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"Latar Belakang: Emergence delirium (ED) merupakan kondisi yang dapat terjadi saat anak pulih dari anestesi dengan cara yang tidak nyaman. ED dapat menyebabkan cedera pada anak, dan kekhawatiran pada orangtua. Berbagai intervensi dilakukan untuk menurunkan ED, namun belum ada standar khusus yang rutin dilakukan untuk mencegah ED. Deksmedetomidin dan midazolam dikatakan efektif untuk mengurangi ED. Penelitian ini bertujuan mengetahui efektivitas premedikasi deksmedetomidin intranasal dibandingkan midazolam intranasal untuk mencegah ED pada anak yang menjalani operasi mata. Metode : Penelitian ini adalah uji klinik tersamar ganda, pada pasien anak usia 1- 12 tahun dengan status fisik ASA 1 dan 2 yang menjalani operasi mata dengan anestesia umum menggunakan agen inhalasi Sevoflurane. Subjek penelitian 64 orang, didapatkan dengan consecutive sampling selama Februari-Mei 2019 yang kemudian dikelompokan menjadi kelompok deksmedetomidin dan midazolam setelah proses randomisasi. Efektivitas dinilai dari kejadian ED, waktu pulih, dan kejadian desaturasi pasca premedikasi. Analisis data menggunakan uji Chi Square dan Uji Mann-Whitney. Hasil : Kejadian ED pada kelompok deksmedetomidin sebesar 11,18% sedangkan kelompok midazolam 28,12% (p=0,109). Waktu pulih didapatkan median yang sama 6 menit, dan tidak didapatkan kejadian desaturasi di kedua kelompok. Simpulan : Pemberian premedikasi deksmedetomidin intranasal 30 menit sebelum induksi secara statistik tidak lebih efektif dibandingkan midazolam untuk mencegah kejadian ED pada anak yang menjalani operasi mata.

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Background: Emergence Delirium (ED) is a condition that can occur when a child recoverds from anesthesia in a uncomfortable way. ED can cause injury to children and worries to parents. Various interventions were carried out to reduce ED, but there were no specific standards has been estabilished to prevent ED. Dexmedetomidine and midazolam are said to be effective in reducing ED. This study aims to determine the effectiveness of intranasal dexmedetomidine premedication compared to intranasal midazolam to prevent ED in children undergoing eye surgery. Method : This study is a double-blind clinical trial, in pediatric patients aged 1-12 years with physical status ASA 1 and 2 who underwent eye surgery under general anesthesia using Sevoflurane inhalation agents. There were 64 childen obtained by consecutive sampling, who underwent eye surgery in our institution during February-Mayl 2019. The subjects then grouped into dexmedetomidine group and midazolam group. Effectiveness was assessed from ED events, recovery time, and post-premedication desaturation events. Data analysis using Chi Square test and Mann-Whitney test. Result : ED incidence in the dexmedetomidin group was 11.18% while the midazolam group was 28,12% (p = 0.109). The recovery time was the same median 6 minutes, and no desaturation was found in either group. Conclusion : There are statistically no difference between the effectiveness of intranasal dexmedetomidine and midazolam premedication 30 minutes before induction to prevent ED occurrence in children undergoing eye surgery. "

"Latar Belakang: Ventilator-associated pneumonia (VAP) merupakan infeksi yang sering terjadi di intensive care unit (ICU) dan memiliki angka mortalitas yang tinggi. Pengetahuan tentang prediktor mortalitas dapat membantu pengambilan keputusan klinis untuk tatalaksana pasien. Studi-studi tentang faktor prediktor mortalitas VAP menunjukkan hasil yang berbeda-beda dan tidak ada penelitian yang komprehensif di Indonesia.Tujuan: Mengetahui faktor-faktor prediktor mortalitas pasien VAP di RSCM.Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien ICU RSCM yang didiagnosis VAP selama tahun 2003-2012. Data klinis dan laboratorium beserta status luaran (hidup atau meninggal) selama perawatan diperoleh dari rekam medis. Analisis bivariat dilakukan pada variabel kelompok usia, infeksi kuman risiko tinggi, komorbiditas, renjatan sepsis, kultur darah, prokalsitonin, ketepatan antibiotik empiris, acute lung injury, skor APACHE-II, dan hipoalbuminemia. Variabel yang memenuhi syarat akan disertakan pada analisis multivariat regresi logistik.Hasil: Sebanyak 201 pasien diikutsertakan pada penelitian ini. Didapatkan angka mortalitas selama perawatan sebesar 57,2%. Kelompok usia, komorbiditas, renjatan sepsis, prokalsitonin, ketepatan antibiotik empiris, dan skor APACHE II merupakan variabel yang berpengaruh terhadap mortalitas pada analisis bivariat. Prediktor mortalitas pada analisis multivariat adalah antibiotik empiris yang tidak tepat (OR 4,70; IK 95% 2,25 sampai 9,82; p < 0,001), prokalsitonin > 1,1 ng/mL (OR 4,09; IK 95% 1,45 sampai 11,54; p = 0,01), usia ≥ 60 tahun (OR 3,71; IK 95% 1,35 sampai 10,20; p = 0,011), dan adanya renjatan sepsis (OR 3,53; IK 95% 1,68 sampai 7,38; p = 0,001).Kesimpulan: Pemberian antibiotik empiris yang tidak tepat, prokalsitonin yang tinggi, usia 60 tahun atau lebih, dan adanya renjatan sepsis merupakan pediktor independen mortalitas pada pasien VAP.

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Background: Ventilator-associated pneumonia (VAP) is a frequent infection with high mortality rates in intensive care unit (ICU). The prediction of outcome is important in decision-making process. Studies exploring predictors of mortality in patients with VAP produced conflicting results and there are no comprehensive reports in Indonesia.

Objective: To determine predictors of mortality in patients with VAP in Cipto Mangunkusumo Hospital.

Methods: We performed a retrospective cohort study on patients admitted to the ICU who developed VAP between 2003?2012. Clinical and laboratory data along with outcome status (survive or non-survive) were obtained for analysis. We compared age, presence of high risk pathogens infection, presence of comorbidity, septic shock status, blood culture result, procalcitonin, appropriateness of initial antibiotics therapy, presence of acute lung injury, APACHE II score, and serum albumin between the two outcome group. Logistic regression analysis performed to identify independent predictors of mortality.

Results: A total of 201 patients were evaluated in this study. In-hospital mortality rate was 57.2%. Age, comorbidity, septic shock status, procalcitonin, appropriateness of initial antibiotics therapy, and APACHE II score were significantly different between outcome groups. The independent predictors of mortality in multivariate logistic regression analysis were inappropriate initial antibiotics therapy (OR: 4.70; 95% CI 2.25 to 9.82; p < 0.001), procalcitonin > 1.1 ng/mL (OR: 4.09; 95% CI 1.45 to 11.54; p = 0.01), age ≥ 60 years old (OR: 3.71; 95% CI 1.35 to 10.20; p = 0.011), and presence of septic shock (OR: 3.53; 95% CI 1.68 to 7.38; p = 0.001).

Conclusion: Inappropriate initial antibiotic therapy, high serum procalcitonin level, age 60 years or older, and presence of septic shock were independent predictors of mortality in patients with VAP."

"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."

"Aspergilosis invasif AI merupakan infeksi jamur invasif disebabkan Aspergillus spp sedangkan aspergilosis paru invasif API merupakan manifestasi AI yang sering ditemukan Gejala klinis laboratorium rutin dan radiologis tidak khas sehingga sering terjadi keterlambatan diagnosis dan tatalaksana Pemeriksaan biopsi tidak selalu dapat dilakukan dan berisiko tinggi sedangkan pemeriksaan biakan memiliki keterbatasan sensitivitas dan waktu Deteksi antigen galaktomanan GM merupakan uji penapis AI yang dinilai baik tetapi di Indonesia kit GM tidak rutin tersedia dan mahal sehingga perlu dicari uji diagnostik alternatif antara lain menggunakan deteksi antibodi anti Aspergillus yang sederhana mudah murah dan terjamin ketersediaannya Tujuan penelitian ini membandingkan hasil pemeriksaan deteksi antibodi anti Aspergillus metode immunodiffusion test IDT menggunakan crude antigen Aspergillus dengan deteksi antigen GM serta mengetahui nilai sensitivitas dan spesifisitasnya Penelitian berdisain potong lintang ini merupakan bagian dari penelitian multisenter sebelumnya mengenai insidens API pada 405 pasien ICU di 6 rumah sakit di Jakarta Selanjutnya ditentukan 125 pasien non neutropenia diduga AI yang bahan klinisnya menjalani pemeriksaan uji diagnostik di atas Biakan Aspergillus sp tumbuh pada bahan klinis ekskreta paru yang dimiliki 26 dari 125 pasien tersebut 20 8 Diagnosis AI putative ditegakkan pada 26 pasien 6 2 dari 405 pasien keseluruhan Dari 125 pasien yang diperiksa uji GM positif ditemukan pada 62 pasien 48 6 sedangkan uji IDT positif pada 74 pasien 59 2 Analisis statistik menunjukkan tidak terdapat perbedaan bermakna antara hasil uji GM dan uji IDT tetapi nilai kesetaraannya sangat lemah nilai kappa 0 169 Uji IDT menggunakan crude antigen Aspergillus mempunyai sensitivitas 67 7 dan spesifisitas 49 1

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Invasive aspergillosis IA is an invasive fungal infections caused by Aspergillus spp while invasive pulmonary aspergillosis IPA is the most common manifestation of IA Clinical symptoms routine laboratory and radiological features are not typical and could lead to diagnosis and treatment delayed Biopsy is high risk and not always possible to be performed whereas culture examination has limited sensitivity and time consumed Galactomannan GM antigen detection is good for IA screening but the kit is expensive and not routinely available in Indonesia It is necessary to find an alternative tests such as detection of anti Aspergillus antibody which is simple inexpensive and more available This study aims to determine the sensitivity and specificity of immunodiffusion test IDT for detecting anti Aspergillus antibody using crude antigen compare to GM antigen detection on diagnosis of IA This cross sectional study is part of previous multicenter study on incidence of IA in ICU patients at six hospitals in Jakarta 405 patients Then clinical materials of 125 non neutropenic patients suspected IA were determined to undergo both clinical diagnostic tests Aspergillus sp were isolated from clinical materials of lung excreta from 26 out of 125 patients 20 8 Putative IA was diagnosed in 26 patients 6 2 out of 405 patients From 125 patients examined GM positive test was found in 62 patients 48 6 while IDT test positive in 74 patients 59 2 Statistical analysis showed no significant differences between the results of IDT test compared to GM but the equality value is very weak kappa 0 169 IDT test using crude Aspergillus antigen has a sensitivity of 67 7 and specificity of 49 1 ; Invasive aspergillosis IA is an invasive fungal infections caused by Aspergillus spp while invasive pulmonary aspergillosis IPA is the most common manifestation of IA Clinical symptoms routine laboratory and radiological features are not typical and could lead to diagnosis and treatment delayed Biopsy is high risk and not always possible to be performed whereas culture examination has limited sensitivity and time consumed Galactomannan GM antigen detection is good for IA screening but the kit is expensive and not routinely available in Indonesia It is necessary to find an alternative tests such as detection of anti Aspergillus antibody which is simple inexpensive and more available This study aims to determine the sensitivity and specificity of immunodiffusion test IDT for detecting anti Aspergillus antibody using crude antigen compare to GM antigen detection on diagnosis of IA This cross sectional study is part of previous multicenter study on incidence of IA in ICU patients at six hospitals in Jakarta 405 patients Then clinical materials of 125 non neutropenic patients suspected IA were determined to undergo both clinical diagnostic tests Aspergillus sp were isolated from clinical materials of lung excreta from 26 out of 125 patients 20 8 Putative IA was diagnosed in 26 patients 6 2 out of 405 patients From 125 patients examined GM positive test was found in 62 patients 48 6 while IDT test positive in 74 patients 59 2 Statistical analysis showed no significant differences between the results of IDT test compared to GM but the equality value is very weak kappa 0 169 IDT test using crude Aspergillus antigen has a sensitivity of 67 7 and specificity of 49 1 ; Invasive aspergillosis IA is an invasive fungal infections caused by Aspergillus spp while invasive pulmonary aspergillosis IPA is the most common manifestation of IA Clinical symptoms routine laboratory and radiological features are not typical and could lead to diagnosis and treatment delayed Biopsy is high risk and not always possible to be performed whereas culture examination has limited sensitivity and time consumed Galactomannan GM antigen detection is good for IA screening but the kit is expensive and not routinely available in Indonesia It is necessary to find an alternative tests such as detection of anti Aspergillus antibody which is simple inexpensive and more available This study aims to determine the sensitivity and specificity of immunodiffusion test IDT for detecting anti Aspergillus antibody using crude antigen compare to GM antigen detection on diagnosis of IA This cross sectional study is part of previous multicenter study on incidence of IA in ICU patients at six hospitals in Jakarta 405 patients Then clinical materials of 125 non neutropenic patients suspected IA were determined to undergo both clinical diagnostic tests Aspergillus sp were isolated from clinical materials of lung excreta from 26 out of 125 patients 20 8 Putative IA was diagnosed in 26 patients 6 2 out of 405 patients From 125 patients examined GM positive test was found in 62 patients 48 6 while IDT test positive in 74 patients 59 2 Statistical analysis showed no significant differences between the results of IDT test compared to GM but the equality value is very weak kappa 0 169 IDT test using crude Aspergillus antigen has a sensitivity of 67 7 and specificity of 49 1 "

"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 "