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"Gangguan cairan dan elektrolit merupakan masalah yang sering  mendasari anak dirawat di Gangguan cairan dan elektrolit merupakan masalah yang sering mendasari anak dirawat di ruang perawatan intensif anak dan datang dalam kondisi hipovolemia, sehingga membutuhkkan cairan intravena. Pemberian cairan intravena pada anak agar volume sirkulasi tercapai dan mencegah terjadinya syok. Tujuan Karya Ilmiah Akhir ini yaitu memberikan gambaran asuhan keperawatan pada anak dengan gangguan cairan dan elektrolit dan perawatan CVC menggunakan bundle CVC melalui pendekatan Model Konservasi Levine di ruang perawatan intensif anak. Model Konservasi Levine digambarkan pada 5 kasus anak. Pengkajian berdasarkan 4 prinsip konservasi yaitu konservasi energi, konservasi integritas struktural, konservasi integritas personal, konservasi integritas sosial. Trophicognosis dan hipotesis disusun berdasarkan masalah anak. Kemudian dilakukan intervensi agar anak mampu adaptasi sehingga mencapai keutuhan (wholeness). Model Konservasi Levine efektif dalam memberikan asuhan keperawatan pada anak dengan gangguan cairan dan elektrolit di ruang intensif. Implementasi Evidence Based Nursing menggunakan desain Pra-eksperimen, one group pre-posttest design, dengan besar sampel 20 anak di ruang intensif anak selama bulan Maret-April 2024. Hasil analisis dengan uji Cochran, menunjukkan bahwa setelah dilakukan perawatan CVC menggunakan bundle CVC tidak ada perbedaan bermakna terhadap kejadian infeksi CVC (p-value: 0,321).

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Fluid and electrolyte disorders are common problem which exists in children with hypovolemic under pediatric intensive care unit, so they need intravena fluid. The purpose of giving intravena fluid is to reach the volume circulation and to avoid shock conditions. The purpose of this paper is giving the description of nursing care for children with the case of fluid and electrolyte disorders and CVC care using a CVC bundle through the Levine Conservation Model approach. Levine Conservation Model is described in five pediatric cases. The assessment is based on four principles of conservation, namely energy conservation, structural integrity, personal integrity and social integrity. Trophicognosis and hypothesis is arranged based on pediatric problems. After that, intervention needs to be done so that children are able to adapt  to reach the wholeness. Levine Conservation Model is effective to give nursing care for the pediatric with fluid and electrolyte disorders in the Pediatric Intensive Care Unit. The implementation of Evidence Based Nursing uses Pra-experiment design, one group pre-posttest design, twenty pediatric patients under intensive care unit during March-April 2024. The results of the analysis using the Cochran test showed that after CVC care using the CVC bundle, there was no significant difference in the incidence of CVC infection (p-value: 0.321)."

"Tujuan. Memperjelas gelombang P untuk mempertajam diagnosis aritmia, menggunakan semprit-larutan garam (SLG) sebagai konektor/konduktor elektrode eksplorasi guna merekam elektrogram venasentral (EGV), pada pasien pascabedah jantung terbuka.Tempat. Unit perawatan intensif bedah pada Pusat Kesehatan Jantung Nasional. Subyek. Pasien pascabedah jantung terbuka yang telah dipasangi elektrode epikardial-atrium-kanan dan kateter venasentral.Metode. Kateter venasentral setiap pasien dihubungkan dengan semprit kacalogam 20 ml hydrosalphyngograph-Riester yang berisi larutan NaCl 3% (sempritlarutan garam). Elektrogram atrial (EGA), EGV (SLG) dan elektrokardiogram (EKG) konvensional sandapan dada, direkam secara simultan menggunakan alat elektrokardiograf 3-saluran (V1-2-3). Dua dokter terpisah mengukur tingginya gelombang atrial/P dan 2 kardiolog terpisah membuat diagnosis aritmia. Jika terjadi perbedaan diagnosis aritmia, seorang kardiolog lain bertindak sebagai validator. Dengan titik potong tinggi gelombang (peak to peak) 0,5 mm, EGV (SLG) dan EKG dibandingkan dengan EGA sebagai baku emas.Hasil. Studi populasi yang terdiri dari 192 pasien berturutan pascabedah jantung terbuka dari Juli 1995 sampai Maret 1997 (n = 1997 pasien). Dalam mendeteksi adanya gelombang P berdasarkan EGA sebagai baku emas, EGV (p = 0,5) lebih sensitif (sensitivitas = 98,9%) dibandingkan dengan EKG konvensional (p = 0,001; sensitivitas = 84,2%), terjadi peningkatan sensitivitas sebesar 14,7% (98,9% - 84,2%). Pada diagnosis aritmia, EGV (SLG) lebih sensitif dari EKG (0,995; 98,7% dibandingkan 0,001; 78,5%), terjadi peningkatan sensitivitas sebesar 20,2% (98,7% - 78,5%).Kesimpulan. EGV (SLG) memperjelas gelombang P dan meningkatkan sensitivitas deteksi aritmia pascabedah jantung terbuka.

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Objectives. To enhance P waves in order to improve the diagnosis of arrhythmia, central venous electrogram (CVEG) using salt-solution syringe procedure, as a potential (connector/conductor) exploring lead, was performed in patients who underwent open heart surgery.Setting. Surgical Intensive Care Unit of the National Cardiac CenterSubjects. After open heart surgery patients in whom the epicardial-right-atrial wire electrode and central venous catheter were installed.Methods. The central venous catheter from each patient was connected with a 20-ml hydrosaiphyngograph-Riester glass-metal syringe containing 3% NaCl solution (salt-solution syringe ). Atrial electrogram (AEG), CVEG using salt-solution syringe procedure, and conventional chest lead ECG were recorded simultaneously using 3-channel (V1-2-3) electrocardiograph machine. Two doctors who were blinded in manner analyzed the recorded atrial (P) waves and 2 cardiologist confirmed the diagnosis of arrhythmia from all patients. If a different diagnosis occurred, the other cardiologist would act as validator. With the cut-off point of 0.5 mm, identification of peak to peak P waves in CEVG using salt-solution syringe and ECG were compared with AEG as a gold standard.Results. The study population consisted of 192 cosecutive patients after open heart surgery from July 1995 to March 1997 (n = 1997 patients). In detecting the presence of P wave, comparing to-the AEG as a gold standard, CVEG using salt-solution syringe procedure (p = 0.5) is more sensitive (sensitivity = 98.9%) than conventional ECG (p = 0.001; sensitivity = 84.2%), increases the sensitivity by 14.7% (98.9% - 84.2%). In the diagnosis of arrhythmia, CVEG using salt solution syringe procedure is more sensitive than ECG (0.995; 98.7% vs 0.001; 78.5%), increases the sensitivity by 20,2% (98.7% - 78.5%).Conclusions. CVEG using salt-solution syringe procedure significantly amplifies P waves and improves the sensitivity in detecting arrhythmia after open heart surgery.;Objectives. To enhance P waves in order to improve the diagnosis of arrhythmia, central venous electrogram (CVEG) using salt-solution syringe procedure, as a potential (connector/conductor) exploring lead, was performed in patients who underwent open heart surgery."

"Introduction: Central venous stenosis (CVS) or occlusion is a severe complication in hemodialysis patients, which significantly decreases the patency of all vascular dialysis access components, including arteries and branches, AV anastomosis, peripheral veins, and central veins. The main etiology of CVS is mostly secondary to the placement of temporary or permanent dialysis catheters in the subclavian vein, internal jugular vein, and femoral vein. Standard endovascular therapy for central venous stenosis is conventional balloon angioplasty. Method: This is a retrospective study using medical records from June 2013 to August 2018. Patients who underwent plain old balloon angioplasty (POBA) procedures in the CVS condition due to the installation of hemodialysis catheter access were included in this study. The analysis was performed to assess the characteristics and data distribution of each variable. Results: Significant factors related to the success of endovascular procedure in patients with central venous stenosis with POBA were the onset of clinical symptoms (<3 months; p <0.001), duration of catheter placement (<2.5 months; p <0.001), history of previous catheter placement (no more than once, p <0.001), initial stenosis (<80; p <0.001), and diameter of POBA (≥ 10 mm; p <0.001). Conclusion: Some factors influenced the success of the POBA procedure for overcoming CVS. The need to understanding the use of hemodialysis catheter access according to the guideline is important."

"Since their first application in 1982, Totally Implantable Venous Access Devices (TIVADs) have become increasingly important in the clinical practice, as more intensive chemotherapy and parenteral treatments have come into use. At this time, there is objective evidence that TIVADs are a safe, effective strategy for long-term venous access; they play a significant role throughout the management of the oncology patient, as they are needed in the initial phases for active treatments as well as in the last stages for palliative measures, making possible repeated administration of chemotherapeutic vesicant agents, nutrients, antibiotics, analgesics, and blood products. According to a number of prospective studies, use of TIVADs is associated with a significant complication rate (10% to 25% of all patients). Evidence-based data support that most complications are directly related to inappropriate technique of placement and/or nursing care, sometimes leading to TIVAD loss, significant morbidity, increased duration of hospitalization, and additional medical cost."

"ABSTRAKAbstrakLatar belakang. Penggunaan kateter hemodialisis temporer pada kondisi kronik merupakan faktor risiko terjadinya stenosis vena sentral. Penelitian ini bertujuan untuk mengetahui hubungan penggunaan kateter hemodialisis temporer non-cuffed/non-tunneled double lumen catheter jangka panjang serta faktor risiko lainnya yang berperan dalam terjadinya stenosis vena sentral pada populasi pasien hemodialisis di RSUP dr Cipto Mangunkusumo RSCM .Metode. Dilakukan studi deskriptif analitik dengan desain kasus kontrol pada populasi pasien penyakit ginjal kronis stadium 4-5 yang menjalani hemodialisis di RSCM dan terdiagnosis stenosis vena sentral, baik secara klinis maupun radiologis pada periode tahun 2012-2016 yang dilakukan di Divisi Vaskular dan Endovaskular Departemen Ilmu Bedah FKUI-RSCM mulai bulan Maret 2016 sampai Juli 2016 yang memenuhi kriteria inklusi dan eksklusi. Sumber data diambil dari rekam medik data sekunder dengan mengambil seluruh kasus stenosis vena sentral total sampling dan kontrol dengan perbandingan 1:1 antara kasus dan kontrol. Analisis data berupa analisis univariat, bivariat dan multivariat dan diuji dengan SPSS version 17.0 for Windows. Hasil. Data subjek penelitian yang diperoleh sebanyak 126 subjek 63 kasus dan 63 kontrol . Durasi penggunaan kateter hingga terjadinya stenosis vena sentral rata-rata 469 hari. Stenosis vena sentral paling banyak terjadi pada vena brakiosefalika 36 subjek, 57,14 , vena subklavia 22 subjek, 34,92 dan vena jugularis interna 5 subjek, 7,94 . Dari hasil analisis multivariat, faktor yang berperan dalam terjadinya stenosis vena sentral yaitu penggunaan jenis kateter temporer p = 0,006, OR 5,97, IK 95 1,65 ndash;21,58 , sisi pemasangan kateter di sebelah kiri p = 0,007, OR 10,17, IK 95 2,01 ndash;52,34 dan penggunaan kateter >2 kali p = 0,006, OR 11,15, IK 95 1,65 ndash;51,05 . Simpulan. Penggunaan kateter non-cuffed/non-tunneled terutama pada kondisi kronik >1 minggu yang dipasang pada sisi kiri tubuh dan dengan riwayat >2 kali pemasangan berisiko tinggi menyebabkan terjadinya stenosis vena sentral.

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ABSTRACTBackground The use of temporary hemodialysis catheters in chronic condition is a risk factor for central venous stenosis. This study aims to determine the relationship of temporary hemodialysis catheter use non cuffed non tunneled double lumen catheter in chronic condition as well as other factors that play a role in the occurrence of central venous stenosis in hemodialysis patient population in Dr. Cipto Mangunkusumo Hospital RSCM .Method This was a descriptive analytic study with case control design conducted in the Division of Vascular and Endovascular Surgery Department of the Faculty of Medicine RSCM from March 2016 to July 2016. The study population was patients with stage 4 5 chronic kidney disease undergoing hemodialysis RSCM and diagnosed with central venous stenosis, both clinically and radiologically in the period of 2012 2016, which meet the inclusion and exclusion criteria. Source data were extracted from medical records secondary data by taking all cases of central venous stenosis total sampling and control with the ratio of 1 1 between cases and controls. Analysis of the data was presented in the form of univariate, bivariate and multivariate analysis and tested with SPSS version 17.0 for Windows.Results The data obtained by the research subjects were 126 subjects 63 cases and 63 controls . The average duration of catheter use until the occurrence of central venous stenosis was 469 days. Central venous stenosis is the most common among brachiocephalic vein 36 subjects, 57.14 , the subclavian vein 22 subjects, 34.92 and the internal jugular vein 5 subjects, 7.94 . From the results of the multivariate analysis, the factors that play a role in the occurrence of central venous stenosis were namely the use of temporary catheters p 0.006, OR 5.97, 95 CI 1.65 to 21.58 , catheter implantation on the left side ipsilateral to fistula p 0.007, OR 10.17, 95 CI 2.01 to 52.34 and the use of catheters 2 times p 0.006, OR 11.15, 95 CI 1.65 to 51.05 .Conclusions The use of non cuffed non tunneled catheters especially in chronic condition 1 week which is implanted on the left side of the body ipsilateral to fistula and with a history of 2 times catheter implantations cause central venous stenosis.Keywords central venous stenosis, temporary hemodialysis catheter, vascular access"

"Infeksi merupakan penyebab kematian neonatal tertinggi dengan patogen terbanyak adalah Enterobacteriaceae. Meningkatnya angka resistensi antimikroba membuat penanganan sepsis neonatorum semakin sulit, terutama resistensi terhadap karbapenem sebagai pilihan antibiotik terakhir. Studi ini bertujuan untuk mengetahui profil dan faktor risiko kejadian SNAL karena carbapenem-resistant enterobacteriaceae (CRE). Studi kohort retrospektif dilakukan dengan mengumpulkan data dari rekam medis pasien SNAL dengan kultur darah positif Enterobacteriaceae yang dirawat di RSCM pada bulan Januari 2022 hingga Desember 2023. Pada penelusuran rekam medis didapatkan sebanyak 122 kasus SNAL dengan kultur darah positif Enterobacteriaceae yang diikutkan ke dalam studi ini. Dari seluruh kasus SNAL dengan kultur darah tumbuh Enterobacteriaceae, sebanyak 56,9% kasus merupakan infeksi CRE. Klebsiella pneumoniae CRE yang paling banyak ditemukan (90,1%). Sebanyak 53,5% dari seluruh isolat CRE memenuhi kriteria XDR dan 26,8% dikategorikan sebagai tersangka PDR. Alat medis invasif merupakan satu-satunya variabel yang berhubungan dengan terjadinya SNAL karena CRE dengan OR 3,0 (95% CI 1,3- 7,3). Prevalens SNAL karena CRE dari seluruh infeksi Enterobacteriaceae di RSCM adalah 56,9%. Faktor risiko independen SNAL karena CRE pada studi ini adalah penggunaan alat medis invasif yaitu ventilator dan CVC.

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Infection remains one of the leading causes of neonatal mortality with Enterobacteriaceae being the most common pathogen. The increasing rate of antimicrobial resistance makes neonatal sepsis management more difficult, especially against pathogens resistant to last resort antibiotics such as carbapenems. This research aims to study the risk factors for carbapenem-resistant enterobacteriaceae (CRE) infection in late-onset neonatal sepsis (LONS) cases. A retrospective cohort study was conducted by utilizing data from medical records of SNAL cases with positive blood cultures for Enterobacteriaceae at RSCM from January 2022 to December 2023. One hundred twenty two cases of SNAL with positive blood cultures for Enterobacteriaceae were included in this study. Of all Enterobacteriaceae-related LONS included in this study, 56.9% of cases were due to CRE. Klebsiella pneumoniae was the most frequently identified CRE (90.1%). A total of 53.5% of all CRE isolates met criteria for XDR criteria and 26.8% were categorized as possible PDR. Invasive medical devices were the only variable associated with the occurrence of SNAL due to CRE (OR 3.0 , 95% CI 1,3- 7,3). Conclusion: The prevalence of CRE-related SNAL of all Enterobacteriaceae infections at RSCM is 56.9%. The independent risk factor for CRE-related SNAL in this study was the use of invasive medical devices. "

"Latar Belakang: Akses vaskular sebagai jalur kehidupan pasien gagal ginjal kronik yang menjalani hemodialisis dapat mengalami disfungsi. Stenosis merupakan salah satu penyebab disfungsi akses vaskular yang dapat menurunkan kualitas hemodialisis. Terapi endovaskular seperti angioplasty adalah salah satu solusi efektif untuk mengatasi masalah ini, tetapi tindakan ini memerlukan biaya yang cukup tinggi. Penelitian ini bertujuan untuk mengidentifikasi faktor-faktor yang mempengaruhi keberhasilan tindakan single balloon angioplasty, yang merupakan alternatif dari tindakan angioplasty standar, pada penderita stenosis vena sentral.Metode: Penelitian ini merupakan studi kohort retrospektif analitik yang menilai faktor-faktor yang berpengaruh terhadap keberhasilan tindakan single balloon angioplasty di RSCM, RS Hermina Bekasi, RSUP Fatmawati dan RSUD Tangerang pada periode Januari 2018 sampai Desember 2020. Analisis dilakukan untuk mengidentifikasi hubungan lokasi stenosis, riwayat pemasangan kateter vena sentral, panjang lesi dan stenosis awal dengan keberhasilan tindakan single balloon angioplasty berdasarkan stenosis residual dan adekuasi hemodialisis pascatindakan.Hasil: Terdapat 109 pasien yang diinklusi dalam penelitian ini, dengan rerata usia 55,17±11,51 tahun. Dari jumlah tersebut, 58 subjek (53,2%) adalah laki-laki; 96 subjek (88,1%) memiliki komorbid hipertensi dan 38 subjek (34,9%) menderita komorbid diabetes. Pasien dengan panjang lesi >2 cm memiliki proporsi keberhasilan sebesar 21,1%, lebih rendah dibandingkan kelompok panjang lesi ≤2 cm (78,9%) (p<0,001). Derajat stenosis inisial >80% juga lebih banyak ditemukan memiliki stenosis residual ≥30% (p<0,001). Pasien dengan panjang stenosis ≤2 cm memiliki peluang keberhasilan 5,089 kali (IK 95%, 2,103–12,31) lebih tinggi dibandingkan pasien dengan panjang stenosis >2 cm. Pasien dengan derajat stenosis 50–80% memiliki peluang keberhasilan 31,62 kali (IK 95%, 7,00–142,83) lebih tinggi dibandingkan pasien dengan derajat stenosis inisial >80%. Patensi vena sentral pada 3 bulan pertama didapatkan pada 59 pasien (54,1%) dan berkurang menjadi 28,4% pada bulan ke-6 dan 9,2% pada bulan ke-12.Kesimpulan: Terdapat hubungan antara panjang lesi dan derajat stenosis inisial dengan keberhasilan tindakan single balloon angioplasty

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Background: Vascular access is the lifeline of a hemodialysis patient. Hemodialysis vascular access dysfunction is a major cause of morbidity and mortality in the hemodialysis population. Venous stenosis may result in access dysfunction, which impairs dialysis quality. Endovascular intervention such as angioplasty is an effective solution to treat this condition; however, the cost of this procedure is unacceptably high for most patients.  This study aims to identify factors affecting the success of single balloon angioplasty, which is a modification of standard angioplasty technique, for patients with central venous stenosis.

Methods: This is a retrospective analytic cohort study identifying factors affecting the success rate of single balloon angioplasty procedure in dr. Ciptomangunkusumo, Hermina Bekasi, Fatmawati, and Tangerang General Regional hospitals from January 2018 to December 2020. Statistical analysis was conducted to identify the correlation between stenosis location, previous history of central venous catheter placement, lesion length, and initial stenosis with the success rate of single balloon angioplasty according to residual stenosis and hemodialysis adequacy postoperatively.

Results: There were 109 patients included in this study, with an average age of 55.17±11.51 years. Of the 109 subjects, 58 (53.2%) were men; 96 subjects (88.1%) suffered from chronic hypertension, while 38 were diabetics. Patients with lesion length of >2 cm had a 21.1% lower success rate compared with those with lesion length of ≤2 cm (78.9%) (p<0.001). Patients with an initial stenosis of >80% was more likely to have residual stenosis of ≥30% (p<0,001). Patients with stenosis length of ≤2 cm had a 5.089-times (95% CI, 2.103–12.31) higher success rate compared with those with stenosis length of >2 cm. Patients with a degree of stenosis 50–80% had a 31.62-times (95% CI, 7.00–142.83) higher success rate compared with patients with an initial stenosis of >80%. Central venous was patent in 59 patients (54.1%) in the first 3 month and decreased to 28.4% and 9.2% in the 6th and 12th month, respectively.

Conclusion: Lesion length and the degree of initial stenosis were significantly correlated with the success rate of single balloon angioplasty."

"Latar Belakang : Syok sepsis merupakan kondisi mengancam nyawa dengan beban morbiditas dan mortalitas tinggi terutama di Asia Tenggara. Perencanaan resusitasi cairan yang optimal pada pasien sepsis membutuhkan panduan status hemodinamik tubuh, namun pengukuran Central Venous Pressure (CVP) yang saat ini paling umum digunakan merupakan tindakan invasif dengan segala kekurangannya. Sejumlah penelitian sebelumnya mengajukan pemeriksaan ultrasonografi vena cava inferior (USG IVC) sebagai metode alternatif estimasi status hemodinamik tubuh, namun dengan hasil yang bervariasi. Diskrepansi hasil penelitian sebelumnya dan kurangnya data penelitian pada populasi syok sepsis di Indonesia menunjukkan perlunya ada penelitian lebih lanjut. Tujuan : Penelitian ini bertujuan untuk mengetahui korelasi antara parameter USG IVC berupa diameter, Collapsibility Index (CI), dan velositas maksimal (maxV) terhadap nilai CVP. Metode : Desain penelitian merupakan studi korelasi dengan teknik potong lintang. Data primer didapatkan dari hasil pemeriksaan USG IVC dan CVP menggunakan manometer manual dari sampel pasien syok sepsis yang dirawat di RSUPN Cipto Mangunkusumo dengan waktu penelitian Juli hingga Oktober 2020. Pengukuran diameter, CI, dan maxV dari IVC diambil di regio subxiphoid, dilakukan sendiri oleh peneliti dengan supervisi langsung dari spesialis radiologi konsultan abdomen. Hasil : Didapatkan 27 sampel USG IVC tanpa perbedaan proporsi yang bermakna antar subyek berdasarkan umur dan jenis kelaminnya. Didapatkan korelasi positif sedang antara diameter dengan nilai CVP (r = 0,459, p = 0,016), korelasi negatif sedang antara CI dengan nilai CVP (r = - 0,571, p = 0,002), dan tidak ada korelasi yang bermakna secara statistik antara maxV dengan nilai CVP (r = 0,074, p = 0,715). Kesimpulan : Korelasi bermakna antara diameter dan CI IVC terhadap nilai CVP menunjukkan bahwa pemeriksaan USG IVC dapat digunakan sebagai metode pemeriksaan alternatif non-invasif untuk estimasi nilai CVP dalam perencanaan penatalaksanaan pasien syok sepsis.

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Background : Septic shock is one of life-threatening condition with high morbidity and mortality rate, especially in the South East Asia. Optimal fluid resuscitation planning requires adequate portrayal of hemodynamic status, but the most often used indicator, Central Venous Pressure (CVP), is an invasive procedure with all its drawbacks. Several studies has been done worldwide to propose Inferior Vena Cava Ultrasonography (IVC USG) as an alternative method to estimate hemodynamic status, to varying degree of success. These discrepancies from previous studies, and the lack of data for septic shock population in Indonesia suggests the need for further study.

Objective : This study aims to determine the correlation strength between IVC USG parameters such as diameter, Collapsibility Index (CI), and maximum velocity (maxV) with CVP. Method : The study design is cross-sectional correlation study. Primary data was acquired from IVC USG examination results and CVP values was acquired by manual measurement from septic shock patients in Cipto Mangunkusumo National Central General Hospital (RSUPN CM) from July until October 2020. Measurements of diameter, CI, and maxV were done in the subxiphoid region under direct supervision from abdominal consultant radiologist. Result: In total, 27 samples of IVC USG were acquired without statistically significant difference of proportion across age and gender. Moderate positive correlation were found between diameter and CVP (r = 0,459, p = 0,016). Moderate negative correlation were found between CI and CVP (r = - 0,571, p = 0,002). No statistically significant correlation were found between maxV and CVP (r = 0,074, p = 0,715). Conclusion : Significant correlation between IVC diameter and CI with CVP values implies that IVC USG is an acceptable non-invasive alternative method to estimate CVP values in accordance to septic shock therapy planning."

"Latar belakang: Pemasangan central venous catheter (CVC) adalah prosedur penting untuk pemantauan hemodinamik serta pemberian cairan dan obat-obatan tertentu, namun tingkat komplikasi pada operator kurang berpengalaman masih mencapai 4-12%. Metode Virtual Reality (VR) diharapkan dapat menjadi salah satu metode pembelajaran yang meningkatkan pengetahuan, kepercayaan diri dan kepuasan yang akan dinilai dengan kuesioner . Uji validasi dan reabilitas untuk kuesioner yang dipergunakan pada penelitian pembelajaran metode VR dan konvensional selanjutnya perlu dilakukan.Metodologi: Penelitian ini melibatkan 13 residen anestesi junior yang belum pernah melakukan pemasangan CVC, dibagi menjadi dua kelompok: pembelajaran konvensional dan VR. Pre-test, post-test, serta kuesioner kepercayaan diri dan kepuasan diberikan kepada seluruh peserta.Hasil: Dari total 13 peserta, 7 mengikuti metode VR dan 6 metode konvensional. Kuesioner kepercayaan diri (Cronbach’s alpha 0,944) dan kepuasan metode VR (Cronbach’s alpha 0,953) dinyatakan valid dan reliabel, sementara kuesioner kepuasan metode konvensional (Cronbach’s alpha 0,877) memerlukan evaluasi ulang pada empat pertanyaan. Kuesioner pretest dan posttest (Cronbach’s alpha 0,620) membutuhkan pengujian ulang dengan sampel lebih besar. Kelompok VR menunjukkan hasil lebih baik dinilai dari persentase gain score (52,38% vs 22,61%), kepercayaan diri (81,43% vs. 75,33%), dan kepuasan (85,57% vs. 78%).Kesimpulan: Studi ini menegaskan bahwa kuesioner kepercayaan diri dan kepuasan VR valid dan reliabel. Namun, kuesioner kepuasan konvensional memerlukan re-evaluasi pada empat pertanyaan untuk meningkatkan reliabilitasnya. Kuesioner pre-test dan post-test memerlukan pengujian lebih lanjut dengan jumlah sampel yang lebih besar untuk menjamin validitasnya. Meskipun hasil-hasil penelitian ini mendukung kelanjutan penelitian, mengatasi permasalahan yang teridentifikasi dalam kuesioner sangatlah penting untuk memperkuat metodologi dan hasil penelitian lanjutan.

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Background: Central venous catheter (CVC) insertion is a crucial procedure for hemodynamic monitoring and the administration of specific fluids and medications. However, complication rates among less experienced operators remain at 4-12%, VR learning method. Virtual reality (VR)-based learning methods are expected to enhance knowledge and confidence in performing CVC insertion. The validity and reability of the questionnaires used for further research need to be studied.

Methods: This study involved 13 junior anesthesia residents with no prior experience in CVC placement, divided into two groups: conventional learning and VR-based learning. Pre-tests, post-tests, and questionnaires on confidence and satisfaction were distributed to all participants.

Results: Of the 13 participants, 7 were in the VR group and 6 in the conventional group. The confidence questionnaire (Cronbach’s alpha 0.944) and the VR satisfaction questionnaire (Cronbach’s alpha 0.953) were found to be valid and reliable, while the conventional satisfaction questionnaire (Cronbach’s alpha 0.877) required reevaluation of four questions. The pre-test and post-test questionnaires (Cronbach’s alpha 0.620) also required further testing with a larger sample. The VR group outperformed the conventional group in terms of gain score percentage (52,38% vs 22,61%), confidence (81.43% vs. 75.33%), and satisfaction (85.57% vs. 78%).

Conclusion: The study confirms that the confidence and VR satisfaction questionnaires are valid and reliable. However, the conventional satisfaction questionnaire requires reevaluation of four items to improve its reliability. The pre-test and post-test questionnaires need further testing with a larger sample size to ensure validity. While the results support the continuation of the research, addressing the identified issues in the questionnaires is essential to strengthen the study's methodology and outcomes."

"Background: lactate clearance and central venous oxygen saturation (ScvO2) are two methods for determining tissue oxygenation adequacy. There is a controversy regarding method better associates with and predicts sepsis and septic shock patients’ mortality. This study address the association of achieving one or two targets of microcirculatory resuscitation endpoints and early mortality in sepsis and septic shock. Methods: a cohort study was conducted in adult sepsis and septic shock patients in Intensive Care Unit, Cipto Mangunkusumo Hospital, Indonesia. Patients’ resuscitation endpoints data and outcome were observed during the first 120 hours of hospitalization. Cox’s proportional hazard regression analysis was used to analyse the early mortality risk in subject groups achieving lactate clearance target only, ScvO2 target only, both targets, and not achieving any target in 6 hours after onset of resuscitation adjusted for number of organ dysfunction. Results: subjects consisted of 268 patients. There were significant differences in the mortality risk between subjects who achieved both targets with subjects who achieved ScvO2 target only (adjusted hazard ratio [aHR] 13.47; 95% confidence interval [CI] 5.17-35.08) and subjects who not achieve any target (aHR 16.12; 95%CI 7.43-34.95). There were insignificant difference the early mortality risk between subjects who achieved both targets with subjects achieved lactate clearance target only (aHR 2.29; 95%CI 0.83-6.32). Conclusion: in patients with sepsis and septic shock, achievement of lactate clearance and ScvO2 targets associates with similar early mortality risk compared to achievement of lactate clearance target only. However, it associates with lower early mortality risk compared with ScvO2 target only

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Latar belakang: bersihan laktat dan saturasi oksigen vena sentral (ScvO2) adalah dua metode untuk menentukan kecukupan oksigenasi jaringan. Di antara kedua metode tersebut, terdapat kontroversi metode yang lebih berhubungan dengan dan dapat memprediksi mortalitas pasien sepsis dan renjatan sepsis. Penelitian ini bertujuan untuk menilai hubungan pencapaian target parameter akhir resusitasi mikrosirkulasi dan mortalitas dini pasien sepsis dan renjatan sepsis.

Metode: penelitian ini merupakan studi kohort pada pasien sepsis dan renjatan sepsis dewasa di Unit Perawatan Intensif RS Cipto Mangunkusumo, Indonesia. Data parameter akhir resusitasi dan luaran pasien diamati dalam 120 jam pertama perawatan. Analisis Cox’s proportional hazard regression digunakan untuk menilai risiko mortalitas dini pada kelompok subjek yang mencapai target bersihan laktat saja, target ScvO2 saja, kedua target dan tidak mencapai target apapun dalam 6 jam pertama sesudah awitan resusitasi, dengan penyesuaian terhadap jumlah disfungsi organ.

Hasil: subjek terdiri atas 268 pasien. Terdapat perbedaan risiko mortalitas yang bermakna antara kelompok subjek yang mencapai kedua target dibandingkan kelompok subjek yang mencapai target ScvO2 saja (adjusted hazard ratio [aHR] 13,47; 95% interval kepercayaan [IK] 5,17-35,08) dan yang tidak mencapai target apapun (aHR 16,12; 95% CI 7,43-34,95). Tidak terdapat perbedaan risiko mortalitas yang bermakna antara kelompok subjek yang mencapai kedua target dibandingkan kelompok subjek yang mencapai target laktat saja (aHR 2,29; 95%CI 0,83-6,32).

Kesimpulan: pada pasien sepsis dan renjatan sepsis, pencapaian target bersihan laktat dan ScvO2 berhubungan dengan risiko mortalitas dini yang tidak berbeda dengan dengan pencapaian target bersihan laktat saja, namun berhubungan dengan peningkatan risiko mortalitas dini dibandingkan dengan pencapaian target bersihan ScvO2 saja"