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Marpaung, Madeline F.N.
"[ABSTRAK
Latar belakang. Penyuntikan berulang pada prosedur anestesia spinal berkaitan dengan tingginya angka komplikasi dan ketidaknyamanan pasien. Sistem prediksi praoperatif yang akurat terhadap kemungkinan kesulitan penempatan jarum spinal dapat membantu mengurangi insiden penyuntikan berulang sehingga mengurangi risiko komplikasi terhadap pasien. Penelitian ini bertujuan untuk mengetahui ketepatan prediksi kesulitan penempatan jarum spinal berdasarkan gambaran radiologis dan penanda anatomis pada pasien bedah urologi.
Metode. Penelitian ini bersifat observasional analitik terhadap pasien bedah urologi yang menjalani anestesia spinal di Rumah Sakit Cipto Mangunkusumo pada bulan April sampai Mei 2015. Sebanyak 109 subyek diambil dengan metode consecutive sampling. Data pasien (usia, jenis kelamin, indeks massa tubuh, status fisik, gambaran radiologis vertebrae lumbal, dan kualitas penanda anatomis tulang belakang), jumlah penusukan kulit dan redireksi jarum spinal, serta angka kesulitan penempatan jarum spinal dicatat. Kesulitan penempatan jarum spinal ditentukan berdasarkan jumlah penusukan kulit dan redireksi jarum spinal. Variabel yang signifikan ditentukan melalui uji Pearson?s Chi-square dan uji Fisher, kemudian analisis multivariat dengan metode regresi logistik digunakan untuk melihat hubungan antara kesulitan penempatan jarum spinal dengan variabel-variabel yang signifikan.
Hasil. Faktor usia memiliki hubungan yang bermakna hanya pada analisis bivariat (p=0,028). Kualitas penanda anatomis dan gambaran radiologis vertebrae lumbal memiliki nilai prediksi terhadap kesulitan penempatan jarum spinal (p=0,000 dan p=0,006). Hasil uji kalibrasi menunjukkan kualitas prediksi yang baik. Dari uji diskriminasi didapatkan AUC sebesar 0,84 (IK 95% 0,751-0,929).
Simpulan. Kualitas penanda anatomis dan gambaran radiologis vertebrae lumbal mampu memprediksi kesulitan penempatan jarum spinal dengan tepat pada pasien bedah urologi. ABSTRACT Background. Multiple attempts at spinal puncture have been related to many complications and patient discomfort. Accurate preoperative prediction of spinal needle insertion difficulty would reduce the incidence of multiple puncture and minimize the complications consequently. This study was designed to determine the accuracy of lumbar vertebrae radiological characteristics and spinal bony landmark quality in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure.
Methods. This was an analytic observational study in urologic patients scheduled for spinal anesthesia at Cipto Mangunkusumo hospital between April and May 2015. A total of 109 subjects were included in the study by consecutive sampling. Patient data (age, sex, body mass index, physical status, radiological characteristics of the lumbar vertebrae, and quality of spinal bony landmark), number of skin puncture and needle redirection, and the prevalence of spinal needle insertion difficulty were recorded. The first skin puncture success and number of needle redirection were used to assess the difficulty. Significant variables were first determined by Pearson?s Chi-square and Fisher test, and then multivariate analysis using logistic regression method tested the association of the skin puncture success and number of needle redirection with the significant variables.
Results. Age was significant only in bivariate analysis (p=0,028). The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae had predictive value on spinal needle insertion difficulty (p=0,000 and p=0,006 respectively). Calibration test showed that the prediction quality was good. The discrimination test resluted in AUC of 0,84 (CI 95% 0,751 to 0,929).
Conclusion. The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae were accurate in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure. ;Background. Multiple attempts at spinal puncture have been related to many complications and patient discomfort. Accurate preoperative prediction of spinal needle insertion difficulty would reduce the incidence of multiple puncture and minimize the complications consequently. This study was designed to determine the accuracy of lumbar vertebrae radiological characteristics and spinal bony landmark quality in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure.
Methods. This was an analytic observational study in urologic patients scheduled for spinal anesthesia at Cipto Mangunkusumo hospital between April and May 2015. A total of 109 subjects were included in the study by consecutive sampling. Patient data (age, sex, body mass index, physical status, radiological characteristics of the lumbar vertebrae, and quality of spinal bony landmark), number of skin puncture and needle redirection, and the prevalence of spinal needle insertion difficulty were recorded. The first skin puncture success and number of needle redirection were used to assess the difficulty. Significant variables were first determined by Pearson?s Chi-square and Fisher test, and then multivariate analysis using logistic regression method tested the association of the skin puncture success and number of needle redirection with the significant variables.
Results. Age was significant only in bivariate analysis (p=0,028). The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae had predictive value on spinal needle insertion difficulty (p=0,000 and p=0,006 respectively). Calibration test showed that the prediction quality was good. The discrimination test resluted in AUC of 0,84 (CI 95% 0,751 to 0,929).
Conclusion. The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae were accurate in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure. , Background. Multiple attempts at spinal puncture have been related to many complications and patient discomfort. Accurate preoperative prediction of spinal needle insertion difficulty would reduce the incidence of multiple puncture and minimize the complications consequently. This study was designed to determine the accuracy of lumbar vertebrae radiological characteristics and spinal bony landmark quality in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure.
Methods. This was an analytic observational study in urologic patients scheduled for spinal anesthesia at Cipto Mangunkusumo hospital between April and May 2015. A total of 109 subjects were included in the study by consecutive sampling. Patient data (age, sex, body mass index, physical status, radiological characteristics of the lumbar vertebrae, and quality of spinal bony landmark), number of skin puncture and needle redirection, and the prevalence of spinal needle insertion difficulty were recorded. The first skin puncture success and number of needle redirection were used to assess the difficulty. Significant variables were first determined by Pearson’s Chi-square and Fisher test, and then multivariate analysis using logistic regression method tested the association of the skin puncture success and number of needle redirection with the significant variables.
Results. Age was significant only in bivariate analysis (p=0,028). The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae had predictive value on spinal needle insertion difficulty (p=0,000 and p=0,006 respectively). Calibration test showed that the prediction quality was good. The discrimination test resluted in AUC of 0,84 (CI 95% 0,751 to 0,929).
Conclusion. The quality of spinal bony landmark and the radiological characteristics of the lumbar vertebrae were accurate in predicting the difficulty of spinal needle insertion in patients undergoing urologic procedure. ]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Ulya Amanina
"Pendahuluan: Perdarahan intraoperatif menjadi penyebab utama terjadi henti jantung di ruang operasi. Perdarahan dapat ditangani dengan pemberian transfusi. Pemberian transfusi berisiko menyebabkan infeksi dan reaksi alergi sehingga tidak semua pasien dengan perdarahan diberikan transfusi. Jumlah transfusi dapat dipengaruhi oleh berbagai faktor seperti kadar Hb praoperasi, jumlah perdarahan, gangguan hemodinamik serta perkiraan allowable blood loss. Berdasarkan hal tersebut, penelitian ini dilakukan untuk membuktikan hipotesis terdapat hubungan antara faktor-faktor tersebut terhadap jumlah transfusi pada pasien perdarahan intraoperatif Metode: Penelitian ini bersifat analitik observasional dengan desain potong-lintang. Data diperoleh dari 84 rekam medis pasien di Rumah Sakit Cipto Mangunkusumo, Jakarta. Data yang dianalisa adalah kadar Hb praoperasi, jumlah perdarahan, gangguan hemodinamik, perkiraan allowable blood loss dan jumlah transfusi intraoperatif. Uji yang dilakukan adalah uji bivariat pada masing-masing faktor dengan uji korelasi Pearson, Spearman dan uji komparatif Mann Whitney menggunakan perangkat lunak SPSS versi 20. Hasil: Didapatkan bahwa jumlah perdarahan (p=0,000) mempengaruhi jumlah transfusi. Pada kelompok dengan gangguan hemodinamik didapatkan perbedaan jumlah transfusi dibandingkan dengan kelompok tanpa gangguan hemodinamik (p=0,009). Hb praoperasi dan perkiraan allowable blood loss tidak mempengaruhi jumlah transfusi (p=0,794, p=0,250). Kesimpulan: Jumlah perdarahan berhubungan dengan jumlah transfusi. Nilai Hb praoperasi dan perkiraan allowable blood loss tidak berhubungan dengan jumlah transfusi intraoperatif.

Introduction: Intraoperative haemorrhage is the leading cause of cardiac arrest in surgery. Transfusion can be given to replace intraoperative blood loss. Transfusion can trigger infection and allergy reactions. Hence it must be given cautiously. Blood transfusion volume can be related to many factors, ie, preoperative hemoglobin value, blood loss volume, the presence or absence of hemodynamic instability, and allowable blood loss value. This study aimed to know the relationship between those factors and the blood transfusion volume. Method: This was an observational analytic study with a cross-sectional design that included 84 patients who had received an intraoperative blood transfusion in Ciptomangunkusumo Hospital, Jakarta. Preoperative hemoglobin, blood loss volume, estimated allowable blood loss, hemodynamic instability, and intraoperative blood transfusion volume data were obtained from medical records and analyzed. Bivariate test (Pearson, Spearman correlation test, and the Mann Whitney comparative test, was performed using SPSS ver. 20.0. Results: Blood loss volume (p=0,000) was significantly associated with the blood transfusion volume. Blood transfusion volume was significantly different in patients with hemodynamic instability than patients with stable hemodynamic (p=0.009). Preoperative hemoglobin level and estimated allowable blood loss value were not significantly associated with blood transfusion volume (p=0.794 and p=0.250, respectively). Conclusion: Blood loss volume was significantly related to blood transfusion volume. Preoperative hemoglobin level and estimated allowable blood loss were not significantly associated with blood transfusion volume."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Skripsi Membership  Universitas Indonesia Library
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Diantika Narinastiti
"ABSTRAK
Pendahuluan: Pasien pascaoperasi berisiko mengalami perubahan suhu tubuh. Upaya tubuh untuk mengembalikan suhu tubuh ke dalam rentang normal akan meningkatkan kebutuhan tubuh akan oksigen. Pada pasien kritis, kadar laktat >2 mmol/L merupakan prediktor morbiditas dan mortalitas. Kadar laktat dapat meningkat ketika terdapat gangguan perfusi jaringan. Hipoperfusi jaringan dapat terjadi karena hipotermia. Berdasarkan hal tersebut, penelitian ini dilakukan untuk membuktikan hipotesisnya yaitu adanya hubungan antara suhu tubuh dengan kadar laktat pada pasien dewasa pascaoperasi. Metode: Penelitian ini bersifat analitik observasional dengan desain potong lintang. Data diperoleh dari 194 rekam medis pasien pascaoperasi di ICU Rumah Sakit Cipto Mangunkusumo, Jakarta. Data yang dianalisa adalah suhu tubuh dan kadar laktat saat pasien masuk ICU. Uji yang dilakukan adalah uji korelasi Spearman menggunakan perangkat lunak SPSS versi 20. Hasil: Dari 194 pasien dewasa pascaoperasi di ICU Rumah Sakit Cipto Mangunkusumo, didapatkan rerata suhu tubuh 36.3°C dan rerata kadar laktat adalah 1,7 mmol/L. Korelasi antara suhu tubuh dan kadar laktat dianalisis dengan uji korelasi Spearman dan menghasilkan korelasi positif lemah yang bermakna secara statistik dengan nilai r=0,2 (p=0,005). Kesimpulan: Terdapat hubungan berupa korelasi positif antara suhu tubuh dengan kadar laktat pasien dewasa pascaoperasi di ICU.

ABSTRACT
Introduction: Postoperative patients are at risk of experiencing changes in body temperature. The bodys effort to restore body temperature to its normal range will increase the bodys need for oxygen. In critical patients, lactate levels >2 mmol/L is a predictor of morbidity and mortality. Lactate levels might increase when there is tissue perfusion impairment. Tissue hypoperfusion can occur due to hypothermia. Based on that, this study was conducted to prove its hypothesis that there is a relationship between body temperature and lactate levels in postoperative adult patients. Method: This study is an observational analytic study with a cross-sectional design. Data was collected from 194 medical records of postoperative patients in the ICU of Cipto Mangunkusumo Hospital, Jakarta. The analyzed data was body temperature and lactate level at the time patients moved into ICU. The applied test was Spearman correlation test using SPSS version 20 software. Results: Obtained from 194 postoperative adult patients in the ICU of Cipto Mangunkusumo Hospital, the average body temperature was 36.3°C and the average lactate level was 1,7 mmol/L. Correlations between body temperature and lactate levels were analyzed by the Spearman correlation test and resulted in a statistically significant positive weak correlation with a value of r=0,2 (p=0,005). Conclusion: There is a relationship in the form of a weak positive correlation between body temperature with lactate level of postoperative adult patients in ICU."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2020
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UI - Skripsi Membership  Universitas Indonesia Library
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Dicka Adhitya Kamil
"Latar Belakang Pneumonia adalah suatu penyakit akibat infeksi pada paru yang menjadi masalah serius, dengan tingkat mortalitas yang mencapai 42,4% di Indonesia sendiri. Pneumonia dikaitkan dengan mortalitas tinggi, salah satunya pada kondisi kegagalan ekstubasi yang terjadi pada pasien yang memerlukan intubasi. Proses patologis ini dikaitkan dengan peningkatan sitokin proinflamasi seperti IL-6 yang dapat ditemukan pada serum ataupun bilasan bronkoalveolar. Penelitian-penelitin terdahulu belum menentukan kaitan sitokin IL-6 dengan prognosis pasien terkait mortalitas dan kegagalan ekstubasi, serta belum menentukan korelasi kadar IL-6 serum dan bilasan bronkoalveolar pada pasien meninggal dan pasien gagal ekstubasi.
Tujuan Mengetahui perbandingan kadar IL-6 pada serum dan bilasan bronkoalveolar pada pasien sesuai dengan status mortalitas dan ekstubasi pada pasien pneumonia berat, serta korelasi kadar IL-6 sersum dan bilasan bronkoalveolar pada pasien meninggal dan gagal ekstubasi.
Metode Penelitian dengan desain kohort prospektif dilakukan pada 40 pasien pneumonia berat yang terintubasi dan menjalani tindakan bronkoskopi di IGD dan ruang intensif RSCM sejak November 2020 hingga Januari 2021. Kadar IL-6 pada pemeriksaan serum dan pemeriksaan bilasan bronkoalveolar kemudian dianalisis dengan observasi keberhasilan ekstubasi selama 20 hari dan status mortalitas selama 28 hari. Analisis univariat pada karakteristik pasien dilanjutkan dengan analisis bivariat dengan uji perbedaan dua rerata tidak berpasangan dengan data skala numerik dilakukan pada data sebaran normal dan uji Mann-Whitney dilakukan pada data sebaran tidak normal.
Hasil Dalam penelitian, didapatkan rasio gagal ekstubasi dan mortalitas sebesar 80% dan 75% secara berurutan. Tidak ditemukan perbedaan bermakna antara kadar IL-6 serum ataupun bilasan bronkoalveolar pada status mortalitas dan ekstubasi pasien. Namun, ditemukan korelasi positif antara kadar IL-6 serum dan kadar IL-6 bilasan bronkoalveolar pada pasien meninggal (r=0,551) dan gagal ekstubasi (r=0,567).
Kesimpulan Tidak terdapat perbedaan bermakna pada kadar IL-6 serum dan bilasan bronkoalveolar antara pasien meninggal dan hidup, serta pasien berhasil atau gagal ekstubasi. Namun, terdapat hubungan positif antara kadar IL-6 serum dan bilasan bronkoalveolar pada pasien meninggal dan gagal ekstubasi.

Background. Pneumonia is a disease caused by infection in the lungs which has become a serious health issue, with a mortality rate of 42.4% in Indonesia itself. Pneumonia is associated with high mortality, one of which is in conditions of extubation failure that occurs in patients who require intubation. This pathological process is associated with an increase in pro-inflammatory cytokines such as IL-6 that can be found in serum or bronchoalveolar lavage. Previous studies have not determined the association of the IL6 cytokine with the prognosis of patients related to mortality and extubation failure, nor have they determined the correlation of serum IL-6 levels and bronchoalveolar lavage in patients dying and patients failing to extubate.
Purpose. To analyze the comparison of IL-6 levels in serum and bronchoalveolar lavage in patients based on their mortality and extubation status in severe pneumonia patients, as well as the correlation of IL-6 levels in serum and bronchoalveolar lavage in patients who died and failed extubation.
Method. The study with a prospective cohort design was conducted on 40 severe pneumonia patients who were intubated and underwent bronchoscopic procedures in the emergency room and intensive room of RSCM from November 2020 to January 2021. IL6 levels were examined on serum and bronchoalveolar lavage sample, which then analyzed with the observation for extubation status for 20 days and mortality status for 28 days. Univariate analysis on patient characteristics was followed by bivariate analysis with unpaired two-mean difference tests with numerical scale data performed on normal distribution data and Mann-Whitney test performed on abnormal distribution data
Result. In the study, the ratio of extubation failure and mortality was 80% and 75% respectively. No significant difference was found between serum IL-6 levels or bronchoalveolar lavage IL-6 levels based on the mortality and extubation status of patients. However, a positive correlation was found between serum IL-6 levels and IL-6 levels of bronchoalveolar lavage in patients who died (r=0.551) and failed extubation (r=0.567).
Conclusion. There were no significant differences in serum IL-6 levels and bronchoalveolar lavage between deceased and living patients, as well as patients succeeded or failed to be extubated. However, there was a positive correlation between serum IL-6 levels and bronchoalveolar lavage IL-6 levels in patients who died and failed extubation.
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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2023
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UI - Tugas Akhir  Universitas Indonesia Library
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Calvin Kurnia Mulyadi
"Latar Belakang: Pneumonia komunitas berat (severe community acquired pneumonia atau SCAP) merupakan salah satu bentuk penyakit kritis yang sering dijumpai dengan angka mortalitas jangka pendek yang tinggi. Pelbagai model prediksi klinis general telah banyak dievaluasi memiliki performa yang baik dalam memprediksi luaran klinis untuk penyakit kritis, namun evaluasi performa SAPS 3 sebagai salah satu sistem skor yang luas digunakan dalam perawatan intensif terhadap SCAP hingga saat ini belum memadai untuk memandu klinisi dalam menangani kasus tersebut.
Tujuan: Penelitian ini bertujuan untuk mengetahui proporsi mortalitas SCAP serta mengevaluasi performa kalibrasi dan diskriminasi dari SAPS 3 terhadap mortalitas rawat inap.
MetodeL Penelitian ini menggunakan desain kohort retrospektif dan mengambil data rekam medis dari pasien dengan SCAP yang masuk rawat di instalasi gawat darurat, ruang perawatan high care maupun intensive care di RSUPN Cipto Mangunkusumo selama 3 tahun (Maret 2019-Maret 2021). Dilakukan penilaian mortalitas rawat inap selama 30 hari perawatan. Data terkumpul dianalisis dengan uji Hosmer-Lemeshow goodness-of-fit untuk mengetahui performa kalibrasi dan pembuatan kurva Receiver Operating Curve (ROC) untuk mengetahui performa diskriminasi skor SAPS 3 terhadap luaran mortalitas rawat inap.
Hasil: Diperoleh 484 subjek SCAP dengan proporsi mortalitas 49,2%. Sebanyak 73,8% adalah infeksi viral (COVID-19) dan sisanya bakterial (25,6%) dan campuran fungal-bakterial (0,6%). Performa kalibrasi adalah baik (p=0,519, koefisien korelasi r=0,993). Performa diskriminasi tampak sangat baik untuk skor total SAPS 3 dengan nilai AUC 0,921 (IK95% 0,898-0,944).
Kesimpulan: Performa kalibrasi dan diskriminasi SAPS 3 dalam memprediksi mortalitas rawat inap SCAP adalah baik.
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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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UI - Tesis Membership  Universitas Indonesia Library
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Kartika Juwita
"Latar Belakang: Pneumonia berat adalah infeksi saluran napas yang masih memiliki angka mortalitas yang tinggi. Pasien pneumonia berat sering kali memerlukan intubasi untuk mencapai ventilasi yang adekuat. Terjadinya kegagalan ekstubasi dapat meningkatkan komplikasi dan mortalitas pada pasien, sehingga pasien dengan risiko gagal ekstubasi perlu dikenali sedini mungkin.
Tujuan: Mengetahui faktor yang dapat memprediksi kegagalan ekstubasi pada pasien pneumonia berat
Metode: Studi ini merupakan studi kohort retrospektif yang melibatkan pasien dengan pneumonia berat yang terintubasi dan dirawat di ICU/HCU RSCM pada tahun 2015-2019. Data pasien dan hasil pemeriksaan laboratorium diambil dari rekam medis. Analisis bivariat dilakukan dengan uji Chi-square atau uji Fischer, sementara analisis multivariat dilakukan dengan uji regresi cox.
Hasil: Sebanyak 192 subjek pasien pneumonia berat dilibatkan dalam penelitian ini. Insidensi kegagalan ekstubasi pada pasien pneumonia berat di RSCM adalah 70,3%, dengan angka mortalitas pada pasien yang mengalami gagal ekstubasi adalah sebesar 85,2%. Dari analisis bivariat, didapatkan usia >60 tahun, merokok, Charlson Comorbidity Index sedang-berat, tidak adanya penyakit neuromuskular, terapi pengganti ginjal, prokalsitonin > 2 ng/mL, dan skor APACHE II ≥25 sebagai variabel yang berhubungan signifikan dengan kegagalan ekstubasi. Selanjutnya, analisis multivariat menemukan bahwa Charlson Comorbidity Index sedang-berat (p=0,002, HR 2,254, IK95% 1,353-3,755), dan prokalsitonin > 2 ng/mL (p<0,001, HR 1,859, IK95% 1,037-3,333) merupakan prediktor independen terhadap kegagalan ekstubasi pada pasien pneumonia berat.
Kesimpulan: Faktor-faktor yang secara independen merupakan prediktor kegagalan ekstubasi pada pasien pneumonia berat adalah Charlson Comorbidity Index sedang-berat, dan kadar prokalsitonin > 2 ng/mL.

Background: Severe pneumonia is a lower respiratory tract infection still presenting with a high a mortality rate. Patients with severe pneumonia often require intubation in order to achieve adequate ventilation. Extubation failure, however, is associated with increased complications and mortality. Therefore, it is crucial to recognize risk factors associated with extubation failure as soon as possible.
Objective: To determine the predictors associated with extubation failure in patients with severe pneumonia
Methods: A retrospective cohort study was conducted, which included patients with severe pneumonia who were intubated in ICU/HCU of Ciptomangunkusumo General Hospital over the period of 2015-2019. Patient characteristics and laboratory values were obtained from medical records. Bivariate analysis was performed with Chi-square or Fischer test, whereas multivariate analysis was performed with cox regression model.
Results: A total of 192 subjects with severe pneumonia was included in this study. Incidence of extubation failure among patients with severe pneumonia was 70,3%, with a mortality rate of 85,2%. Bivariate analyses found that age of >60 years, smoking history, moderate-to-severe Charlson Comorbidity Index, procalcitonin > 2 ng/mL, not having neuromuscular disease, renal replacement therapy, and APACHE II score of ≥25 were significantly associated with extubation failure. In multivariate analysis, moderate-to-severe Charlson Comorbidity Index (p=0,002, HR 2,254, 95% CI 1,353-3,755) and procalcitonin > 2 ng/mL (p<0,001, HR 1,859, 95% CI 1,037-3,333) were found to be independent predictors of extubation failure in patients with severe pneumonia.
Conclusion: Moderate-to-severe Charlson Comorbidity Index and procalcitonin level of > 2 ng/mL were independent predictors of extubation failure in patients with severe pneumonia.
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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2021
SP-pdf
UI - Tugas Akhir  Universitas Indonesia Library
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Regina Prima Putri
"[ABSTRAK
Latar 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.

ABSTRACT
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., 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.]"
2015
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Anita Santoso
"Latar belakang: Angka kejadian mual-muntah pascabedah sekitar 20-30 % dari seluruh pembedahan umum dan lebih kurang 70-80% pada kelompok risiko tinggi. Ketersediaan obat-obatan untuk mencegah mual-muntah pascabedah (PONV) sering sulit didapat, tidak hanya di daerah terpencil, tetapi juga di RSUPN Cipto Mangunkusumo. Terdapat bukti bahwa terapi nonfarmakologis seperti mengunyah permen karet efektif untuk menurunkan risiko PONV. Dalam penelitian ini, kami mengevaluasi efek mengunyah permen karet sebagai ajuvan metoklopramide dalam mengurangi PONV.
Metode: Penelitian ini merupakan uji klinis acak tersamar tunggal. Sejumlah 116 subjek yang akan menjalani pembedahan mata dibagi menjadi 2 kelompok (metoklopramid 10 mg iv dan metoklopramid 10 mg iv ditambah aktivitas mengunyah). Metoklopramide IV diberikan pada akhir pembedahan, sebelum pasien diekstubasi. Kelompok kedua diminta mengunyah permen karet selama 15 menit di ruang pemulihan. Efektivitas mual-muntah pascabedah dinilai dari kejaidan mual-muntah dan derajatnya sampai 24 jam pascabedah (jam ke-2, jam ke-6, jam ke-12, jam ke-18, dan jam ke-24).
Hasil: Terdapat perbedaan bermakna antara dua kelompok untuk kejadian PONV dengan nilai p= 0,016. Namun, penilaian derajat keparahan PONV tidak bermakna secara statistik.
Simpulan: Penambahan aktivitas mengunyah permen karet sebagai ajuvan metoklopramid efektif untuk pencegahan PONV.

Background: Incidence of PONV is around 20-30% in patients who underwent surgery with general anesthesia, and up to 70-80% in high risk patients. Availability of PONV drugs is often limited, not only in rural area, but also in Cipto Mangunkusumo Hospital. Evidence showed that non-pharmacological therapy such as chewing gum is effective in reducing PONV. In this study, we evaluated the effect of chewing gum as adjuvant to metoclopramide for reducing PONV.
Method: This is a single-blind randomized controlled trial. One hundred and sixteen adult subjects scheduled for elective ophthalmologic surgery with general anesthesia were allocated into two groups (IV metoclopramide 10 mg and IV metoclopramide 10 mg plus chewing gum). IV metoclopramide was given at the end of surgery, before the patient were extubated. The second group was instructed to chew gum for 15 minutes in recovery room. Effectiveness to prevent PONV was measured by incidence of PONV and its degree of severity up to 24 hours post operatively (2-hour, 6-hour, 12-hour, 18-hour, and 24-hour).
Results: The difference in PONV incidence is statistically significant between two groups (p=0.016). However, degree of PONV severity is not significant.
Conclusion: Chewing gum as an adjuvant to metoclopramide is effective for PONV prevention."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2018
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Reihan Hadiansyah
"Pendahuluan. Angka kejadian POST dilaporkan dapat mencapai 60%. LMA masih memiliki kejadian POST hingga 26.3%. Berkumur dengan benzydamine hydrochloride terbukti efektif mengurangi POST, namun distribusinya di Indonesia belum merata. Kumur magnesium sulfat dapat dijadikan alternatif untuk mengurangi POST, harga dan distribusinya lebih merata. Penelitian ini bertujuan untuk membandingkan efektifitas kumur magnesium sulfat dengan benzydamine hydrochloride dalam mengurangi POST pascapemasangan LMA. Metode. Penelitian ini merupakan uji klinis acak tersamar tunggal. Sebanyak 164 subjek penelitian diambil secara consecutive sampling. Subjek penelitian mendapatkan botol penelitian yang berisikan obat kumur yang sudah dirandomisasi, dilanjutkan dengan prosedur anestesi. Setelah selesai operasi, pasien akan dinilai : kejadian nyeri tenggorok, derajat nyeri tenggorok, efek samping, odinofagia dan disfagia pada jam ke 2, 6, 24 dan 48 pascaoperasi. Hasil. Berdasarkan hasil penelitian, tidak didapatkan perbedaan bermakna antara kedua kelompok; pada kejadian nyeri tenggorok pasca-LMA di jam ke 2, 6 dan 24 dengan nilai P > 0.05 dan perbandingan derajat nyeri pasca-LMA kedua kelompok dengan nilai P > 0.05. Kejadian odinofagia kedua kelompok rendah dan hampir serupa. Tidak didapatkan efek samping dan kejadian disfagia pada penelitian ini. Simpulan. Kumur magnesium sulfat memiliki efektifitas yang tidak lebih buruk dibandingkan dengan kumur benzydamine hydrochloride dalam mengurangi kejadian nyeri tenggorok pascapemasangan LMA

Introduction. The reported incidence of POST can reach 60%. LMA still has a POST incidence of up to 26.3%. Gargling with benzydamine hydrochloride has been proven to be effective in reducing POST, but its distribution in Indonesia is not evenly distributed. Magnesium sulfate gargle can be used as an alternative to reduce POST; its price and distribution are more even. This study aims to compare the effectiveness of magnesium sulfate gargle with benzydamine hydrochloride in reducing POST after LMA insertion. Method. This study was a single-blind, randomized clinical trial. A total of 164 research subjects were selected by consecutive sampling. Research subjects received research bottles containing randomized mouthwash, followed by an anesthesia procedure. After completion of the operation, the patient will be assessed for the incidence of throat pain, the degree of throat pain, side effects, odynophagia, and dysphagia at 2, 6, 24, and 48 hours after surgery. Results. Based on the research results, there were no significant differences between the two groups on the incidence of post-LMA throat pain at 2, 6, and 24 hours with a P value > 0.05 and a comparison of the degree of post-LMA pain between the two groups with a P value > 0.05. The incidence of odynophagia in both groups was low and almost similar. There were no side effects or incidences of dysphagia in this study. Conclusion. Magnesium sulfate gargle has no worse effectiveness than benzydamine hydrochloride gargle in reducing POST after LMA insertion."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2024
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Julianti Norva Nemba
"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.

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."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2024
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