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"[ABSTRAKLatar Belakang: Parameter ektubasi yang ada saat ini masih belum akurat sehingga terjadi kesulitan penyapihan ventilasi mekanis pada pasien pneumonia. Salah satu sistem penilaian untuk diagnosis dan evaluasi pneumonia adalah skor modified clinical pulmonary infection score (MCPIS). Skor ini menilai faktor suhu tubuh, hitung jenis dan jumlah leukosit, volume dan sifat sekret trakea, oksigenasi dan rontgen toraks. Pemantauan MCPIS diharapkan dapat menjadi alat bantu untuk penilaian keberhasilan penyapihan, prediktor ekstubasi, serta gambaran prognosis pasien pneumonia di UPI.Metode: Penelitian ini merupakan studi kohort prospektif pada pasien UPI dengan diagnosis pneumonia dan penggunaan ventilasi mekanis di UPI RSUPN Cipto Mangunkusumo bulan Oktober 2014 sampai Februari 2015. Subjek dengan diagnosis pneumonia yang dirawat di UPI dengan ventilasi mekanis dinilai skor MCPIS pada awal dan setelah 72 jam perawatan. Tanggal pasien diekstubasi dicatat untuk mengetahui lama ventiasi mekanis subjek.Hasil: Sebanyak 48 subjek diikutsertakan dalam penelitian. Skor MCPIS awal (median 6) secara keseluruhan lebih tinggi dari pada skor MCPIS setelah 72 jam (median 5) dengan lama ventilasi mekanis berkisar 3-19 hari (median 7). Tidak didapatkan korelasi yang bermakna antara skor MCPIS awal dengan lama ventilasi mekanis (p=0,180; r=0,197). Terdapat korelasi yang bermakna antara skor MCPIS setelah 72 jam dengan lama ventilasi mekanis dengan kekuatan korelasi sedang dan arah korelasi positif (p=0,000; r=0,539).Simpulan: Terdapat korelasi bermakna antara skor MCPIS setelah 72 jam dengan lama ventilasi mekanis pada pasien pneumonia di UPI.

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ABSTRACTBackground: Extubation parameters that currently used is not accurate hence weaning from mechanical ventilation is difficult to perform in pneumonia patient so a scoring system is needed. One of scoring system for diagnosis and evaluation pneumonia is modified clinical pulmonary infection score (MCPIS) score. This score evaluates temperature, leucocyte count and differential count, volume and consistency tracheal secret, oxygenation and chest x-ray. MCPIS monitoring can be expected as tool for evaluating weaning process, extubation predictor and prognostic prediction for pneumonia patient in ICU.Methode: This is a prospective cohort study in ICU patient with pneumonia diagnosis and mechanical ventilation in Cipto Mangunkusumo hospital's ICU from October 2014 to February 2015. Subject diagnosed with pneumonia in ICU with mechanical ventilation was scored with early and after 72 hours MCPIS score. Date of extubation was recorded to find out mechanical ventilation duration.Result: A total of 48 subjects enrolled in this study. Early MCPIS score (median 6) was higher than MCPIS score after 72 hours (median 5) with mechanical ventilation duration 3-19 days (median 7). There was no significant correlation between early MCPIS score with mechanical ventilation duration (p=0,180; r=0,197). There was significant correlation between MCPIS score after 72 hours with mechanical ventilation duration. The strength of correlation was moderate and the direction of correlation was positive (p=0,000; r=0,539).Conclusion: There was significant correlation between MCPIS after 72 hours with mechanical ventilation duration in pneumonia patient in ICU.;Background: Extubation parameters that currently used is not accurate hence weaning from mechanical ventilation is difficult to perform in pneumonia patient so a scoring system is needed. One of scoring system for diagnosis and evaluation pneumonia is modified clinical pulmonary infection score (MCPIS) score. This score evaluates temperature, leucocyte count and differential count, volume and consistency tracheal secret, oxygenation and chest x-ray. MCPIS monitoring can be expected as tool for evaluating weaning process, extubation predictor and prognostic prediction for pneumonia patient in ICU. Methode: This is a prospective cohort study in ICU patient with pneumonia diagnosis and mechanical ventilation in Cipto Mangunkusumo hospital's ICU from October 2014 to February 2015. Subject diagnosed with pneumonia in ICU with mechanical ventilation was scored with early and after 72 hours MCPIS score. Date of extubation was recorded to find out mechanical ventilation duration. Result: A total of 48 subjects enrolled in this study. Early MCPIS score (median 6) was higher than MCPIS score after 72 hours (median 5) with mechanical ventilation duration 3-19 days (median 7). There was no significant correlation between early MCPIS score with mechanical ventilation duration (p=0,180; r=0,197). There was significant correlation between MCPIS score after 72 hours with mechanical ventilation duration. The strength of correlation was moderate and the direction of correlation was positive (p=0,000; r=0,539). Conclusion: There was significant correlation between MCPIS after 72 hours with mechanical ventilation duration in pneumonia patient in ICU., Background: Extubation parameters that currently used is not accurate hence weaning from mechanical ventilation is difficult to perform in pneumonia patient so a scoring system is needed. One of scoring system for diagnosis and evaluation pneumonia is modified clinical pulmonary infection score (MCPIS) score. This score evaluates temperature, leucocyte count and differential count, volume and consistency tracheal secret, oxygenation and chest x-ray. MCPIS monitoring can be expected as tool for evaluating weaning process, extubation predictor and prognostic prediction for pneumonia patient in ICU. Methode: This is a prospective cohort study in ICU patient with pneumonia diagnosis and mechanical ventilation in Cipto Mangunkusumo hospital's ICU from October 2014 to February 2015. Subject diagnosed with pneumonia in ICU with mechanical ventilation was scored with early and after 72 hours MCPIS score. Date of extubation was recorded to find out mechanical ventilation duration. Result: A total of 48 subjects enrolled in this study. Early MCPIS score (median 6) was higher than MCPIS score after 72 hours (median 5) with mechanical ventilation duration 3-19 days (median 7). There was no significant correlation between early MCPIS score with mechanical ventilation duration (p=0,180; r=0,197). There was significant correlation between MCPIS score after 72 hours with mechanical ventilation duration. The strength of correlation was moderate and the direction of correlation was positive (p=0,000; r=0,539). Conclusion: There was significant correlation between MCPIS after 72 hours with mechanical ventilation duration in pneumonia patient in ICU.]"

"Latar Belakang: Sebanyak 86% pasien dengan administrasi cairan mengalami akumulasi cairan positif hingga menyebabkan 35% dari seluruh pasien ICU tahun 2009-2012 mengalami volume cairan berlebih. Efek terburuk akibat hal ini adalah kegagalan multi sistem organ tubuh. Sehingga, salah satu penanganan volume cairan berlebih adalah intervensi diuresis untuk menyelesaikan masalah fisiologis. Masih belum dibuktikan melalui penelitian mengenai manfaat penyelesaian disfungsi sistem organ dari diuresis furosemid untuk menurunkan balans cairan di saat pasien justru mengalami hipoperfusi organ serta berbagai efek samping dari furosemid tersebut. Tujuan: Atas dasar itu, dilakukan penelitian berupa analisis hubungan antara perubahan status disfungsi sistem organ berdasarkan skor MSOFA dengan penggunaan furosemid, beserta analisis data demografik dan klinik pasien volume cairan berlebih di perawatan intensif. Metode: Desain penelitian merupakan kohort retrospektif dengan pengambilan data dari 194 sampel rekam medik yang didapatkan secara consecutive sampling. Data penggunaan furosemid dan perubahan skor MSOFA pada pasien fluid overload dimasukkan dalam tabel 2x2, kemudian dianalisis menggunakan metode chi square. Hasil: Hasil membuktikan bahwa terdapat hubungan signifikan antara perubahan status disfungsi sistem organ dengan penggunaan furosemid pada pasien perawatan intensif (p<0,05). Nilai risiko relatif menunjukkan bahwa penggunaan furosemide justru menghasilkan nilai MSOFA yang lebih tinggi sebanyak 1,271 kali daripada pasien yang tidak menggunakan furosemide (95% IK 1,108 - 1,458). Diskusi: Penggunaan furosemid memperburuk disfungsi organ berdasarkan skor MSOFA. Hal ini dapat terjadi akibat efek iatrogenik kekurangan balans cairan dan efek samping. Data klinis yang berkorelasi signifikan dan perlu dianalisa lebih lanjut, mencakup: balans cairan sebelum dan sesudah terapi, faktor risiko, dan komponen disfungsi sistem organ.

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Background: Eighty-six percent of patients were administrated with IV Fluid resuscitation had positive fluid accumulation that results in fluid overload in 35% of all ICU patients in 2009-2012. The worst consequence of this situation is multi organs failures. Thus, one of the fluid overload treatment is pharmacological diuresis to solve the physiological problems. Despite of its adverse effects and fluid balance decrement on the hypoperfusion organ, the organ failure resolution of furosemide usage has not been proven through any research. Hence, a research which analyzed the correlation of organ system failure status based on modified sequential organ failure assessment score with furosemide usage on intensive care patient and their demographics data has been conducted.

Method: The research design was a retrospective cohort which analyzed 194 subjects from Cipto Mangunkusumo Hospital ICU medical records selected by consecutive sampling method. Data of furosemide usage and MSOFA Score changes were recorded to the 2x2 table, then they were analyzed by chi square method.

Results: The result proves that there is significant association between worsening organ system failure with furosemide usage on critically ill patients (p<0,05), especially in cardiovascular and central venous system. The relative risk result shows that furosemide usage resulted in higher MSOFA score 1,271 times more than those patients with no furosemide diuresis usage (95% CI 1,108 - 1,458).

Conclusions: The furosemide usage worsens the organ failure based on MSOFA score. These can be resulted by iatrogenic effect of too negative fluid balance and furosemide's adverse effects in the patients. There are clinical data which have significant correlation and can be analysed further, including: fluid balance before and after therapy, risk factors, and organ failure components."