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All Journal SAINS MEDIKA : JURNAL KEDOKTERAN DAN KESEHATAN Jurnal Anestesiologi Indonesia Jurnal Anestesi Perioperatif Medica Arteriana (Med-Art) Journal of Anaesthesia and Pain Asian Journal of Social and Humanities Jurnal Komplikasi Anestesi
Calcarina Fitriani Retno Wisudarti
Departemen Anestesiologi Dan Terapi Intensif Fakultas Kedokteran Universitas Gadjah Mada/RSUP Dr. Sardjito Yogyakarta
Decision Sciences, Operations Research & Management Earth & Planetary Sciences Education Environmental Science Health Professions Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Public Health

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THE RELATIONSHIP OF LACTATE-ALBUMIN RATIO TO MORTALITY AND LENGTH OF STAY IN SEPSIS PATIENTS AT ICU DR. SARDJITO GENERAL HOSPITAL Pasmawati, Desti; Wisudarti, Calcarina Fitriani Retno; Adiyanto, Bowo
Jurnal Komplikasi Anestesi Vol 12 No 1 (2024)
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.v12i1.15961

Abstract

Background : Sepsis is one of the causes of morbidity and mortality patients hospitalized in the intensive care unit (ICU) which requires early detection and management to predict outcomes. An increase in lactate together with decrease in albumin is encountered in severe inflammatory states. Lactate-albumin ratio has a predictive value of mortality in patient with sepsis that is similar to APACHE II and SOFA scores. These biomarkers can be done quickly, affordable, and available in many hospitals in Indonesia. Objective : To determine the relationship between the lactate-albumin ratio and mortality and length of stay patient with sepsis in ICU of Dr. Sardjito Hospital. Method : Research design using a retrospective cohort observational study method by collecting data from the medical records of sepsis patients treated at ICU of Dr. Sardjito Hospital. Data on lactate and albumin in plasma levels at admission and mortality events were collected to calculate the optimal cutoff using the ROC curve. The relationship between lactate-albumin ratio levels and mortality was analyzed using the chi-square test method followed by logistic regression in multivariate analysis. Results : The total study subjects were 136 patients, wuth a median age of 55 years. The cut-off value for the Lactate-Albumin ratio in predicting mortality was found to be 0,878, with a sensitivity of 73.0 % and a specificity of 57.1% (AUC = 0,687; 95% CI 0,56-0,81; p=0,007). The cut-off value for the Lactate-Albumin ratio in predicting ICU length of stay was found to be 0,878, sensitivity 71,2% and specificity 63,6% (AUC = 0,684; 95% CI 0,53-0,84; p=0,043). Multivariate analysis showed that an increase in the Lactate-Albumin ratio was an independent and significant factor as a predictor of mortality (OR=3,43; 95% CI 1,29-9,16; p=0,013) and ICU length of stay (OR=4,33; 95% CI 1,19-15,68; p=0,036). Age, sex, hypertension, diabetes mellitus, cancer, obesity, and cerebrovascular disease were not independently associated with mortality dan ICU length of stay. Conclusion : An increase in the Lactate-Albumin ratio is independently and significantly associated with an increased risk of mortality and length of stay in sepsis patients.
Prevention and Management of Stress Ulcers in Critically ill Patients Zulfakhri, Zulfakhri; Jufan, Akhmad Yun; Wisudarti, Calcarina Fitriani Retno
JAI (Jurnal Anestesiologi Indonesia) Vol 16, No 3 (2024): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.61232

Abstract

Stress ulcers or stress related mucosal damage (SRMD) is a term defining inflammation, erosion, and ulceration in the upper gastrointestinal tract complicating patients with critical illness. Stress ulcers occur because of imbalance between the aggressive factors in stomach (gastric acid, pepsin, and bile salt) and the defensive factors (mucous, bicarbonate, microcirculation, epithelial layer, and prostaglandin). The most common clinical feature of stress ulcers is upper gastrointestinal tract bleeding in which the incidence rate is 2.6% in critically ill patients. Stress ulcers commonly happen after a gastrointestinal mucosal break in 75–100% of intensive care unit (ICU) patients in the first 24 hours of admission. The classification of stress ulcers includes asymptomatic stress ulcers, stress ulcers with occult and overt bleeding, and stress ulcers with clinically significant gastrointestinal bleeding. The diagnosis of stress ulcers can be made by assumption only and do not need an endoscopy. Some cases of stress ulcers that need an endoscopy are patients with overt and clinically significant gastrointestinal bleeding stress ulcers. Thus, the treatment of stress ulcers is similar to upper gastrointestinal bleeding. Stress ulcers can be prevented by administering stress ulcers prophylaxis such as histamine H2 receptor antagonist, proton pump inhibitor, cytoprotective agent (sucralfate), and usage of enteral feeding method.
Management of Adult-Onset Still's Disease Patients in Intensive Care Unit: a Case Report Andriani, Ika Jati Setya; Rakhmatjati, Pradana Bayu; Wisudarti, Calcarina Fitriani Retno; Widodo, Untung
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 1 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.65781

Abstract

Background: Adult-onset Still's disease (AOSD) is a rare inflammatory disorder characterized by the classic triad of fever, arthritis, and evanescent rash. AOSD is a multi-systemic disorder with unclear etiology. Glucocorticoids are the first line treatment for AOSD, and disease-modifying anti-rheumatic drugs (DMARDs) are often used in some patients with a poor response to glucocorticoids. Parenchymal lung involvement in AOSD is rare (only 5% of AOSD), one of them is acute respiratory distress syndrome (ARDS), where ARDS is the most severe complication. Management of such conditions in the intensive care unit (ICU) is crucial.Case: A 25-year-old woman came with unresolved fever for one week which was preceded by joint pain and reddish spots on the skin. The patient was diagnosed as AOSD complicated with ARDS due to pneumonia which kept the patient in the ICU for 24 days.Discussion: AOSD is a multigenic auto-inflammatory disorder involving the innate and adaptive immune systems. Based on Yamaguchi's criteria, the patient was diagnosed with AOSD where there was a high fever that lasted more than a week, arthritis, salmon rash, leucocytosis, sore throat, splenomegaly, alanine aminotransferase (ALT) abnormalities, and negative antinuclear antibodies (ANA) test. The first-line therapy given was methylprednisolone, doses were tapered gradually. As the patient didn't respond to therapy, she was then given immunosuppressive therapies such as cyclosporine, hydroxychloroquine and underwent therapeutic plasma exchange (TPE). The patients responded to treatments and showed good laboratory results.Conclusion: This case report describes a patient with AOSD that was diagnosed based on clinical manifestations and Yamaguchi criteria. The patient improved clinically with high dose administration of corticosteroids, immunosuppressive agents, and TPE. Making a correct diagnosis and starting an appropriate treatment as soon as feasible is crucial in this case as the patient suffers complications.
Nutrition Therapy in Post-Hartmann’s Procedure Patients in The Intensive Care Unit Palupi, Isnafianing; Adiyanto, Bowo; Wisudarti, Calcarina Fitriani Retno
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 2 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.67337

Abstract

Background: The Hartmann procedure is a surgical procedure for treating colorectal cancer that is widely used in emergencies because it is fast and has a minimal risk of anastomotic leakage. This procedure is usually performed on rectosigmoid cancer. Colorectal cancer patients who undergo gastrointestinal surgery are considered at risk of malnutrition, so adequate nutritional therapy is needed.Case: We report a 51-year-old male patient who came to the intensive care unit (ICU) with an unconscious condition, was intubated, received Norepinephrine support, and had a reddish black product in the nasogastric tube (NGT). The patient was referred with a diagnosis of post-operative Hartmann’s procedure day-3 (D-3) for indications of high obstructive ileus due to rectosigmoid tumor, septic shock, acute kidney injury (AKI), and peptic ulcer. During treatment in the ICU, the patient received antibiotic therapy (Meropenem and Metronidazole), proton pump inhibitors (PPIs), and parenteral nutrition via a central venous catheter (CVC).Discussion: Parenteral nutrition was given from the beginning of admission to the ICU because oral and enteral nutrition could not be provided due to gastrointestinal bleeding (peptic ulcer). Moreover, the patient was considered at risk of malnutrition with evidence of critical illness more than 48 hours post-gastrointestinal surgery due to cancer. Also, there was a post-operative fasting period, usually for several hours to 1-2 days, depending on the patient's condition.Conclusion: Nutritional therapy, as part of the management of critically ill patients, should be given at the right time, in the most effective way, and in appropriate doses for each individual to avoid malnutrition during treatment.
Fluid Management for Critically Ill Patients, Based on the ROSE Concept, an Old Method but Effective Enough Agustina, Ayu Yesi; Wisudarti, Calcarina Fitriani Retno; Widodo, Untung
Journal of Anaesthesia and Pain Vol. 5 No. 1 (2024): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2024.005.01.02

Abstract

Fluid therapy is one of the most essential things in managing critical patients, such as ICU patients. Although it seems simple, this is difficult to do in this group of patients. The fluid needs of ICU patients vary according to the course of the disease. Therefore, fluids must be given according to individual needs, and each phase of the disease must be reassessed. To support this, there is a conceptual model that explains fluid administration based on the phases of the disease that the patient is going through. The ROSE concept (resuscitation, optimization, stabilization, and evacuation) describes the phases of a patient's illness and how fluids should be administered. In the resuscitation phase, the goal is lifesaving and is achieved by positive fluid balance. In the optimization phase, fluid balance is neutral and aims to save organs. In the stabilization phase, the fluid balance has started to move in a negative direction and aims to support the organs. Finally, in the evacuation phase, fluid balance is negative and organ repair has occurred. By implementing this model, it is hoped that ICU patients will have better outcomes
The comparison score of SPEEDS, MEDS, SOFA, APACHE II, and SAPS II as predictor of sepsis mortality: A Systematic Review Maryani, Nova; Wisudarti, Calcarina Fitriani Retno
Asian Journal of Social and Humanities Vol. 2 No. 1 (2023): Asian Journal of Social and Humanities
Publisher : Pelopor Publikasi Akademika

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59888/ajosh.v2i1.116

Abstract

We performed the comparison of characteristics and values under the curve, including Sepsis Patient Evaluation Emergency Department Score (SPEEDS), Mortality in Emergency Department Sepsis (MEDS), Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Simplified Acute Physiology Score (SAPS II). We searched PubMed, Science direct, ProQuest, and EBSCO for identify full-text English-language papers published between 2012-2022. We discovered that each of the five-scoring lead to mortality forecasts in sepsis patients. MEDS predicted mortality in sepsis patients better than SAPS II after 28 days but the SPEEDS was more accurate than MEDS. The SOFA score predicts mortality better than the APACHE II. APACHE II has lesser validity than SAPS II. The AUC SOFA scores have greater in diagnosing sepsis patients’ mortality than other scores. However, they are overstated, inefficient, and non-cost-effective, making SOFA scoring unfavourable in enhancing healthcare quality.
Co-Authors Agustina, Ayu Yesi Akhmad Yun Jufan Akhsaniati, Novi Dwi Andriani, Ika Jati Setya Anggraini, Diana Anindita, Triatma Anisa Fadhila Farid Atmanagara, Dikho Bambang Suryono, Bambang Baskoro, Windu Adi Bayu, Timor Krisna Bhirowo Yudo Pratomo Bowo Adiyanto Daniswara Dian Ayu Listiarini Djayanti Sari Ferdiansyah, David Gupta, Adista Yugadhyaksa Helen Yudi Irianto, Helen Yudi Ikhsan, Isroful Jufan, Ahmad Yun Juni Kurniawaty Muhdar Abubakar Djayanti Sari Krisdiyantoro, Nova Krisna Bayu, Timor Krispratama, Avian Kuncoro, Kusuma Edhi Kusumasari, Nur Hesti Loho, Irvan Revaldi Mahardieni, Karlina Maryani, Nova Meta Restu Synthana Mi’raj, Geza Getar Mochammad Imron Awalludin Mustikawati, Siti Rakhmah Naomi, Diah Anis Nasution, Rusdi Anwar Negara, Adista Yugadhyaksa Gupta Nova Maryani Nova Maryani Nugraha, Achmad Fauzani Nur, Muhammad Ikhwan Palupi, Isnafianing Pasmawati, Desti Pradana, Gilar Rizki Aji Prasamya, Erlangga Pratomo, Bhirowo Yudho Rahman, Farhan Ali Rakhmatjati, Pradana Bayu Ratih Kumala Fajar Apsari Ridha, Ihsanur Sadiyanto, Dewang Sari, Ayu Rosema Setiandari, Kristina Siti Helmyati Sri Rahardjo Sudadi Taneo, Desy Chery Marlyn Trijayanti, Christiana Untung Widodo Untung Widodo, Untung Utami, Vengky Utomo, F uad Cipto Utomo, Wandito Gayuh wandito, Gayuh Utomo Wibowo, Catur Prasetyo Yuliani, Irma Yunita Widyastuti Yusmein Yusmein Uyun Zulfakhri, Zulfakhri