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All Journal Jurnal Anestesiologi Indonesia Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Jurnal Anestesi Perioperatif The Indonesian Journal of Public Health Indonesian Journal of Anesthesiology and Reanimation (IJAR) Jurnal Anestesi Obstetri Indonesia Jurnal Kesehatan Tambusai Solo Journal of Anesthesi, Pain and Critical Care Journal of Anesthesiology and Clinical Research Majalah Anestesia & Critical Care (MACC) Jurnal Komplikasi Anestesi
Juni Kurniawaty Muhdar Abubakar Djayanti Sari
Departemen Anestesiologi Dan Terapi Intensif, Fakultas Kedokteran, Kesehatan Masyarakat Dan Keperawatan, Universitas Gadjah Mada, Yogyakarta|Universitas Gadjah Mada
Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Dentistry Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Hyperlactatemia Post-CABG: Case Studies in Three Patients Wardhana, Ardyan; Kurniawaty, Juni
Majalah Anestesia & Critical Care Vol 43 No 3 (2025): Oktober
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif (PERDATIN) / The Indonesian Society of Anesthesiology and Intensive Care (INSAIC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55497/majanestcricar.v43i3.429

Abstract

Introduction: Hyperlactatemia after CABG may signal intra- or postoperative complications by reflecting a mismatch between tissue oxygen supply and metabolic demand, with potential for organ dysfunction and worse outcomes. This case report examined contributing factors—including metabolic acidosis, postoperative metabolic stress, and inotropic agents—to guide targeted interventions and improve clinical results. Case Description: Three patients underwent CABG, with the first and second remaining hemodynamically stable in the ICU on dobutamine and nitroglycerin, whereas the third required norepinephrine, epinephrine, and temporary pacing for instability. None exceeded 4 mmol/L during CPB or immediately after separation, yet all showed immediate-onset hyperlactatemia (IHL)—a phenomenon reported in 17% of cases, especially with longer CPB/cross-clamp times. All subsequently developed late-onset hyperlactatemia (LHL) at 4–12 hours: first and third patient had hyperglycemia, whereas the second reached the highest 12-hour lactate peak without hyperglycemia. LHL likely reflected type-B lactate from postoperative inflammatory/metabolic stress and insulin resistance, typically normalizing within 12–24 hours without a marked drop in base excess. Third patient’s sharp4-hour surge was plausibly epinephrine-related—more consistent with preserved metabolic reserve than with adverse prognosis. Conclusion: In post-CABG patients, hyperlactatemia may arise from non-hypoxic, multifactorial mechanisms (inflammation, metabolic stress, and inotropes) and thus warrants context-aware interpretation and targeted management rather than reflexive attribution to tissue hypoxia.
Validation of the APACHE IV Score for ICU Mortality Prediction in Dr. Sardjito Hospital During the Pandemic Era Rayhandika; Akhmad Yun Jufan; Widyastuti, Yunita; Juni Kurniawaty
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 2 (2023): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V5I22023.72-80

Abstract

Introduction: ICU service quality must continuously improve to provide better patient service. One of these improvement efforts is the use of a risk prediction system to predict mortality rates in the ICU by utilizing risk factors. This system helps healthcare services perform evaluations and comparative audits of intensive services, which can also aid with more targeted planning. APACHE IV is considered to have good validity. However, its predictive capabilities may change over time due to various factors, such as the pandemic, where changes in the case mix may affect its predictive abilities. Therefore, this research tests the validity of APACHE IV on the Indonesian population through Dr. Sardjito Hospital patients. The findings can be utilized for future use and risk stratification, and ICU quality benchmarking. Objective: This study aims to assess the validity of the APACHE IV score in ICU Mortality prediction in Dr. Sardjito Hospital for medical patients, surgical patients, and patients with both cases during the pandemic. Methods: This study used retrospective data from 336 patients at Dr. Sardjito Hospital Yogyakarta from the 1st of January 2020 to the 31st of December 2021. All data required for calculating the APACHE IV score was collected, and the patient's observed ICU Mortality was used. The model's predictive validity is measured by finding the discrimination and calibration of the APACHE IV score and comparing it to the observed ICU mortality. Validation was also conducted separately for medical and surgical cases. Results: APACHE IV shows good discrimination ability in all cases (AUC-ROC 95% CI: 0.819 [0.772-0.866]) but poor calibration (p = 0.023) for mortality prediction in the ICU. For medical cases, the discrimination ability is poor but still acceptable (AUC-ROC 95% CI: 0.698 [0.614-0.782]), and in surgical cases, the discrimination ability is good (AUC-ROC 95% CI: 0.848 [0.776-0.921]). Both cases showed good calibration (p: medical = 0.569, surgical = 0.579) in predicting mortality during the pandemic. Conclusion: APACHE IV showed good discrimination but poor calibration ability for predicting mortality for all ICU patients during the pandemic era. Mortality prediction for surgical cases showed good discrimination and calibration. However, medical cases showed poor discrimination but good calibration.
Co-Authors . Supomo Akhmad Yun Jufan Alqustar, Adam Ancilla, Cornelia Anindita, Mohammad Pradhana Baskoro, Ronggo Bhirowo Yudo Pratomo Bowo Adiyanto Budi Yuli Setianto Calcarina Fitriani Retno Wisudarti Cindy Elfira Boom Cornelia Ancilla Daniswara Dewi, Baiq Dessy Resmana Djayanti Sari Fadinie, Wulan Gentong, Metia Gledis Gilang Hartiah Haroen Herdono Poernomo Hermawan, Hendra Joni, Rendy Pranda Khoeri, Fatkhur Roofi Kurniaji Kurniaji Kusuma, Danur Adi Kusumandaru , Novierta Prima Meta Restu Synthana Muhammad Mufti Sofyanoor Muhdar Abubakar Novita Intan Arovah Nurdiansyah, Elba Oktavian Rizki Ilahi Pambudi, Estu Agung R W, Calcarina Fitriani Rani, Hajar Rafika Ratih Kumala Fajar Apsari Rayhandika Ridha, Ihsanur Rifdhani Fakhrudin Nur Rifdhani Fakhrudin Nur Sadewo, Yuri Sari, Dhanty Dwita SATRIYAS ILYAS Setiandari, Kristina Sofwan, Fachruddin Sudadi Utomo, F uad Cipto Wardhana, Ardyan Wibowo, Erry Alamsyah Asjhuri yudihart, Subhan Yunita Widyastuti Yusmein Uyun