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Pengaruh Posisi Elevasi Head Of Bed 300 Dibandingkan dengan Elevasi Head Of Bed 600 terhadap Peningkatan PaO2 dan Rasio PaO2/FiO2 pada Pasien dengan Ventilasi Mekanik di ICU RSUP Dr. Sardjito Anindita, Triatma; Wisudarti, Calcarina Fitriani Retno; Rahardjo, Sri
Jurnal Komplikasi Anestesi Vol 10 No 3 (2022)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v10i3.7349

Background: Mechanical ventilation is the frequent reason of admitting patients to the Intensive Care Unit(ICU). Mechanical ventilation was used in resuscitating critical patient with lung disorder where the lung fails to oxygenite arterial blood. Patients with mechanical ventilation are more prone to immobilization because of the decrease of consciousness. Some researches had showed that the position change of patients with several conditions including mechanical ventilation increased the lung function thus resulting better blood oxygenation.Objectives: To compare the benefits of positioning patients with 600 HOB elevation to 300 HOB elevation by evaluating the PaO2 and PaO2/FiO2 ratio.Methods: This research was done with clinical trial using One Group Pretest Posttest. Patients was positioned first in the standard position (supine), elevation position Head of Bed (HOB) 300 and HOB 600. Then we measured the hemodynamic parameters, blood pressure, heart rate, respiratory parameters, peripheral O2 saturation and Blood Gas Analysis.Results: We obtained 21 subjects in this research 10 males and 11 females. We found significant increaseof PaO2 with elevation HOB of 600 compared to 300 (192.2 vs 160.7, p<0,05). The PaO2/FiO2 ratio showedsignificant increase in the HOB 600 (382.3 vs 322.2, p<0,05). The hemodynamic and respiratory parameters, we found that mean MAP, tidal volume, PIP and compliance in position of HOB elevation 600 were highercompared to the HOB elevation of 300 while the heart rate, resistance and PH were lower. But those differences were not statistically significant with p>0.05.Conclusion: The elevation head of bed 600 increase the PaO2 and PaO2/FiO2 ratio compared to the elevation head of bed 300 in patients with mechanical ventilation in ICU of RSUP Dr. Sardjito.

Manajemen Diabetes Insipidus pada Pasien Meningioma Pascakraniotomi Pengangkatan Tumor di Ruang Rawat Intensif Wisudarti, Calcarina Fitriani Retno; Jufan, Akhmad Yun; Yuliani, Irma
Jurnal Komplikasi Anestesi Vol 6 No 3 (2019): Volume 6 Number 3 (2019)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v6i3.7362

Surgery in the hypothalamic area is often accompanied by disturbances of water, electrolytes, and osmoregulation due to manipulation and vascular changes of the neurohypophysis. Over the last few decades, surgical approaches to craniopharyngioma have been developed. Initially, tumor resection was the treatment of choice but now evolved to minimally invasive surgery such as transphenoidal surgery. We reported a 58 years old female patient with suprasellar meningioma underwent removal tumor craniotomy. Patient was ASA 2 physical status with controlled Diabetes Mellitus type 2 non-obese. The operation was smooth and hemodynamically stable during surgery. Patient underwent post-surgery treatment in the ICU.During monitoring in the ICU, urin output of the patient was more than >2 cc/kgBB/hour. From the resultsof investigations, patient was diagnosed with Diabetes Insipidus. During the 6 days of ICU care, periodicexamination of serum and urin electrolytes and periodic fluid balances for monitoring, as well as the use ofvasopressin as a management of Diabetes Insipidus were conducted periodically. The patient improved after treatment for 6 days in the ICU, with urin output and electrolytes returning to normal without vasopressin.

Procalcitonin Sebagai Biomarker Diagnostik pada Pasien Sepsis yang Dirawat di ICU RSUP Dr. Sardjito Nur, Muhammad Ikhwan; Wisudarti, Calcarina Fitriani Retno; Rahardjo, Sri
Jurnal Komplikasi Anestesi Vol 10 No 3 (2022)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v10i3.7365

Latar Belakang: Sepsis adalah masalah kesehatan global, yang ditandai adanya disfungsi organ disebabkan oleh disregulasi respon inang dalam menanggapi infeksi mikroba. Insidensi dan mortalitas pasien sepsis yang dirawat di ICU masih cukup tinggi. Diagnosis dinisangat diperlukan untuk pengobatan yang efektif dan menghindari penggunaan antibiotikyang tidak perlu. Procalcitonin adalah biomarker yang menunjukkan nilai diagnostik yang lebih baik daripada penanda proinflamasi lainnya dalam mengidentifikasi pasien dengan sepsis dan dapat digunakan dalam diagnosis infeksi bakteri. Tujuan dari penelitian ini adalah untuk menentukan sensitivitas dan spesifisitas prokalsitonin sebagai biomarker pada pasien sepsis.Metode: Desain penelitian ini adalah retrospektif dengan menggunakan data rekam medis pada pasien yang dirawat di ICU RSUP Dr. Sardjito Yogyakarta periode Januari – Desember 2018. Uji diagnostik dilakukan pada pasien sespsis dan non-sepsis yang mengalami disfungsi organ sesuai dengan kriteria skor SOFA. Cutoff point procalsitonin ditentukan menggunakan analisis receiver operating characteristic (ROC). Analisis data dilakukan untuk mengetahui sensitivitas, spesisifitas, nilai duga positif, nilai duga negatif procalcitonin pada pasien sepsis.Hasil: Pada uji diagnostik procalcitonin pada pasien sepsis dengan cut-off point 3,27 ng/ml, didapatkan hasil sensitivitas 89,0%, spesifisitas 90%, nilai duga positif 90,1% dan nilai duga negatif 88,9%. Pada analisa ROC procalcitonin terhadap sepsis, didapatkan AUC 0,941 (AUC > 0,9).Kesimpulan: Procalcitonin juga memiliki nilai diagnostik yang baik sebagai biomarker pada pasien sepsis yang dirawat di ICU RSUP Dr. Sardjito. Procalcitonin memiliki kemampuan diskriminasi sangat kuat untuk pasien sepsis.

Procalcitonin Sebagai Biomarker Diagnostik pada Pasien Sepsis yang Dirawat di ICU RSUP Dr. Sardjito Nur, Muhammad Ikhwan; Wisudarti, Calcarina Fitriani Retno; Rahardjo, Sri
Jurnal Komplikasi Anestesi Vol 6 No 3 (2019): Volume 6 Number 3 (2019)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v6i3.7369

Latar Belakang: Sepsis adalah masalah kesehatan global, yang ditandai adanya disfungsi organ disebabkan oleh disregulasi respon inang dalam menanggapi infeksi mikroba. Insidensi dan mortalitas pasien sepsis yang dirawat di ICU masih cukup tinggi. Diagnosis dinisangat diperlukan untuk pengobatan yang efektif dan menghindari penggunaan antibiotikyang tidak perlu. Procalcitonin adalah biomarker yang menunjukkan nilai diagnostik yang lebih baik daripada penanda proinflamasi lainnya dalam mengidentifikasi pasien dengan sepsis dan dapat digunakan dalam diagnosis infeksi bakteri. Tujuan dari penelitian ini adalah untuk menentukan sensitivitas dan spesifisitas prokalsitonin sebagai biomarker pada pasien sepsis.Metode: Desain penelitian ini adalah retrospektif dengan menggunakan data rekam medis pada pasien yang dirawat di ICU RSUP Dr. Sardjito Yogyakarta periode Januari – Desember 2018. Uji diagnostik dilakukan pada pasien sespsis dan non-sepsis yang mengalami disfungsi organ sesuai dengan kriteria skor SOFA. Cutoff point procalsitonin ditentukan menggunakan analisis receiver operating characteristic (ROC). Analisis data dilakukan untuk mengetahui sensitivitas, spesisifitas, nilai duga positif, nilai duga negatif procalcitonin pada pasien sepsis.Hasil: Pada uji diagnostik procalcitonin pada pasien sepsis dengan cut-off point 3,27 ng/ml, didapatkan hasil sensitivitas 89,0%, spesifisitas 90%, nilai duga positif 90,1% dan nilai duga negatif 88,9%. Pada analisa ROC procalcitonin terhadap sepsis, didapatkan AUC 0,941 (AUC > 0,9).Kesimpulan: Procalcitonin juga memiliki nilai diagnostik yang baik sebagai biomarker pada pasien sepsis yang dirawat di ICU RSUP Dr. Sardjito. Procalcitonin memiliki kemampuan diskriminasi sangat kuat untuk pasien sepsis.

Perbandingan Induksi Propofol TCI Model Marsh Target Plasma 6 mcg/ml dan Bolus 2 mg/KgBB terhadap Keberhasilan Insersi LMA Supreme Iqbal, Muhammad; Yusmein; Wisudarti, Calcarina Fitriani Retno
Jurnal Komplikasi Anestesi Vol 6 No 3 (2019): Volume 6 Number 3 (2019)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v6i3.7373

Latar belakang: Laryngeal Mask Airway (LMA) adalah peralatan minimal invasif manajemen jalan napas supra glottis. LMA supreme merupakan LMA generasi kedua dengan inovasi desain dan strukturnya bertujuan untuk kemudahan insersi, meminimalisir rotasi dan tertekuk. Keberhasilan insersi LMA supreme membutuhkan kedalaman anestesi adekuat untuk menghasilkan relaksasi rahang dan supresi refleks jalan napas yang optimal. Hingga saat ini belum pernah ada penelitian yang membandingkan teknik induksi propofol TCImodel Marsh target plasma 6 mcg/ml dengan bolus 2 mg/kgBB terhadap keberhasilan insersi LMA supreme.Tujuan: Untuk mengetahui apakah teknik induksi propofol TCI model Marsh target plasma 6 mcg/ml memiliki keberhasilan insersi LMA supreme yang lebih tinggi dibanding bolus 2 mg/kgBB. Metode: Prospektif, uji acak terkendali pembutaan tunggal pada 60 pasien usia 18-60 tahun, status fisik ASA I atau II yang menjalani operasi elektif dengan teknik anestesi umum menggunakan LMA supreme. Dialokasikan secara random menjadi 2 kelompok, yaitu teknik induksi propofol TCI model Marsh target plasma 6 mcg/ml (n=30) dan bolus 2 mg/kgBB (n=30). Luaran primer adalah keberhasilan insersi, yaitu terpasangnya LMA pada usaha pertama tanpa menimbulkan pergerakan dan menghasilkan ventilasi yang adekuat. Luaran sekunder adalah respon hemodinamik saat terinduksi dan setelah insersi LMA serta kejadiantidak diinginkan dari masing-masing kelompok.Hasil: Didapatkan 2 pasien drop out di kelompok TCI dan 3 di kelompok bolus. Angka keberhasilan insersi LMA kelompok TCI lebih tinggi secara bermakna dibanding kelompok bolus, 89.3% vs 66.7% (p<0.05). Semua variabel respon hemodinamik kedua kelompok pada saat post induksi dan post insersi mengalami penurunan dari nilai awal dengan perbandingan penurunan kedua kelompok tidak bermakna secara statistik (p>0.05). Didapatkan kejadian tidak diinginkan berupa hipotensi sebanyak 1 kasus (3.6%) pada kelompok TCI dan 3 kasus (11.1%) pada kelompok bolus (p>0.05).Kesimpulan: Angka keberhasilan insersi LMA supreme dengan induksi propofol teknik TCI model Marsh target plasma 6 mcg/ml lebih tinggi dibanding bolus 2 mg/kgBB.

Hubungan Nilai “Lung Ultrasound Score (LUS)” dengan P/F Ratio pada Pasien Pneumonia yang Dirawat di ICU RSUP Dr Sardjito Wibowo, Catur Prasetyo; Wisudarti, Calcarina Fitriani Retno; Jufan, Akhmad Yun
Jurnal Komplikasi Anestesi Vol 7 No 2 (2020): Volume 7 Number 2 (2020)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v7i2.7448

Background: Respiratory tract disease (about 22.4%) is the frequent reason of admitting patients to the Intensive Care Unit (ICU), with 72.6% of it is caused by infection, such as pneumonia. On patient with pneumonia, there will be impairment in oxygen diffusion from alveoli to the blood flow that can affect the P/F ratio. Lung ultrasonography is directly proportional to the degree of pulmonary aeration or the ratio of air to liquid composition in the lung. Changes in pulmonary aeration can be detected accurately using pulmonary ultrasonography. Objectives: Knowing the relationship of “Lung Ultrasound Score (LUS)” with P/F ratio as a parameter to assess the degree of oxygenation in pneumonia patients treated at ICU Dr. Sardjito General Hospital. Methods: The design of this study was cross sectional study. In this study, every single sample will be examined only one time to obtain Lung Ultrasound Score (LUS) and arterial blood gas analysis (BGA) sampling to get the P/F ratio. LUS measurement was done by performing pulmonary ultrasonography at 12 predetermined examination points (6 in the left hemithorax and 6 in the right hemithorax) then scoring (0-3) per examination point, the total scoring from the 12 examination points is the result of the LUS sample. Inclusion criteria in the subjects of this study were >18 years of age, diagnosed pneumonia (score ≥6 from CPIS score), intubated with mechanical ventilation, and the candidate could be mobilized slightly right and left incline. While exclusion criteria were, patients with unstable hemodynamics (HR <60x / min or>130x / min and MAP <70mmHg or>120mmHg), pulmonary trauma, patients undergoing hemodialysis, there are contraindications to the oblique position (spinal cord injury), patients with wound dressing on the chest, and patients with morbid obese (BMI> 40). Results: There were 60 subjects in this study. Patient observation pointed that have high P/F ratio values tend to have lower Lung Ultrasound Score (LUS) values. Based on the correlation results, the value of p = 0.010 (p <0.05) with the correlation coefficient (r) = -0.332 had a negative sign which means there is a significant negative correlation between the value of Lung Ultrasound Score (LUS) with the P / F ratio with the closer relationship of the category weak (0.2 - 0.399). Conclusion: The higher the P/F ratio, the lower the LUS value in patients with pneumonia who were getting mechanical ventilation in ICU Dr. Sardjito.

Manajemen Extracorporeal Membrane Oxygenation (ECMO) pada Pasien COVID-19 Derajat Kritis Synthana, Meta Restu; Kurniawaty, Juni; Wisudarti, Calcarina Fitriani Retno
Jurnal Komplikasi Anestesi Vol 10 No 2 (2022)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v10i2.8304

We reported 42 years old male patient with weight 84 kg, height 167 cm, and BMI of 30.1 kg/m2 with a diagnosis of severe COVID-19 and ARDS. The patient was previously known to have comorbids of type 2 DM, stage 1 hypertension, cardiac arrhythmias, and grade 1 obesity. On the 7th day of care, the patient clinically and radiologically worsened and we decided to intubate and support with mechanical ventilation. An ECMO indication was assessed, the patient was indicated to have ECMO, so that ECMO was installed immediately after the patient was intubated. ECMO was successfully running 7 hours after the patient was intubated. During hospitalized the patient also received renal replacement therapy, hemadsorption therapy, and plasma exchange. The patient deceased on 31st day of ECMO.

Manajemen Anestesi pada Percutaneus Endoscopic Lumbar Discectomy (PELD) dengan Dexmedetomidine Sari, Djayanti; Wisudarti, Calcarina Fitriani Retno; Ferdiansyah, David
Jurnal Komplikasi Anestesi Vol 10 No 1 (2022)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v10i1.8323

The patient is 49 years old with a diagnosis of Hernia Nucleosus Pulposus (HNP) 4-5 lumbar vertebrae. The patient was scheduled to undergo the PELD procedure. The anesthetic technique used is total intravenous anesthesia (TIVA) with dexmedetomidine. The dose used is loading 1 mcg per kg body weight in 10 minutes followed by titration of 0.2-0.7 mcg/kg body weight/hour. During the procedure the operator requires confirmation from the patient to prevent complications of nerve injury. The action lasts about 2 hours in the prone position. The level of sedation was assessed by the Ramsay scale score. Hemodynamics during the procedure is stable and the patient is quite comfortable.

Hubungan Indeks ROX dengan Mortalitas Pasien COVID-19 di RSUP Dr. Sardjito Naomi, Diah Anis; Wisudarti, Calcarina Fitriani Retno; Widodo, Untung
Jurnal Komplikasi Anestesi Vol 10 No 1 (2022)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v10i1.8327

Background: In December 2019, a new infectious disease caused by a corona virus named SARS-CoV-2 emerged. COVID-19 disease causes multi-organ failure that occurs in the lungs and extra-pulmonary, sepsis, and even death. Pulmonary disorders that often occur in COVID-19 patients are ARDS. Early recognition of ARDS can be done by assessing the clinical condition of the patient and the parameters of RR and SpO2. ROX is a calculation of Index (SpO2/FiO2)/RR. The ROX index may be one of the predictors of mortality in COVID-19 patients. Methods: An observational study with a retrospective cohort approach to COVID19 patients who were hospitalized at Sardjito General Hospital in July 2020 to June 2021. Patients with COVID-19 without oxygen therapy or with nasal cannula oxygen therapy, NRM, or HFNC who were hospitalized, the ROX Index were calculated on the first day of treatment and then assessed for patient mortality and length of stay. The data was taken from medical records at the Medical Records Installation at Sardjito General Hospital. Results: There were 953 research subjects with average age of 51 (± 15.5) years old, 479 women (50.3%) and 474 men (49.7%). There was a significant relationship between the ROX index 15.06 and the mortality of COVID-19 patients (p < 0.001, HR = 2.15, 95% CI 1.57-2.94). Other factors related to mortality in COVID-19 patients were age, oxygen therapy with HFNC, hypertension, diabetes mellitus, chronic kidney failure, and cardiovascular disease. The survival time of subjects with an ROX index of 15.06 was 24 days, shorter than the index group > 15.06, which was 31 days (p < 0.001). The ROX index did not have a significant relationship with the length of stay in the hospital. The average length of stay in the ROX 15.06 index group was 17 days, longer than the > 15.06 index group, which was 14 days (p=0.002). Factors related to length of stay were age ³ 65 years, history of hypertension and diabetes mellitus. Conclusion: There was a significant association of ROX index and mortality of COVID-19 patients at Sardjito General Hospital.

Diagnosis dan Tata Laksana Sepsis Maternal Jufan, Akhmad Yun; Wisudarti, Calcarina Fitriani Retno; Atmanagara, Dikho
Jurnal Komplikasi Anestesi Vol 10 No 1 (2022)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v10i1.8328

Maternal sepsis is a common and potentially preventable cause of direct maternal death globally. A barrierto further progress has been the lack of consensus on the definition of maternal sepsis. Recognition and treatment of maternal sepsis are often delayed due to the physiological adaptations of pregnancy and vague or absent signs and symptoms during its initial presentation. Over the past decade, our understanding of sepsis has evolved and maternal early warning systems have been developed in an effort to help providers promptly identify and stratify parturients who are at risk. In addition, new consensus definitions and care bundles have recently been published by the World Health Organization and the Surviving Sepsis Campaign to facilitate earlier recognition and timely management of sepsis. Standardizing the criteria for maternal sepsis optimizes clinical finding. It may facilitate the evaluation of the role of different clinical parameters and biomarkers in the diagnosis, earlier recognition and management of maternal infection and sepsis. Further work is required to develop an international consensus on the criteria for diagnosing maternal sepsis and any associated organ dysfunction. In this narrative review, we summarize the available evidence about sepsis and provide an overview of the research efforts focused on maternal sepsis to date.

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