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All Journal Majalah Kesehatan FKUB Amerta Nutrition Jurnal Respirologi Indonesia Journal of Anaesthesia and Pain Respiratory Science Jurnal Klinik dan Riset Kesehatan
Arie Zainul Fatoni
Bagian/SMF Anestesi dan Terapi Intensif Fakultas Kedokteran Universitas Brawijaya / RSU dr Saiful Anwar Malang
Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology Nursing Public Health Other

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Managemen Continuous Renal Replacement Therapy (CRRT) pada Pasien Gagal Ginjal Akut dan Syok Sepsis di ICU Fatoni, Arie Zainul; Rusly, Andri; Hartono, Ruddi
Jurnal Klinik dan Riset Kesehatan Vol 2 No 2 (2023): Februari 2023
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.02.2.7

Abstract

Angka Kejadian sepsis sekitar 6% pasien yang ada di rumah sakit. Sepsis yang tidak tertangani dengan baik akan berkembang menjadi syok septik yang akan meningkatkan mortalitas sebesar 50 – 70 %. Gagal Ginjal Akut (GGA) terjadi pada 58-87% pasien dengan syok sepsis. Pada 70% kasus GGA yang disebabkan oleh sepsis dapat memburuk dan memerlukan renal replacement therapy (RRT). Continuous Renal Replacement Therapy (CRRT) merupakan salah satu modalitas RRT yang baik untuk pasien syok septik. Seorang Laki-laki berusia 51 tahun, rujukan dari ICU Rumah sakit lain dengan diagnosa respiratory failure, syok sepsis, pneumonia Hospital Assosiated Pneumonia (HAP), diabetic foot dengan osteomyelitis pedis dextra, GGA Stage 3 dan Diabetes Mellitus (DM) Tipe 2. Dari klinis pasien sesak, penurunan kesadaran, disertai syok yang membutuhkan vasopressor dan dari laboratorium didapatkan ureum 277 mg/dl serta foto thorax didapatkan kesan pneumonia. Tatalaksana pada pasien ini dilakukan pemberian antibiotik, amputasi kaki kanan dan CRRT sebagai modalitas terapi GGA. CRRT dilakukan dengan mode Continuous Venovenous Hemodialysis elama 3 hari. Pada hari ke lima klinis pasien membaik sehingga dapat pindah keluar dari ICU. Pada kondisi syok sepsis dengan GGA, CRRT dapat menjaga stabilitas hemodinamik pasien, mengeluarkan toksin dari ginjal, menyaring sitokin dan endotoksin, mengoreksi asam-basa dan elektrolit, mengontrol volume cairan dengan tepat, memodulasi respon imun sehingga mempercepat renal recovery dan memperbaiki kondisi klinis pasien.
FAKTOR RISIKO AKUISISI BAKTERI CARBAPENEM-RESISTANT Acinetobacter baumannii PADA PASIEN DENGAN VENTILATOR ASSOCIATED PNEUMONIA Santosaningsih, Dewi; Yusuf, Evira Natasya; Fatoni, Arie Zainul
Majalah Kesehatan Vol. 11 No. 1 (2024): Majalah Kesehatan
Publisher : Faculty of Medicine Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/majalahkesehatan.2024.011.01.1

Abstract

Carbapenem-resistant Acinetobacter baumanii (CRAB) merupakan bakteri patogen prioritas penyebab Ventilator Associated Pneumonia (VAP) dengan pilihan antibiotik terbatas sehingga meningkatkan angka kematian dan biaya perawatan. Di Indonesia, faktor yang menentukan penularan bakteri CRAB pada pasien VAP belum diketahui. Penelitian ini bertujuan untuk menganalisis faktor risiko akuisisi bakteri CRAB pada pasien VAP yang meliputi gender, umur, durasi penggunaan ventilator mekanik, durasi perawatan di Intensive Care Unit (ICU), riwayat intubasi ulang, riwayat penyakit penyerta, durasi terapi antibiotik meropenem, dan skor APACHE II. Penelitian case-control dilakukan sejak bulan Juni 2018 hingga Juni 2019 di RSUD Dr. Saiful Anwar Malang. Pada penelitian ini sebanyak 12 orang pasien VAP dengan akuisisi bakteri CRAB sebagai kelompok kasus dan 12 pasien VAP dengan akuisisi Carbapenem-susceptible Acinetobacter baumannii (CSAB) sebagai kelompok kontrol dianalisis faktor risikonya. Hasil penelitian menunjukkan durasi perawatan di ICU lebih dari 8 hari (OR = 10, 95%CI = 1,360-81,053; p = 0,024) serta durasi terapi meropenem lebih dari 5 hari (OR = 17,9, 95%CI = 1,267-250,000; p = 0,032) berhubungan dengan akuisisi CRAB pada pasien VAP. Kesimpulan penelitian ini bahwa perawatan di ICU lebih dari 8 hari dan penggunaan meropenem lebih dari 5 hari merupakan faktor risiko akuisisi CRAB pada pasien VAP. Tindakan pencegahan akuisisi CRAB sangat penting pada pasien yang terpasang ventilator mekanik di ICU.
Succesful Continuous Renal Replacement Therapy (CRRT) for Acute Kidney Injury (AKI) with Septic Shock Underwent Long Coronary Artery Bypass Graft Procedure (CABG) Pertiwi, Previasari Zahra; Fatoni, Arie Zainul; Agustina, Ayu Yesi; Jaya, Wiwi
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.2024.005.01.05

Abstract

Background :AKI occurs in significant numbers of patients undergoing cardiopulmonary bypass surgery for coronary artery disease. Patient with AKI requiring renal replacement therapy (RRT) after cardiac surgery were at a higher risk of postoperative mortality. One of mode of RRT is CRRT. CRRT can keep hemodynamic of the patient stable, excellent control of azotemia, sypport beneficial immunomodulation,increase clearance of inflammatory mediators and potentially less ongoing or repeated renal ischaemia. As an alternative to traditional intermittent hemodialysis, CRRT has now emerged as the leading form of RRT for patients with AKI post CABG because the CRRT can keep hemodynamic still stable.Case: We report a case report of patient who had long aorta cross clamp in CABG procedure. He got AKI with shock condition during hospitalization in ICU, had been done with CRRT and had good response after the procedure.Discussion: The  incidence  of AKI  after  cardiac  surgery in this patient  may  increase  with several risk factors, such as surgical bleeding, diabetes mellitus, pre operative renal dysfunction, low  LVEF,  the use of CPB machine and infection. An  imbalance  between  renal oxygen  supply  and  oxygen demand will induce AKI. This patient had done CRRT and showed good clinical and laboratory condition after that. Conclusion : CRRT is a good choice for AKI patient post CABG procedure with shock condition.
Pengaruh Nutritional Support terhadap Luaran Klinis pada Pasien Intensive Care Unit: Effect of Nutritional Support on Clinical Outcomes of Intensive Care Unit Patients Harti, Leny Budhi; Dini, Cleonara Yanuar; Fatoni, Arie Zainul
Amerta Nutrition Vol. 8 No. 2 (2024): AMERTA NUTRITION (Bilingual Edition)
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/amnt.v8i2.2024.328-334

Abstract

Background: Nutritional support is a globally acknowledged standard of care for critically ill patients, forming an integral component of clinical therapy in Intensive Care Units (ICUs) to enhance overall clinical outcomes. Objectives: This study aimed to assess the impact of enteral nutritional support on clinical outcomes in ICU patients. Methods: This research adopted a systematic review approach, focusing on Randomized Controlled Trial (RCT) studies conducted between 2010 and 2020. The review adhered to the PRISMA guidelines. The clinical outcomes studied included length of stay in the hospital, length of stay in the ICU, and mortality. Discussion: Among 897 reviewed articles, only 6 articles were relevant. The study respondents were ICU in patients who received enteral formula, both in the control and intervention groups. The intervention group received an enteral formula featuring modified energy (normocaloric and high protein) and nutrients (enriched with pectin and immunse-modulating nutrients). Nutritional support in the form of enteral nutrition has varying effects on the length of hospitalization, ICU, and mortality. Conclusions: No significant difference was observed in ICU and hospital stays between patients receiving standard enteral/hypocaloric/high protein nutrition and those receiving enteral nutrition enriched with pectin or immune-modulating nutrients. However, patients receiving enteral nutrition with immune-modulating nutrients experienced a reduced length of hospitalization. The administration of immune-modulating nutrients was associated with an increased risk of mortality at 60 and 28 days in critically ill patients.
Pneumomediastinum and Spontaneous Subcutaneous Emphysema in COVID-19 Patients Using High-Flow Nasal Cannula (HFNC) Suhadayanti, Rizki; Fatoni, Arie Zainul; Jaya, Wiwi; Asmoro, Aswoco Andyk
Jurnal Respirologi Indonesia Vol 44, No 2 (2024)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v44i2.448

Abstract

Background: Spontaneous pneumothorax, pneumomediastinum, and subcutaneous emphysema are rare complications that occur without mechanical ventilation, namely 0.81% of all COVID-19 patients. During the COVID-19 pandemic, high-flow nasal cannulas (HFNC) were used to support respiratory failure in critically ill patients. However, there have been no clinical trials explaining its safety and effectiveness. Hypoxemic normocapnic respiratory failure is an indicator of HFNC use. This study reports a case of associated spontaneous subcutaneous pneumomediastinum and emphysema in a COVID-19 patient using HFNC.Case: A 30-year-old male patient came to the hospital with a chief complaint of increasingly severe shortness of breath and confirmed COVID-19. Physical examination revealed a good airway, spontaneous breathing with a frequency of 28 times/minute; SpO2 of 97% with HFNC Flow 60 and FiO2 60%; blood pressure of 102/69 mmHg; and heart rate of 65 beats per minute. On the second day of treatment in the ICU, the patient did not experience desaturation or hypotension. Patent airway, spontaneous breathing, and oxygenation initiated using NRM 10lpm with a target SpO2 of 97%, RR at 30-32x/minute. On the fifth day, desaturation and hypotension were no longer observed.Discussion: Real-Time Reverse Transcriptase (RT)–PCR Diagnostic Panel detects SARS-CoV-2 in respiratory samples. Chest CT scans show viral pneumonia. Subcutaneous emphysema (SE) and pneumomediastinum cause breathing issues. Severe COVID-19 is treated with antivirals, vitamins, and oxygen therapy. Pneumomediastinum or subcutaneous emphysema may occur due to prolonged non-invasive ventilation but is generally self-limited.Conclusion: Clinical improvement was found in COVID-19 patients with pneumomediastinum and spontaneous subcutaneous emphysema using HFNC.
Correlation Between Coinfection of Severe and Critically Ill COVID-19 Patients In Intensive Care Unit with Leucocyte, Neutrophil, CRP, Procalcitonin and Length of Stay Prayitno, Harman; Sugiri, Yani Jane; Astuti, Tri Wahju; Fatoni, Arie Zainul; Hastuti, Nurima Diyah Puji
Respiratory Science Vol. 5 No. 2 (2025): Respiratory Science
Publisher : Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/respirsci.v5i2.167

Abstract

Background: Severe or critical COVID-19 infections are linked to admissions in the intensive care unit (ICU), which increases the risk of coinfection and results in a worsened prognosis. This research seeks to evaluate the relationship between bacterial and fungal coinfection in COVID-19 and leukocyte, neutrophil, C-Reactive Protein (CRP), procalcitonin levels, length of stay, and outcome (whether the patient was discharged from ICU to the ward or died). Method: This research constitutes a retrospective cohort analysis. Data was collected from the medical records of patients admitted to the ICU of Saiful Anwar General Hospital in Malang from August 2020 to August 2021, who tested positive for COVID-19. A total of 352 individuals qualified according to the inclusion criteria. Results: Coinfection occurred in 22.2% of COVID-19 patients, with bacterial 84.61%, fungal 11.53%, and both bacterial and fungal 3.84%. The average stay for patients without coinfection was 6 days, while it was 13 days for those with coinfection. We also observed a rise in mortality rate for coinfection at 71.8% compared to 31% for non-coinfection. Coinfection with bacterial, fungal, or both types in COVID-19 shows a positive correlation with Leucocyte (P=0.001; r=0.356), Neutrophil (P=0.001; r=0.438), CRP (P=0.003; r=0.164) and Procalcitonin (P=0.001; r=0.192) as well as a positive correlation with the length of stay (P=0.001) and a negative correlation with the outcome (P=0.001). Conclusion: Coinfection occurred in just about one-fifth of COVID-19 patients. We suggest prescribing antimicrobials only when there is a compelling reason. Timely detection of bacterial and fungal coinfection was essential to identify high-risk patients and determine appropriate interventions to prevent longer hospital stays and reduce mortality.
Diabetes Insipidus in Severe Traumatic Brain Injury Patient: A Case Report Zaelany, Allief Ilman; Fatoni, Arie Zainul
Journal of Anaesthesia and Pain Vol. 6 No. 1 (2025): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/

Abstract

Background: Traumatic brain injury (TBI) contributes to significant morbidity and mortality. It leads to neuronal and vascular damage that can disrupt the function of the hypothalamus and pituitary gland, sometimes resulting in diabetes insipidus (DI). This study aims to examine DI as a complication of severe TBI and seeks to emphasize the importance of appropriate diagnosis, intervention, and monitoring to reduce the risk of mortality from TBI with DI. Case: We present a case of a severe TBI patient who had a traffic accident, resulting in subdural hematoma (SDH), subarachnoid hemorrhage (SAH), and ala magna fracture of the sphenoid bone. On the fourth day of treatment (the second day in the ICU), the patient experienced DI, characterized by a urine output rate of 4.2 cm3/kg/hour and hypernatremia (147 mmol/l). The patient was treated with fluid resuscitation and desmopressin. Symptoms improved after eight days of treatment, characterized by a urine output rate of 2.8 cm³/kg/hour and a serum sodium level of 159 mmol/l. This showed significant clinical improvement. On the tenth day, urine output returned to normal, with a lower serum osmolality, and the patient was discharged from the hospital. Conclusion: DI, as a severe complication of TBI, has the potential to increase mortality. This case underscores the importance of early detection, appropriate treatment, and ongoing monitoring to improve prognosis and reduce the risk of death associated with DI after traumatic brain injury (TBI).
Managemen Continuous Renal Replacement Therapy (CRRT) pada Pasien Gagal Ginjal Akut dan Syok Sepsis di ICU Fatoni, Arie Zainul; Rusly, Andri; Hartono, Ruddi
Jurnal Klinik dan Riset Kesehatan Vol 2 No 2 (2023): Februari 2023
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.02.2.7

Abstract

The incidence of sepsis is around 6% of patients in the hospital. Sepsis that is not manage properly will develop into septic shock which will increase mortality by 50-70%. Acute Renal Failure (ARF) occurs in 58-87% of patients with septic shock. In 70% of cases of ARF caused by sepsis can worsen and require renal replacement therapy (RRT). Continuous Renal Replacement Therapy (CRRT) is a good RRT modality for septic shock patients. A 51 year old male, referred from the ICU another hospital with a diagnosis of respiratory failure, septic shock, Hospital Associated Pneumonia (HAP), diabetic foot with osteomyelitis pedis dextra, ARF Stage 3 and Type 2 Diabetic Mellitus (DM). From the clinical sign, patient was shortness of breath, decreased consciousness, accompanied by shock requiring a vasopressor and from the laboratory obtained urea 277 mg/dl and chest X-ray obtained the impression of pneumonia. The management of this patient was administration of antibiotics, amputation of the right leg and CRRT as a therapeutic modality for ARF. CRRT was performed in Continuous Venovenous Hemodialysis (CVVHDF) mode for 3 days. On the fifth day the patient conditiont improved so he could be discharge from the ICU. At septic shock with ARF, CRRT can maintain hemodynamic stability of patients, remove toxins from the kidneys, remove cytokines and endotoxins, correct acid-base and electrolytes, control fluid volume appropriately, modulate the immune response thereby accelerating renal recovery and improving clinical conditions patient.
Succesful Continuous Renal Replacement Therapy (CRRT) for Acute Kidney Injury (AKI) with Septic Shock Underwent Long Coronary Artery Bypass Graft Procedure (CABG) Pertiwi, Previasari Zahra; Fatoni, Arie Zainul; Agustina, Ayu Yesi; Jaya, Wiwi
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.2024.005.01.05

Abstract

Background :AKI occurs in significant numbers of patients undergoing cardiopulmonary bypass surgery for coronary artery disease. Patient with AKI requiring renal replacement therapy (RRT) after cardiac surgery were at a higher risk of postoperative mortality. One of mode of RRT is CRRT. CRRT can keep hemodynamic of the patient stable, excellent control of azotemia, sypport beneficial immunomodulation,increase clearance of inflammatory mediators and potentially less ongoing or repeated renal ischaemia. As an alternative to traditional intermittent hemodialysis, CRRT has now emerged as the leading form of RRT for patients with AKI post CABG because the CRRT can keep hemodynamic still stable.Case: We report a case report of patient who had long aorta cross clamp in CABG procedure. He got AKI with shock condition during hospitalization in ICU, had been done with CRRT and had good response after the procedure.Discussion: The  incidence  of AKI  after  cardiac  surgery in this patient  may  increase  with several risk factors, such as surgical bleeding, diabetes mellitus, pre operative renal dysfunction, low  LVEF,  the use of CPB machine and infection. An  imbalance  between  renal oxygen  supply  and  oxygen demand will induce AKI. This patient had done CRRT and showed good clinical and laboratory condition after that. Conclusion : CRRT is a good choice for AKI patient post CABG procedure with shock condition.
Pneumomediastinum and Spontaneous Subcutaneous Emphysema in COVID-19 Patients Using High-Flow Nasal Cannula (HFNC) Suhadayanti, Rizki; Fatoni, Arie Zainul; Jaya, Wiwi; Asmoro, Aswoco Andyk
Jurnal Respirologi Indonesia Vol 44 No 2 (2024)
Publisher : Perhimpunan Dokter Paru Indonesia (PDPI)/The Indonesian Society of Respirology (ISR)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36497/jri.v44i2.448

Abstract

Background: Spontaneous pneumothorax, pneumomediastinum, and subcutaneous emphysema are rare complications that occur without mechanical ventilation, namely 0.81% of all COVID-19 patients. During the COVID-19 pandemic, high-flow nasal cannulas (HFNC) were used to support respiratory failure in critically ill patients. However, there have been no clinical trials explaining its safety and effectiveness. Hypoxemic normocapnic respiratory failure is an indicator of HFNC use. This study reports a case of associated spontaneous subcutaneous pneumomediastinum and emphysema in a COVID-19 patient using HFNC.Case: A 30-year-old male patient came to the hospital with a chief complaint of increasingly severe shortness of breath and confirmed COVID-19. Physical examination revealed a good airway, spontaneous breathing with a frequency of 28 times/minute; SpO2 of 97% with HFNC Flow 60 and FiO2 60%; blood pressure of 102/69 mmHg; and heart rate of 65 beats per minute. On the second day of treatment in the ICU, the patient did not experience desaturation or hypotension. Patent airway, spontaneous breathing, and oxygenation initiated using NRM 10lpm with a target SpO2 of 97%, RR at 30-32x/minute. On the fifth day, desaturation and hypotension were no longer observed.Discussion: Real-Time Reverse Transcriptase (RT)–PCR Diagnostic Panel detects SARS-CoV-2 in respiratory samples. Chest CT scans show viral pneumonia. Subcutaneous emphysema (SE) and pneumomediastinum cause breathing issues. Severe COVID-19 is treated with antivirals, vitamins, and oxygen therapy. Pneumomediastinum or subcutaneous emphysema may occur due to prolonged non-invasive ventilation but is generally self-limited.Conclusion: Clinical improvement was found in COVID-19 patients with pneumomediastinum and spontaneous subcutaneous emphysema using HFNC.
Co-Authors Agustina, Ayu Yesi Aswoco Andyk Asmoro Dewi Santosaningsih Dini, Cleonara Yanuar Hastuti, Nurima Diyah Puji Leny Budhi Harti Pertiwi, Previasari Zahra Prayitno, Harman Rosita, Theresia Daniella Ruddi Hartono Rusly, Andri Sugiri, Yani Jane Suhadayanti, Rizki Tri Wahju Astuti, Tri Wahju Wiwi Jaya Yusuf, Evira Natasya Zaelany, Allief Ilman