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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. "

"Anak dengan kondisi penyakit kritis yang bertahan di ruang Pediatric Intensive Care Unit (PICU) berisiko mengalami immobilitas karena kondisi penyakit dan penggunaan alat bantu napas yang cukup lama. Mobilisasi dini merupakan salah satu cara yang efektif dan aman untuk mengurangi komplikasi akibat immobilisasi yang lama. Tujuan studi kasus ini adalah untuk memberikan gambaran asuhan keperawatan berdasarkan Model Konservasi Levine pada anak yang mengalami gangguan mobilitas fisik. Model konservasi Levine digambarkan pada 5 kasus pasien anak. Pengkajian dilakukan berdasarkan 4 jenis konservasi Levine yaitu konservasi energi, integritas struktural, personal dan sosial. Tropikognosis, hipotesis dan intervensi ditujukan untuk mencapai adaptasi serta membuat pasien mencapai keutuhan dalam menjalani proses perawatan di rumah sakit. Model Konservasi Levine direkomendasikan dalam memberikan asuhan keperawatan pada anak dengan gangguan mobilitas fisik.

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Children with critical illness condition who survive in Pediatric Intensive Care Unit (PICU) are at risk of immobility due to the disease condition and the use of long breathing aids. Early mobilization is an effective and safe way to reduce complication due to prolonged immobilization. The purpose of this case study is to provide an overview of the application of Levine Conservation Model in children who are at risk of physical mobility barriers and the development of an early mobilization protocol at PICU. Levine Conservation Model was described in five cases of pediatric patients. The assesment is base on four types of Levine conservation there are energy conservation, structural integrity, personal and social. Tropicognosis, hypotheses and interventions are aimed at achieving adaptation and making patients achieve integrity in undergoing the hospital treatment process. Levine conservation model is recommended in providing nursing care to children with risk of impaired physical mobility. "

"Latar belakang: Skor MSOFA telah dikembangkan sebagai critical care triage pada rumah sakit dengan sumber daya terbatas. Di Indonesia telah diteliti performa MSOFA sebagai prediktor mortalitas terhadap pasien penyakit kritis namun terbatas pada pasien bedah. Hasil evaluasi prediksi mortalitas MSOFA menunjukkan kemampuan prediksi mortalitas yang cenderung rendah. Penambahan variabel lain pada skor MSOFA untuk meningkatkan prediksi mortalitas perlu diteliti lebih lanjut. Hiperglikemia pada penyakit kritis tanpa riwayat diabetes melitus (hiperglikemia akibat stres) berdasarkan penelitian merupakan faktor risiko independen terhadap mortalitas.Tujuan: Melakukan validasi MSOFA serta nilai tambah kadar glukosa darah sebagai prediktor mortalitas pasien penyakit kritis tanpa riwayat diabetes melitus.Metode penelitian: Penelitian prospektif kohort pada pasien penyakit kritis medis maupun bedah di RSUPN Cipto Mangunkusumo selama periode Agustus hingga Desember 2013. Pasien dilakukan anamnesis, pemeriksaan fisik, saturasi oksigen perifer, glasgow coma scale, pemeriksaan laboratorium kadar kreatinin, pemeriksaan glukosa darah sewaktu serta A1C dalam 24 jam pertama perawatan. Outcome penelitian ini adalah mortalitas dalam 28 hari. Analisis statistik menggunakan tes Hosmer-Lemeshow, plot kalibrasi serta kurva ROC.Hasil: Subjek penelitian sebanyak 150 pasien. Mortalitas terjadi pada 52 pasien (34,67%) dengan sepsis sebagai masalah terbanyak. Kalibrasi MSOFA menunjukkan Hosmer-Lemeshow x2=13,748(p=0,056). Diskriminasi MSOFA menunjukkan AUC 0,83 (IK 95% 0,76-0,89). Hiperglikemia terjadi pada 79 pasien (52,67%). Penambahan kadar glukosa darah pada MSOFA tidak menunjukkan peningkatan AUC.Simpulan: Validasi MSOFA menunjukkan kalibrasi dan diskriminasi yang baik pada pasien penyakit kritis baik medis maupun bedah. Penambahan kadar glukosa darah pada skor MSOFA tidak meningkatkan kemampuan prediksi mortalitas.

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Background: MSOFA, a simple scoring system, has been developed as a critical care triage in centers with limited resources. Previous study have evaluated MSOFA’s performance but limited only in surgical critically ill patients which showed a low precision in predicting mortality. Addition of another variable to improve MSOFA’s performance merits further investigation. Hyperglycemia in critically ill patients without previous history of diabetes (stress hyperglycemia) has been shown to be an independent risk factor of mortality.

Objective: to evaluate MSOFA scoring system’s performance and addition of admission blood glucose test to predict mortality in critically ill patient without previous history of diabetes.

Methods: This was a prospective cohort study recruiting medical and surgical critically ill patients admitted to Cipto Mangunkusomo Hospital during a period of August to December 2013. History taking, physical examination, peripheral oxygen saturation, Glasgow Coma Scale, creatinine, blood glucose and A1C were obtained within 24 hour of admission. The outcome was mortality within 28 days. Performance of MSOFA was evaluated with the Hosmer-Lemeshow goodness of fit test and measuring the AUC.

Results: 150 patients completed the study protocols. Mortality was observed in 52 patients (34,67%) with sepsis being the most prevalent diagnosis. Calibration of MSOFA showed a Hosmer-Lemeshow test x2=13.748 (p = 0.056). Receiver Operating Curve (ROC) of MSOFA showed an AUC of 0,83 (95% CI 0,76-0,89). Stress hyperglycemia was evident in 79 patients (52,67%) recruited in this study. Addition of blood glucose to MSOFA scoring system did not show improvement in MSOFA’s performance.

Conclusion: We have validated MSOFA in this study which showed good calibration and discrimination in both medical and surgical critically ill patients. Adding blood glucose to MSOFA scoring system did not improve MSOFA’s performance."

"Latar Belakang: Jumlah pasien penyakit kritis semakin meningkat dengan mortalitas yang cukup tinggi, sehingga diperlukan model prediksi yang memiliki performa yang baik untuk memprediksi mortalitas. MSOFA adalah salah satu sistem skor yang dapat memprediksi mortalitas 28 hari. Walaupun validasi MSOFA menunjukkan hasil yang baik di berbagai negara, masih diperlukan untuk melakukan validasi di Indonesia dan mencari parameter lain untuk meningkatkan ketepatan prediksi mortalitas. Kadar magnesium darah perlu diperhitungkan penggunaannya dalam memprediksi mortalitas terutama jika ditambahkan pada skor MSOFA. Tujuan: Menilai performa kalibrasi dan diskriminasi MSOFA serta nilai tambah kadar magnesium total dalam memprediksi mortalitas pasien penyakit kritis medis di Unit Perawatan Intensif Rumah Sakit Umum Pusat Rujukan Nasional Cipto Mangunkusumo (UPI RSUPNCM). Metode: Penelitian ini merupakan studi kohort prospektif dengan subjek penelitian pasien penyakit kritis medis yang dirawat di UPI RSUPNCM pada periode April-Juli 2013. Hasil pemeriksaan fisik, Glasgow Coma Scale, saturasi oksigen perifer, serum kreatinin dan magnesium dinilai saat pasien masuk ke UPI. Outcome dinilai saat pasien mencapai hari ke 28 setelah hari perawatan pertama. Performa kalibrasi dinilai dengan plot kalibrasi dan uji Hosmer-Lemeshow. Performa diskriminasi dinilai dengan area under the curve (AUC). Kemampuan prediksi skor MSOFA bersama magnesium ditentukan dengan ROC dari nilai predicted probability terhadap mortalitas. Hasil: Sebanyak 150 pasien diikutsertakan dalam penelitian dengan angka mortalitas 33,3%. Plot kalibrasi MSOFA menunjukkan koefisien korelasi r = 0,7 dan uji Hosmer-Lemeshow menunjukkan p = 0,08. Performa diskriminasi ditunjukkan dengan nilai AUC 0,83 (IK 95% 0,76-0,90). Kadar magnesium darah tidak memiliki nilai tambah terhadap MSOFA dalam memprediksi mortalitas pasien penyakit kritis. Simpulan: MSOFA memiliki performa kalibrasi dan diskriminasi yang baik dan kadar magnesium darah tidak memiliki nilai tambah terhadap MSOFA dalam memprediksi mortalitas pasien penyakit kritis.

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Background: Critically ill patients are increasing in number with high mortality rate and good performance of prediction model is needed to predict mortality. MSOFA is one of the scoring systems which can predict 28 days mortality. MSOFA has showed a good validation in many patients abroad, yet still need to be tested in Indonesia and improving its performance. Total magnesium serum can be used as an added value to improve MSOFA performance.

Objective: To evaluate calibration and discrimination of MSOFA and magnesium as an added value to predict mortality in critically ill patients.

Methods: This is a prospective cohort study of medical critically ill patient who admitted to Intensive Care Cipto Mangunkusumo Hospital. Physical examination, Glasgow Coma Scale, peripheral oxygen saturation, creatinine and magnesium serum were obtained when the patient was admitted at ICU. Outcome was assessed when patients have reached 28 days after the first day of admission. Calibration was evaluated calibration plot and Hosmer-Lemeshow test. Discrimination was evaluated with area under the curve (AUC). Prediction performance of MSOFA and magnesium were evaluated with ROC curve.

Results: 150 patients was submitted to this study with mortality rate 33,3%. Calibration plot of MSOFA showed r = 0,7 and Hosmer-Lemeshow test showed p = 0,08. Discrimination was shown by ROC curve with AUC 0,83 (CI 95% 0,76-0,90). Magnesium total serum has no added value to MSOFA as a mortality predictor in critically ill patients.

Conclusion: MSOFA has good callibration and discrimination performance, and magnesium blood level has no added value to MSOFA for predicting mortality in critically ill patients."