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"Latar Belakang: Menentukan kemampuan memprediksi sulit visualisasi laring (DVL) dari beberapa prediktor jalan nafas preoperatif berikut, baik tunggal atau gabungan: skor Mallampati (MMT), jarak tiromental (TMD), rasio jarak hiomental (HMDR).Metode: Sebanyak dua ratus tujuh puluh tujuh pasien yang menjalani anestesi umum dievaluasi dengan menggunakan MMT, TMD, HMDR dan titik potong untuk masing-masing prediktor jalan napas adalah skor Mallampati III dan IV; <6.5 cm, <1.2. Pada saat dilakukan laringoskopi langsung, visualisasi laring dinilai berdasarkan klasifikasi Cormack Lehane (CL). Skor CL derajat III dan IV dianggap sulit visualisasi. Kemudian ditentukan nilai area di bawah kurva (AUC), sensitivitas, spesifisitas untuk setiap prediktor jalan napas, baik tunggal maupun kombinasi. Analisis regresi logistik digunakan untuk menentukan prediktor independen terhadap DVL.Hasil : Kesulitan untuk memvisualisasikan laring ditemukan pada 28 (10,1%) pasien. Area di bawah kurva (AUC), sensitivitas, spesifisitas untuk tiga prediktor jalan nafas adalah: MMT (0.614; 10.7%, 99.2), HMDR (0.743; 64.2%, 74%), TMD (0.827; 82.1%, 64.7%) . TMD dengan titik potong 6,5 cm memiliki akurasi diagnostik (daerah di bawah kurva) dan profil validitas diagnostik (sensitivitas dan spesifisitas) yang lebih besar dibandingkan prediktor tunggal lainnya (P <0.05). Kombinasi prediktor terbaik dalam penelitian kami adalah gabungan MMT, HMDR dan TMD dengan nilai gabungan AUC, sensitivitas, dan spesifisitas berturut-turut 0.835, 60.7%, 88.8%. Analisis regresi logistik menunjukkan bahwa MMT, HMDR dan TMD adalah prediktor independen dari DVL.Kesimpulan: TMD dengan titik potong 6.5 cm adalah prediktor yang dapat diandalkan secara klinis untuk menentukan sulit visualisasi laring DVL pada populasi ras Melayu.

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Background: To determine the ability to predict difficult visualization of the larynx (DVL) from the following preoperative airway predictors, in isolation and combination: modified Mallampati test (MMT), thyromental distance (TMD), hyomental distance ratio (HMDR).

Methods : Two hundred and seventy seven consecutive patients undergoing general anesthesia were evaluated using the MMT, TMD, HMDR and the cut-off points for the airway predictors were Mallampati III and IV; < 6.5 cm, < 1.2 respectively. During direct laryngoscopy, the laryngeal view was graded using the Cormack and Lehane (CL) classification. CL grades III and IV were considered difficult visualization. Area under curve (AUC), sensitivity, specificity for each airway predictor in isolation and in combination were determined. Logistic regression analysis was used to determine independent predictors of DVL.

Results : Difficulty to visualize the larynx was found in 28 (10.1%) patients. The area under the curve (AUC), sensitivity, specificity for the three airway predictors were: MMT (0.614; 10.7%; 99.2), HMDR (0.743; 64.2%; 74%), TMD (0.827; 82.1%; 64.7%). The TMD with the cut-off point of 6.5 cm had greater diagnostic accuracy (AUC) and showed a greater diagnostic validity profile (sensitivity and specificity) than other single predictors (P < 0.05). The combination providing the best prediction in our study involved the MMT, HMDR and TMD with AUC, sensitivity, and specificity of 0.835, 60.7%; 88.8% respectively. Logistic regression analysis showed that MMT, HMDR and TMD were independent predictors of DVL.

Conclusions : The TMD with a cut-off point of 6.5 cm is a clinically reliable predictor of DVL in a Malay race population."

"ABSTRAK Imbang nitrogen pada pasien sakit kritis selalu negatif akibat respon stres. Pada lansia perubahan metabolismenya berisiko memperburuk imbang nitrogen. Tujuan penelitian ini adalah untuk mengetahui imbang nitrogen dan hubungannya dengan asupan energi dan protein pada lansia sakit kritis dalam 48 jam pertama di ICU. Penelitian ini menggunakan metode potong lintang, consecutive sampling. Subyek penelitian adalah 26 lansia sakit kritis. Hasil penelitian pada 24 jam I dan II adalah; imbang nitrogen -5,2 (-31,2 − -4,1) g dan -4,5+4,6; asupan energi 78,8+45,0% dan 91,1+50,2% terhadap target; asupan protein 0,57+0,35 g/kgBB/hari dan 0,71+0,37 g/kgBB/hari serta terdapat korelasi positif bermakna antara imbang nitrogen dengan asupan energi; r=0,6 dan r=0,5 dan korelasi positif bermakna antara imbang nitrogen dengan asupan protein; r=0,5 dan r=0,4. Kesimpulan penelitian ini adalah terdapat hubungan bermakna antara imbang nitrogen dengan asupan energi dan protein pada lansia sakit kritis

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ABSTRAK Nitrogen balance in criticaly ill patients tend to be negative due to stress response. In the elderly patients, the metabolic changes risk to worsening nitrogen balance.The aim of this study is to determine nitrogen balance and its relation with energy and protein intake in critically ill elderly patients within 48 hours in ICU. The study was cross sectional, consecutive sampling on 26 subjects. The nitrogen balances were -5.2 (-31.2 − -4.1) g and -4.5+4.6 g; energy intakes were 78.8+45.0% and 91.1+50.2% target; protein intakes were; 0.57+0.35 g/kgBW/d and 0.71+0.37 g/kgBW/d. There were positive correlation between nitrogen balance and energy intake; r=0.6 and r=0.5, and between nitrogen balance and protein intake; r=0.5 and r=0.4 in 24 hours I and II respectively. The conclusion is there were positive correlation between nitrogen balance with energy and protein intakes."

"[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.]"

"ABSTRAKLatar Belakang. Salah satu cara untuk mengurangi nyeri saat penyuntikan dalam prosedur medis adalah dengan pemberian anestesia. Krim EMLA sering digunakan untuk anestetik lokal pada penyuntikan spinal, tetapi memiliki onset kerja yang cukup lama sehingga kurang cocok untuk pasien rawat jalan. Vapocoolant spray yang berisi etil klorida memiliki berbagai keuntungan yaitu onsetnya yang cepat, aman, biaya rendah, dan banyak tersedia sehingga cocok digunakan sebagai anestesia pada pasien one-day care. Penelitian ini ingin mengetahui efektifitas vapocoolant spray dan krim EMLA dalam menurunkan nyeri pada tindakan anestesia spinal. Metode. Penelitian ini menggunakan desain uji eksperimental klinis pada 94 pasien dengan 47 pasien pada masing-masing kelompok EMLA dan vapocoolant spray. Efektifitas anestesia dinilai dengan skala nyeri VAS dan gerakan pasien. Hasil. Dengan menggunakan anestesia, skala nyeri yang diperoleh yaitu VAS 0 0-3 untuk kelompok EMLA dan VAS 0 0-4 untuk kelompok vapocoolant spray. Tidak terdapat perbedaan bermakna pada kedua kelompok untuk data skala nyeri menurut uji Mann-Whitney. Untuk gerakan pasien, pergerakan saat penyuntikan hanya terjadi pada satu 2,1 pasien pada kelompok EMLA dan satu 2,1 pasien pada kelompok vapocoolant spray. Berdasarkan uji Fisher, tidak ditemukan perbedaan bermakna untuk gerakan pasien antara kedua zat anestetik tersebut. Kesimpulan. Tidak ditemukan perbedaan skala nyeri VAS dan gerakan pasien antara kelompok krim EMLA dan vapocoolant spray pada tindakan anestesia spinal pada pasien one-day care. Diperlukan penelitian lebih lanjut mengenai penggunaan vapocoolant spray dalam berbagai prosedur dan praktik klinik kedokteran.

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ABSTRACTBackground. One way to reduce pain during injection in medical procedures is by administering anesthesia. EMLA cream is often used for local anesthesia in spinal injections, but it has long onset of action so less suitable for outpatients. Vapocoolant spray containing ethyl chloride has numerous advantages, such as fast onset, safe, low cost, and widely available, so suitable as local anesthetic for one day care patients. This study aimed to find the effectiveness of vapocoolant spray and EMLA in reducing pain for local anesthesia procedure. Method. This study used an experimental design on 94 patients which 47 patients in each group were treated with EMLA and vapocoolant spray consecutively. Effectiveness of anesthesia was assessed by VAS pain scale and patient movement. Results. By using anesthesia, pain scale obtained were VAS 0 0 3 for EMLA group and VAS 0 0 4 for vapocoolant spray group. There was no significant difference between two groups for pain scale according to Mann Whitney test. For patient movement, the movement was reported only in one 2.1 patient in EMLA group and one 2.1 patient in vapocoolant spray group. Based on Fisher 39 s test, there was no significant differences between the two group for movement. Conclusions. There were no differences in VAS pain scale and patient movement between EMLA cream and vapocoolant spray for spinal anesthesia in one day care patients. Further research is needed for the use of vapocoolant spray in various medical procedures and clinical practice."

"ABSTRAK Latar belakang: Penggunaan kateter vena sentral yang semakin banyak seiring meningkatnya mutu pelayanan kesehatan di kamar operasi dan ruang rawat intensif membuat risiko komplikasi juga semakin meningkat. Ultrasonografi direkomendasikan untuk menurunkan insiden komplikasi kanulasi vena jugularis interna. Namun, keterbatasan akses dan ketersedian ultrasonografi membuat metode penanda anatomi masih diminati walaupun insiden komplikasi mencapai 19 Merrer, 2011 , sehingga posisi yang tepat diharapkan dapat mengurangi insiden komplikasi. Rotasi kepala pada sudut tertentu mempengaruhi posisi vena jugularis interna dan arteri karotis. Penelitian ini bertujuan ingin mengetahui pengaruh rotasi kepala kontra lateral terhadap jarak dan overlapping vena jugularis interna terhadap arteri karotis setinggi kartilago krikoid dengan bantuan ultrasonografi pada ras Melayu di Indonesia.Metode: Penelitian ini bersifat analitik observasional denga rancangan potong lintang pada pasien yang menjalani operasi bedah terencana di Instalasi Bedah Pusat RSUPN Ciptomangunkusumo Jakarta. Setelah mendapatkan izin komite etik dan informed consent sebanyak 34 subyek diambil dengan metode consecutive sampling pada bulan Oktober 2016. Jarak dan rasio overlapping vena jugularis interna terhadap arteri karotis setinggi kartilago krikoid diukur dengan menggunakan ultrasonografi dua dimensi pada sudut rotasi kontra lateral 0o, 30o, 45o, 60o. Data diolah menggunakan program SPSS 21. Uji Anova digunakan untuk melihat hubungan jarak vena dan rasio overlapping jugularis interna terhadap arteri karotis dilanjutkan dengan uji post hoc Tukey.Hasil: Terdapat perbedaan yang bermakna jarak dan overlapping vena jugularis interna dan arteri karotis setinggi kartilago krikoid pada ras Melayu di Indonesia pada sudut rotasi kepala kontra lateral 0o, 30o, 45o, 60o p < 0,001 . Terdapat hubungan antara berat badan dan tinggi badan terhadap rasio overlapping vena jugularis interna dan arteri karotis. Tidak Terdapat hubungan antara jenis kelamin, usia dan Indeks Massa Tubuh IMT terhadap rasio overlapping vena jugularis interna dan arteri karotis.Simpulan: Terdapat pengaruh rotasi kepala kontra lateral terhadap jarak dan overlapping vena jugularis interna dan arteri karotis setinggi kartilago krikoid dengan bantuan ultrasonografi pada ras Melayu di Indonesia.Kata kunci: rotasi kepala kontra lateral, jarak dan overlapping vena jugularis interna dan arteri karotis, ras Melayu ABSTRACT Background The use of central venous catheters are widely increasing as well as improvement of health care quality in the operating theather and the intensive care unit. Complication incidences also increasing too. Ultrasound is recommended to decrease complication of internal jugular vein cannulation. However, limited access and availability to ultrasound makes anatomical landmark methods still in demand even though the incidence of complications was 19 Merrer, 2011 , exact position is expected to reduce the incidence of complications. Certain head rotation the position of the internal jugular vein and carotid artery. This study aims the effect of contra lateral head rotation to distance and overlapping of internal jugular vein and carotid artery at cricoid cartilage level by ultrasound guidance on the Malay race in Indonesia. Methods This study was analytical observational with cross sectional design in patients undergone elective surgery at Central Surgery Unit RSUPN Ciptomangunkusumo Jakarta. After getting approval from ethics committee and informed consent, 34 subjects were taken with consecutive sampling method in October 2016. Distance and overlapping ratio the internal jugular vein to carotid artery at cricoid level was measured using two dimensional ultrasound in contra lateral head rotation angle of 0o, 30o, 45o, 60o. The data were processed using SPSS 21. Anova test used to view the relationships within the vein and internal jugular overlapping ratio of the carotid artery followed by post hoc Tukey test. Results There were significant differences on distance and overlapping of the internal jugular vein and carotid artery at cricoid level on the Malay race in Indonesia at contra lateral head rotation angle 0o, 30o, 45o, 60o p "