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Neutrophil Gelatinase-Associated Lipocalin (NGAL) in Urine as a Potential Non-Invasive Method for Determine Kidney Damage in Predialysis Patients Titisari, Nurina; Hernowati, Tinny Endang; Ratnawati, Retty; Fauzi, Ahmad; Gunawan, Atma; Jaya, Wiwi
Research Journal of Life Science Vol 8, No 3 (2021)
Publisher : Direktorat Riset dan Pengabdian Masyarakat, Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.rjls.2021.008.03.1

NGAL expression in acute kidney failure is well known. It is approved that NGAL expression occurs earlier than the level of BUN and creatinine in acute kidney failure. NGAL is not only expressed in the blood but also in the urine, where urine collection has many advantages over blood collection. This study aims to observed the expression of NGAL in predialysis patients and to determine the correlation between NGAL serum and NGAL urine of patients. The sample was taken from healthy persons as control and predialysis patients. The examination of BUN, creatinine, and urinalysis were done to approve the diagnose in predialysis patients. While NGAL in serum and urine were analyzed using the Enzyme-Linked Immunoabsorbent Assay (ELISA). The results showed that the concentration of NGAL in serum was higher in the predialysis patients compared to the healthy subjects (p<0.05). There was a strong positive correlation between the NGAL in the serum and the NGAL in the urine (r= 0.98 and p<0.000). It is concluded that the non-invasive examination of NGAL in urine can be choose rather than using serum NGAL. However, it must be noted that NGAL could be used for chronic renal failure in predialysis patients as long as other biomarkers have been proven.

Percutaneous Dilatational Tracheostomy; Diagnosis and Mortality Rate in Intensive Care Saiful Anwar Hospital Ariady, Randika Rea; Wiwi Jaya; Arie Zainul Fatoni; Isngadi; Aswoco Andyk Asmoro
Journal of Anesthesiology and Clinical Research Vol. 5 No. 1 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i1.457

Introduction: Tracheostomy is a common surgical procedure performed on critically ill intensive care patients. Reports have documented considerable associated morbidity, with complication rates varying from 6 to 66%. The reports on mortality associated with tracheostomy range from 0 to 5%. Since its introduction, percutaneous dilatational tracheostomies (PDT) have gained increasing popularity. The most commonly cited advantages are the ease of the familiar technique and the ability to perform the procedure at the bedside.7 This paper aims to study the mortality rate and diagnosis of patients who performed the percutaneous dilatational tracheostomy procedure in the ICU of Saiful Anwar Malang Hospital. Methods: Observational analytical research is carried out cross-sectionally. Data was collected from the medical records of patients undergoing PDT for the period July 2022 – October 2022. Statistical analysis using the Chi-square test. Results: From 39 subjects, 34 (87.2%) subjects experienced respiratory failure. The most common cause was HAP pneumonia (61.5%), followed by CVA (17.9%) and CAP pneumonia (12.8%); the rest were EDH, SAH, and ASD secundum, as much as 2.6%. The outcome was that 13 (33.3%) subjects died, and the rest survived and were transported to a care ward. Correlation between patient outcomes with respiratory failure p=0.735, with diagnosis p=0.309. Conclusion: The most common diagnosis of PDT is HAP pneumonia. There was no significant correlation between diagnosis and mortality of patients performed by PDT.

Chula Formula is recommended in Estimating the Length of Tracheal Tube Insertion in Patients Receiving Mechanical Ventilation in Intensive Care Units in the Absence of Chest X-Ray Laksono, Buyung Hartiyo; Hartono, Ruddi; Tamam, Abdul Rasyid; Jaya, Wiwi
Journal of Anaesthesia and Pain Vol 4, No 2 (2023): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2023.004.02.01

Background: Chest X-Ray (CXR) is one of the most effective ways of confirming the length of the tracheal tube (TT) insertion. However, some intensive care unit in developing countries has no sufficient facilities. This study aims to evaluate the accuracy of TT length insertion using the Chula formula and Colombian formula in patients receiving mechanical ventilation in intensive care units.Methods: This study is a comparative observational study of 50 adults in the Intensive care unit, divided into two groups. Group A used the Chula formula for TT length insertion (n= 25) and Group B used the Colombian formula (n= 25). The TT length insertion accuracy was evaluated using radiological parameters. Statistical analysis used: Data were analyzed statistically using the T-test and Chi-square test.Result: The Chula formula is significantly more precise than the Colombian formula in estimating the length of TT insertion based on the radiographic parameters of the TT length insertion right midway between the medial tip of the clavicle and TT located in the T3 or T4 vertebrae (p <0.05), but not significantly different in the two other parameters.Conclusion: Both the Chula formula and the Colombian formula can estimate the length of TT insertion in adult patients. However, the Chula formula is more recommended in the length of TT insertion and benefit in the ICU with insufficient CXR.

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

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.

Continuous Ketamine Administration Decreases Monocyte Count in Sepsis Patients in Intensive Care Units Hartono, Ruddi; Jaya, Wiwi; Mayasari, Mayasari; Isngadi, Isngadi
Journal of Anaesthesia and Pain Vol 4, No 1 (2023): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2023.004.01.01

Background: Cytokines storm becomes the most common cause of mortality in sepsis patients treated in the intensive care unit (ICU). Cytokines storm is characterized by an excessive elevation in the immunocompetent cells, including monocyte. Ketamine, as a sedating agent, has immunosuppressive properties. This study was conducted to determine the effect of ketamine on monocyte count in septic patients in the ICU.Methods: This is a quantitative case-control study of 30 patients treated in the ICU. The study subjects were divided into control (n=15) and treatment (n=15) groups. The treatment group received ketamine HCl therapy at 0.3 mg/kg body weight/hour. The mean monocytes were counted at 0, 24, and 48 hours post-therapy. Data analysis used an independent sample t-test with α=5%.Result: Administration of ketamine therapy in septic patients treated in the ICU showed a decrease in the monocytes during observation from 0 to 48 hours post-therapy. Administration of ketamine at 48 hours had a significantly lower monocyte (5.21%) compared to control (7.67%) (p=0.012).Conclusion: Ketamine administration reduces the monocytes count in septic patients treated in the intensive care unit. Ketamine is expected to be a therapeutic option in sepsis 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

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.

Management of Bungarus sp. Envenomation Presenting as Rapidly Progressing Respiratory Failure: An Intensive Care Case Report Mohammad Sutami; Wiwi Jaya; Eka Oktaviana Hirda
Journal of Anesthesiology and Clinical Research Vol. 6 No. 1 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i1.746

Introduction: Envenomation by snakes of the Bungarus genus (kraits) represents a critical medical emergency, particularly prevalent in South and Southeast Asia, including Indonesia. Krait venom is primarily neurotoxic, often containing potent presynaptic toxins (β-bungarotoxins) that disrupt neuromuscular transmission, leading to rapidly progressive descending paralysis. Respiratory failure due to diaphragmatic and intercostal muscle paralysis is the most life-threatening complication, necessitating immediate and expert intensive care management. Case presentation: We report the case of a 55-year-old Indonesian male who presented to the emergency department approximately five hours after being bitten on his right hand by a snake suspected to be a Weling (Bungarus sp.). He exhibited rapidly deteriorating neurological function, including dysarthria and decreased consciousness, progressing swiftly to acute respiratory failure with paradoxical breathing and hypoxia. Emergent endotracheal intubation and mechanical ventilation were instituted. Subsequent management in the Intensive Care Unit (ICU) involved continued ventilatory support, administration of polyvalent snake antivenom (SABU), sedation, broad-spectrum antibiotics for complicating pneumonia, and comprehensive supportive care. Nerve conduction studies later confirmed bilateral phrenic nerve palsy and severe sensorimotor axonal polyneuropathy. Conclusion: This case highlights the fulminant respiratory failure characteristic of severe Bungarus envenomation. Prompt recognition, aggressive airway management, and mechanical ventilation are paramount lifesaving interventions. While antivenom administration is a standard therapy, its efficacy in reversing established presynaptic neuromuscular blockade remains debated, underscoring the critical role of prolonged ventilatory support and meticulous ICU care until neuromuscular function recovers, which can be significantly delayed due to the nature of presynaptic toxins. This case reinforces the need for high vigilance and resource preparedness in managing neurotoxic snakebites in endemic regions.

Inappropriate Empirical Antibiotic Therapy and Mortality in Critical Illness: A Retrospective Cohort Study with Propensity Score Analysis in an Indonesian ICU Riska Yulinta Viandini; Wiwi Jaya; Arie Zainul Fatoni
Journal of Anesthesiology and Clinical Research Vol. 6 No. 2 (2025): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v6i2.807

Introduction: Inappropriate empirical antibiotic therapy (IEAT) is a critical driver of mortality in sepsis, particularly in regions with high antimicrobial resistance (AMR) like Southeast Asia. This study aimed to quantify the association between IEAT and 28-day mortality in a critically ill Indonesian patient cohort, employing advanced statistical methods to control for confounding. Methods: We conducted a retrospective cohort study of 280 adult patients who received empirical antibiotics and had positive cultures upon admission to a tertiary ICU in Indonesia (January 2022–December 2023). The primary exposure was the appropriateness of the initial antibiotic regimen (IEAT vs. AEAT) based on in-vitro susceptibility. We used multivariate logistic regression and a 1:1 propensity score-matched (PSM) analysis to adjust for baseline differences in patient severity, including APACHE II score and the presence of septic shock. Results: In the full cohort, 108 patients (38.6%) received IEAT. The 28-day mortality was profoundly higher in the IEAT group than the AEAT group (77.8% vs. 8.1%; p < 0.001). After multivariate adjustment, IEAT remained a powerful predictor of mortality (Adjusted Odds Ratio [aOR]: 38.72; 95% CI: 18.91–79.30; p < 0.001). In the PSM cohort of 200 patients with balanced baseline characteristics, the association remained strong and significant (OR: 25.15, 95% CI: 11.54–54.81; p < 0.001). Local prescribing patterns revealed that levofloxacin monotherapy, the most common regimen, had an inappropriateness rate of 76.4%. Conclusion: Inappropriate empirical antibiotic therapy is strongly associated with a substantially increased risk of death in critically ill Indonesian patients. This association persists after rigorous adjustment for confounding. These findings highlight the urgent need for robust antimicrobial stewardship programs, guided by dynamic local surveillance, to combat the lethal impact of AMR.

Continuous Ketamine Administration Decreases Monocyte Count in Sepsis Patients in Intensive Care Units Hartono, Ruddi; Jaya, Wiwi; Mayasari, Mayasari; Isngadi, Isngadi
Journal of Anaesthesia and Pain Vol. 4 No. 1 (2023): January
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2023.004.01.01

Background: Cytokines storm becomes the most common cause of mortality in sepsis patients treated in the intensive care unit (ICU). Cytokines storm is characterized by an excessive elevation in the immunocompetent cells, including monocyte. Ketamine, as a sedating agent, has immunosuppressive properties. This study was conducted to determine the effect of ketamine on monocyte count in septic patients in the ICU.Methods: This is a quantitative case-controlÂ study of 30 patients treated in the ICU. The study subjects were divided into control (n=15) and treatment (n=15) groups. The treatment group received ketamine HCl therapy at 0.3 mg/kg body weight/hour. The mean monocytes were counted at 0, 24, and 48 hours post-therapy. Data analysis used an independent sample t-test with Î±=5%.Result: Administration of ketamine therapy in septic patients treated in the ICU showed a decrease in the monocytes during observation from 0 to 48 hours post-therapy. Administration of ketamine at 48 hours had a significantly lower monocyte (5.21%) compared to control (7.67%) (p=0.012).Conclusion: Ketamine administration reduces the monocytes count in septic patients treated in the intensive care unit. Ketamine is expected to be a therapeutic option in sepsis patients.

Chula Formula is recommended in Estimating the Length of Tracheal Tube Insertion in Patients Receiving Mechanical Ventilation in Intensive Care Units in the Absence of Chest X-Ray Laksono, Buyung Hartiyo; Hartono, Ruddi; Tamam, Abdul Rasyid; Jaya, Wiwi
Journal of Anaesthesia and Pain Vol. 4 No. 2 (2023): May
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2023.004.02.01

Background: Chest X-Ray (CXR) is one of the most effective ways of confirming the length of the tracheal tube (TT) insertion. However, some intensive care unit in developing countries has no sufficient facilities. This study aims to evaluate the accuracy of TT length insertion using the Chula formula and Colombian formula in patients receiving mechanical ventilation in intensive care units.Methods: This study is a comparative observational study of 50 adults in the Intensive care unit, divided into two groups. Group A used the Chula formula for TT length insertion (n= 25) and Group B used the Colombian formula (n= 25). The TT length insertion accuracy was evaluated using radiological parameters. Statistical analysis used: Data were analyzed statistically using the T-test and Chi-square test.Result: The Chula formula is significantly more precise than the Colombian formula in estimating the length of TT insertion based on the radiographic parameters of the TT length insertion right midway between the medial tip of the clavicle and TT located in the T3 or T4 vertebrae (p <0.05), but not significantly different in the two other parameters.Conclusion: Both the Chula formula and the Colombian formula can estimate the length of TT insertion in adult patients. However, the Chula formula is more recommended in the length of TT insertion and benefit in the ICU with insufficient CXR.

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