, perubahan-perubahan yang terjadi secara statistik tidak berbeda bermakna.

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hospitalized patients are often found with positive accumulative fluid balances. This can be a biological marker as well as a risk factor for worsening organ function failure and death so that correction of fluid balance is necessary. However, as one of preferred diuretic agent, furosemide can cause electrolyte abnormalities. This retrospective cohort study was carried out to analyze difference between serum electrolyte levels and pH changes prior to furosemide usage in patients with positive accumulative fluid balance in intensive care. Data collected from 222 medical records in Cipto Mangunkusumo Hospital obtained by consecutive sampling. The use of furosemide and changes in serum electrolyte levels and pH data were analyzed using independent T-test.

The results show that there are no significance differences between serum electrolyte levels and pH changes prior to furosemide usage (p> 0.05). A decrease in electrolyte levels on 0, 24, 48, and 72 hours after furosemide use measurements can occur due to body's compensation mechanism for urinary Na+-K+-Cl- retention as main effect of furosemide. This plasma electrolyte repletion is compensated by plasma H+ retention and the fluctuation of pH occurred. Even so, changes that occur statistically have no significance."

"Latar Belakang: Ketoasidosis diabetikum (KAD) merupakan salah satu komplikasi akut diabetes mellitus (DM) yang serius dengan tingkat mortalitas yang tinggi. Salah satu terapi yang penting pada KAD ialah resusitasi cairan. Protokol KAD yang ada selama ini menggunakan parameter makrosirkulasi, sedangkan pada KAD juga dapat terjadi disfungsi mikrosirkulasi. Protokol Early Goal Directed Therapy (EGDT) menggunakan parameter mikrosirkulasi untuk menggambarkan keseimbangan suplai dan kebutuhan oksigen jaringan. Penelitian kali ini bertujuan untuk membandingkan keberhasilan resusitasi cairan antara kelompok KAD yang menggunakan protokol konvensional dan protokol EGDT dengan skor MSOFA sebagai parameter keberhasilan tersebut. Metode: Penelitian ini merupakan uji klinis tersamar tunggal dengan randomisasi pada pasien KAD di IGD RSCM pada bulan Desember 2013 sampai Maret 2014. Pasien dibagi menjadi kelompok kontrol dan kelompok EGDT berdasarkan tabel randomisasi, kemudian masing-masing kelompok diresusitasi cairan menggunakan protokol konvensional dan protokol EGDT. Kedua kelompok mendapatkan terapi KAD lainnya yang sama. Skor MSOFA dihitung pada jam ke-0, jam ke-6 dan jam ke-72 perawatan. Hasil: Sebanyak 26 subjek diikutsertakan dalam penelitian ini, dengan 13 subjek di masing-masing kelompok. Tidak didapatkan perbedaan skor MSOFA yang bermakna diantara kedua kelompok pada jam ke-6 dan jam ke-72, namun berdasarkan sebarannya, skor MSOFA di kelompok EGDT lebih menurun dibandingkan kelompok kontrol. Tidak terdapat perbedaan tingkat mortalitas selama 28 hari di kedua kelompok (RR 0,333; IK 95% 0,04-2,801; p = 0,593).

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Background: Diabetic ketoacidosis (DKA) is one of the serious complication of diabetes mellitus (DM) with high mortality rate . One important therapy in DKA is fluid resuscitation. DKA protocol that recently used, is guided by macrocirculation parameters, whereas microcirculation dysfunction can occur in DKA. Early Goal Directed Therapy Protocol (EGDT) uses microcirculation parameters to describe the balance of tissue oxygen supply and demand. The aim of this study aimed to compare the success of DKA fluid resuscitation between the groups using conventional protocols and EGDT protocol with MSOFA score as the parameter.

Methods: This study was a single-blind randomized clinical trial of DKA patients in the Emergency Room of Ciptomangunkusumo Hospital from December 2013 to March 2014. Patients were divided into control and EGDT group based on computerized randomization, then each group was resuscitated using a conventional and EGDT protocol. Both groups received the same other DKA treatment. MSOFA score is calculated at the beginning of this study, 6th hour and 72nd hour.

Results: A total of 26 subjects enrolled in this study, with 13 subjects in each group. There were no significant differences between the two groups in the 6th and 72nd hour, but based on the distribution, MSOFA score in EGDT group was more decreased compared to the control group. There were no significant differences of the mortality within 28 days between two groups (RR 0.333; 95 % CI 0.04- 2.801, p = 0.593)."

"Emergency Ultrasound is firmly established as the first state-of-the-art reference on the training, techniques, and diagnostic skills needed to perform successful ultrasound exams in the emergency department. Utilizing a templated chapter format, this trusted resource presents a wide range of detailed guidelines on performing ultrasound exams, case studies, and side-by-side comparisons of normal and abnormal scans.Emergency Ultrasound, Second Edition, is fully updated and expanded to include the latest uses of this crucial diagnostic tool, including Doppler Ultrasound for deep vein thrombosis. This groundbreaking text is the one you'll rely on for every kind of diagnosis in the emergency setting, from soft tissue infections and peritonsillar abscess, to foreign bodies and lumbar puncture and arthrocentesis."

"Sakit kritis merupakan suatu kondisi terjadinya gangguan fungsi multiorgan yang menyebabkan homeostasis tubuh tidak dapat dipertahankan tanpa adanya intervensi medis di unit perawatan intensif. Proses hiperkatabolik akibat stres metabolik pada pasien sakit kritis terutama di fase akut sangat tinggi sehingga menyebabkan degradasi protein. Tingkat degradasi ini dapat dilihat salah satunya dengan pemeriksaan kehilangan nitrogen melalui urin 24 jam. Asupan energi dan protein berperan penting dalam memelihara proses metabolisme yang terjadi. Asupan yang tidak adekuat diiringi kehilangan protein yang tinggi akan menghasilkan nilai imbang nitrogen yang negatif. Tujuan penelitian ini untuk melihat korelasi asupan protein selama fase akut terhadap perubahan imbang nitrogen yang dinilai pada hari ke-3 dan ke-7 perawatan. Metode penelitian ini menggunakan desain potong lintang yang dilakukan di Intensive Care Unit Rumah Sakit Universitas Indonesia (ICU RSUI) dengan pengambilan sampel secara consecutive sampling. Kriteria penerimaan adalah berusia 18-60 tahun, mendapatkan asupan protein pertama dalam 48 jam, dan bersedia mengikuti penelitian. Kriteria penolakan adalah produksi urin <0.5 ml/kgBB/jam, gangguan fungsi ginjal dan hati kronis, IMT <18.5 atau ≥30 kg/m², skor APACHE II>30, hamil, dan mendapat norepinefrin >0.3 mcg. Kriteria pengeluaran adalah mendapatkan rerata asupan protein hari ke-3 hingga ke-7 <0.5gr/kgBB/hari, dan meninggal sebelum hari ke-7. Pemeriksaan kadar nitrogen urea urin 24 jam dan perhitungan imbang nitrogen dinilai pada hari ke-3 dan ke-7 perawatan. Hasil penelitian menunjukkan rerata asupan protein dan energi pada 21 subyek adalah 0.8 gr/kgBB/hari dan 78% dari EE pada hari ke-3, lalu rerata asupan pada hari ke-7 adalah 1.1 gr/kgBB/hari dan 110% dari EE. Rerata kadar NUU dan imbang nitrogen hari ke-3 adalah 8.1 gr dan -5.3 gr. Rerata kadar NUU dan imbang nitrogen hari ke-7 adalah 7.2 gr dan -1.5 gr. Rerata perubahan imbang nitrogen bernilai positif yaitu 3.8 gr. Terdapat korelasi positif antara asupan energi maupun protein terhadap imbang nitrogen hari ke-3 (r=0.5, p=0.01; r=0.6, p=0.003). Walaupun terdapat perbaikan imbang nitrogen yang signifikan pada subyek penelitian namun tidak didapatkan korelasi bermakna antara asupan protein terhadap perubahan imbang nitrogen (p=0.1). Kesimpulan penelitian ini adalah asupan energi dan protein berkorelasi positif dengan imbang nitrogen pada early acute phase. Asupan protein pada late acute phase tidak berhubungan dengan perubahan imbang nitrogen pada penelitian ini

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Critical illness is a condition where multiorgan dysfunction occurs which causes body homeostasis that cannot be maintained without medical intervention in the intensive care unit. The hypercatabolic process due to metabolic stress in critically ill patients, especially in the acute phase, is very high, causing protein degradation. This level of degradation can be evaluated by examining nitrogen loss through 24-hour urine. Energy and protein intake plays an important role in maintaining the metabolic processes. Inadequate intake accompanied by high protein losses will result in negative nitrogen balance values. The aim of this study was to analyze the correlation of protein intake during the acute phase with nitrogen balance changes on days 3 and 7 of treatment. The method of this study was cross-sectional with consecutive sampling, conducted in the Intensive Care Unit of the University of Indonesia Hospital (ICU RSUI). Inclusion criteria were 18-60 years old, getting their first protein intake within 48 hours, and willing to take part in the research. Exclusion criteria were urine output <0.5 ml/kgBW/hour, chronic kidney and liver function disorders, BMI <18.5 or ≥30 kg/m2, APACHE II score>30, pregnancy, and receiving norepinephrine >0.3 mcg. Drop out criteria were patients having an average protein intake on days 3 to 7 <0.5 gr/kgBW/day, or dying before the 7^th day. Examination of 24-hour urine urea nitrogen (UUN) levels and calculation of nitrogen balance were assessed on days 3 and 7 of treatment. The results of the study showed that the mean of protein and energy intake in the 21 subjects was 0.8 gr/kgBW/day and 78% of EE on day 3, then the mean intake on day 7 was 1.1 gr/kgBW/day and 110% of EE. The mean ​​of UUN levels and nitrogen balance on day 3 were 8.1 gr and -5.3 gr. The mean of UUN levels and nitrogen balance on day 7 were 7.2 gr and -1.5 gr. Mean of nitrogen balance changes was positive, namely 3.8 gr. There was a positive correlation between energy and protein intake with nitrogen balance on day 3 (r=0.5, p=0.01; r=0.6, p=0.003). Although there was a significant improvement in nitrogen balance in the research subjects, there was no significant correlation between protein intake with nitrogen balance changes (p=0.1). The conclusion of this study is that energy and protein intake were positively correlated with nitrogen balance in the early acute phase. Protein intake in the late acute phase was not associated with nitrogen balance changes in this study."

"ABSTRAKPneumonia merupakan peradangan pada parenkim paru yang sering terjadi pada masaanak-anak dan masa bayi. Peradangan tersebut menyebabkan sputum terkumpul diparu, yang membuat sulit untuk bernafas. Salah satu cara untuk mengeluarkansputum adalah CPT. Tujuan dari penelitian ini adalah untuk mengetahui pengaruhchest physiotherapy (CPT) terhadap status pernafasan anak balita pnemonia. Desainpenilitan ini menggunakan quasi eksperiment post test only dengan grup kontrol.Hasil penelitian menunjukkan bahwa ada pengaruh CPT terhadap suara nafas (pvalue= 0,008), retraksi dada (p value= 0,008), frekuensi pernafasan (p value= 0,001)dan saturasi oksigen (p value= 0,01) pada balita. Penelitian ini merekomendasikanCPT sebagai intervensi keperawatan untuk memperbaiki status pernafasan anak.

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ABSTRACTPneumonia is an inflammantory condition of the lung. Child and infant included agroup that have risk to get pneumoni. The inflammantion causes pulmonary sputumcollection and this make difficult to breath. One of the ways to take out the sputum isby doing chest physiotherapy (CPT). The purpose of this research was to find out theeffect of chest physiotherapy (CPT) toward respiratory status of children pnemonia.Design of this study used quasi eksperiment post test only non equivalent group. Theresult of the study showed there was significant effect of CPT againts breath sounds(p value= 0,008), chest retraction (p value= 0,008), respiratory rate (p value= 0,001)and oxygen saturation (p value= 0,010) on children. This research recommend CPTas a nursing intervention to recover children respiratory status."

"Praise for the previous edition: Remarkable, richly illustrated textbook ... enriched by numerous demonstrative illustrations ... the quality of all the 2397 illustrations is an iconographic achievement. Practically no criticism can be raised for this most remarkable book, which one expects will have a wide diffusion. -- Clinical Imaging Differential Diagnosis in Ultrasound Imaging, Second Edition, is a complete revision and extension of this best-selling Thieme title, bringing it up to date with the very latest clinical and technological standards. With a specific focus on general abdominal.This book focuses on general abdominal, genitourinary, and thyroid pathologies to guide readers through the process of sonographic differential diagnosis."

"His 2nd edition of the Practical Guide to Emergency Ultrasound addresses your need for a practical, comprehensive, how-to book on ultrasound techniques in the emergency department, including new and expanded applications. Organized in an easy-to-navigate problem-based and symptom-based approach, chapters cover many uses for ultrasound in the ED and proper ultrasound technique. Over 900 images, many in full color, illustrate key concepts and diagnoses, including the use of echocardiography in the ED and newer applications for imaging ocular, musculoskeletal injuries and the use of ultrasound in the management of undifferentiated hypotension and dyspnea. Chapters on newer applications of ultrasound including thoracic, inferior vena cava, musculoskeletal, and ocular imaging; newer and evolving applications for procedural guidance, including nerve blocks; new and highlighted content for Pediatric applications; and chapters on prehospital use, and use in resource-limited settings. Entire section focusing on Ultrasound use in the Resuscitation of Acute Injury or Illness. Over 900 images demonstrate key diagnoses and proper ultrasound technique. Over 175 online video clips that display more realistic three-dimensional views. More than 60 additional online-only images for several chapters."