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All Journal Jurnal Kedokteran Brawijaya Paediatrica Indonesiana Jurnal Pengabdian Masyarakat dalam Kesehatan Pediatric Sciences Journal
Kurniawan Taufiq Kadafi
Division Of Pediatric Emergency And Intensive Care, Department Of Pediatrics, Faculty Of Medicine, Universitas Brawijaya, Saiful Anwar General Hospital, Indonesia
Health Professions Medicine & Pharmacology Nursing Public Health

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Journal : Paediatrica Indonesiana

 1 
Difference in outcomes of pediatric septic shock after fluid resuscitation according to the Ultrasound-guided Fluid Resuscitation (USFR) and American College of Critical Care Medicine (ACCM) protocols: A randomized clinical trial Saptadi Yuliarto; Kurniawan Taufiq Kadafi; Nelly Pramita Septiani; Irene Ratridewi; Savitri Laksmi Winaputri
Paediatrica Indonesiana Vol 63 No 1sup (2023): Supplementary Issue March 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1sup.2023.49-56

Abstract

Background Sepsis is a major cause of morbidity and mortality in children. The American College of Critical Care Medicine (ACCM) protocol currently in use in the management of septic shock carries a risk of fluid overload. With the use of ultrasonographic monitoring, the Ultrasound-guided Fluid Resuscitation (USFR) protocol may reduce the incidence of fluid overload and mortality. Objective To assess the difference in outcomes of fluid resuscitation in pediatric septic shock using the USFR vs. ACCM protocols. Methods This randomized clinical trial involved 36 subjects randomized equally into the USFR and ACCM groups. After randomization, each subject was given fluid resuscitation starting at 20 mL/kg and repeated every 5-10 minutes as needed, according to the ACCM protocol. After fluid resuscitation was given, patients in the ACCM group were evaluated for clinical signs, liver span, and rhonchi, whereas those in the USFR group underwent USCOM examination for cardiac index (CI), stroke volume index (SVI), and systemic vascular resistance index (SVRI). After 60 minutes, subjects in both groups were re-assessed for clinical signs, USCOM, pulmonary edema using lung ultrasound score (LUS), and liver span. Subjects were blinded as to the protocol they received. We compared 24-hour and 72-hour mortality rates, clinical improvement of shock at 60 minutes, cardiac index (CI), stroke volume index (SVI), and systemic vascular resistance index (SVRI), as well as pulmonary edema and hepatomegaly, between the two groups. Results At 60 minutes after resuscitation, there were significant differences between the ACCM and USFR groups in the proportion of clinical improvement (0/18 vs. 5/18, P=0.016), pulmonary edema (15/18 vs. 4/18, P<0.001), and hepatomegaly (16/18 vs. 5/18, P<0.001). Mortality rates at 24 hours and 72 hours in the ACCM vs. USFR groups were 17% vs. 12% (P=0.199) and 78% vs. 39% (P=0.009), respectively. Conclusion The USFR protocol reduces the occurrence of fluid overload and leads to a lower mortality rate at 72 hours compared to the ACCM fluid resuscitation protocol.
Use of hemodynamic and laboratory monitoring tools to reduce the risk of mortality from pediatric septic shock Saptadi Yuliarto; Kurniawan Taufiq Kadafi; Ika Maya Suryaningtias; Irene Ratridewi; Savitri Laksmi Winaputri
Paediatrica Indonesiana Vol 63 No 1sup (2023): Supplementary Issue March 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1sup.2023.35-48

Abstract

Background Early recognition of septic shock in terms of clinical, macrocirculatory hemodynamic, and microcirculatory laboratory parameters is a fundamental challenge in the emergency room and intensive care unit for early identification, adequate management, prevention of disease progression, and reduction of mortality risk. Objective To evaluate for possible correlations between survival outcomes of post-resuscitation pediatric septic shock patients and parameters of clinical signs, macrocirculatory hemodynamics, as well as microcirculatory laboratory findings. Methods This prospective, study was conducted in the PICU at Saiful Anwar Hospital, Malang, East Java. Inclusion criteria were children diagnosed with septic shock according to the 2005 Surviving Sepsis Campaign (SSC) criteria, aged >30 days-18 years, who were followed up for 72h after resuscitation. The measured variables such as cardiac index (CI), systemic vascular resistance index (SVRI), stroke volume index (SVI) were obtained from ultrasonic cardiac output monitor (USCOM). Blood gas and lactate were obtained from laboratory findings. Heart rate, pulse strength, extremity temperature, mean arterial pressure (MAP), systolic blood pressure (SBP), capillary refill time (CRT), Glasgow coma scale (GCS), and diuretic used were obtained from hemodynamic monitoring tools. Survival outcomes of post-resuscitation pediatric septic shock patients were noted. Results There was a significant correlation between the outcomes of the pediatric septic shock patients 72h after fluid resuscitation and clinical, macrocirculatory hemodynamic, and microcirculatory laboratory parameters. After the 6th hour of observation, strong pulse was predictive of survival, with 88.2% area under the curve (AUC). At the 12th hour of observation, MAP >50th percentile for age was predictive of survival, with 94% AUC. Conclusion For pediatric patients with septic shock, the treatment target in the first 6 hours is to improve strength of pulse, and that in the first 12 hours is to improve MAP >50th percentile for age to limit mortality.
Procalcitonin level, neutrophil to lymphocyte count ratio, and mean platelet volume as predictors of organ dysfunction and mortality in children with sepsis Saptadi Yuliarto; Kurniawan Taufiq Kadafi; Dian Maharani; Irene Ratridewi; Savitri Laksmi Winaputri
Paediatrica Indonesiana Vol 63 No 1sup (2023): Supplementary Issue March 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.1sup.2023.14-20

Abstract

Background Procalcitonin (PCT) level is one of known biomarker in septic diagnosis, but limited studies report its benefit in predicting the outcomes of children with sepsis. Neutrophil to lymphocyte (NLR) and mean platelet volume (MPV) are simple biomarkers of inflammation that can be measured in routine hematological examination which role in predicting organ dysfunction remain unclear. Objective To understand the correlations between PCT level, NLR, and MPV, tested in the first day of admission with outcomes of septic children in intensive care unit. Methods This retrospective cohort study obtained the data from medical record of pediatric patients admitted in PICU and HCU since January 2019. The inclusion criteria were children aged 1 months to 18 years with sepsis; whie exclusion criteria were patients with congenital heart disease, hematologic disease, malignancy, and length of care in intensive care unit less than 3 days or more than 28 days. The PCT, NLR, and MPV levels were assessed in the first day of admission. Organ dysfunction was identified using qSOFA score more than 2 points. Results Sixty-nine septic children were reviewed. Procalcitonin level in the first day of admission correlated significantly with qSOFA score in the third day of admission (R= 0.639; P=0.000); as well as with mortality (R=0.747; P=0.000). Receiver operating characteristic (ROC) curve of PCT level in the first day of admission had area under curve (AUC) of 0.922 to predict organ dysfunction (cut off 3.425; sensitivity 95.8%; specificity 52.4%) and AUC of 0.952 to predict mortality (cut off 21.165; sensitivity 96.4%; specificity 78%). Moreover, NLR in the first day of admission correlated significantly with qSOFA in the third day of admission (R=0.407; P=0.001), but did not correlate with mortality. The ROC of NLR to predict organ dysfunction was 0.829 (cut off 3.52; sensitivity 87.5%; specificity 66.7%). There was no correlation between MPV in the first day of admission with qSOFA score in the third day of admission neither with mortality. Linear regression test showed that PCT level and NLR in the first day of admission simultaneously had correlated with qSOFA score in the third day of admission (R=0.696; P= 0.000) and mortality (R=0.748; P=0.000). Meanwhile, PCT and MPV simultaneously had correlation with qSOFA score in the third day of admission (R=0.688; P=0.000) and mortality (R=0.733; P=0.000). Moreover, NLR and MPV simultaneously had correlation with qSOFA score in the third day of admission (R=0.453; P=0.002). All three independent variables (PCT level, NLR, and MPV) simultaneously correlated with qSOFA score in the third day of admission (R= 0.744; P=0.000) and mortality (R=0.739; P=0.000). Conclusion There are significant correlations between each, PCT level and NLR in the first day of admission with qSOFA score in the third day of admission as well as with mortality. There is no correlation between MPV in the first day of admission with qSOFA score in the third day of admission, neither with mortality. There are significant correlations between PCV level and NLR with or without MPV with qSOFA score in the third day of admission as well as with mortality.
Diagnostic performance of electrical cardiometry (ICON®) parameters in predicting fluid responsiveness in critically ill pediatric patients Kurniawan Taufiq Kadafi; Rizki Dzakiyah Sholikhah, Wanda; Muhammad Reva Aditya; Saptadi Yuliarto; Charity Monica; Abdul Latief; Antonius Hocky Pudjiadi
Paediatrica Indonesiana Vol. 65 No. 6 (2025): November 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Background  Fluid resuscitation with appropriate and adequate amounts is very important in treating critically ill children, so reliable hemodynamic monitoring methods are needed to prevent fluid overload. Contractility index (ICON) is a novel, non-invasive index of left ventricular (LV) function, and contractility related to the electrical cardiometry device (ICON®). ICON® offers a non-invasive hemodynamic monitoring method to assess volume status, but its validity in predicting fluid response in the Indonesian pediatric population remains unknown. Objective To determine the diagnostic performance of ICON-derived parameters, especially change of cardiac output (ΔCO) and change in contractility index (ΔICON), in predicting fluid response, using change of stroke volume (ΔSV)  as a reference standard. Methods A cross-sectional study was conducted in pediatric emergency and intensive care settings. Children aged 1 month to 18 years requiring fluid resuscitation were included. Hemodynamic parameters were measured using ICON® before and after a 10 mL/kg fluid bolus of crystalloid. Fluid responsiveness was defined as a >10% increase in ΔSV. Changes in parameters were analyzed using paired statistical tests. ROC analysis was used to assess the diagnostic accuracy of CO and ICON. Results Sixty-three subjects were analyzed. Significant median changes were observed after fluid bolus administration based on pre- and post-bolus comparison in change of heart rate (ΔHR: –8 bpm, P<0.001), change of systolic blood pressure (ΔSBP: +3 mmHg, P=0.042), change of diastolic blood pressure (ΔDBP: +2 mmHg, P=0.012), change of mean arterial pressure (ΔMAP: +0.67 mmHg, P=0.009). The ROC analysis showed that CO had the highest AUC (0.878), with a cut-off of 5.35%, sensitivity of 78.3%, and specificity of 87.2%. The ICON showed moderate accuracy (AUC 0.757), with a 0.45% cut-off, 69.6% sensitivity, and 71.8% specificity. Conclusion Electrical cardiometry (ICON®) demonstrated measurable changes in objective hemodynamic parameters following fluid bolus administration in critically ill children. Among ICON-derived parameters, a 5.35% increase in CO showed the best predictive performance for fluid responsiveness, while ICON showed moderate diagnostic value. These findings support the clinical utility of electrical cardiometry as a non-invasive tool to guide volume management in pediatric critical care.
Co-Authors Abdul Latief Antonius Hocky Pudjiadi Aslinar Charity Monica Dian Maharani Dimas Dwi Saputro Dimas Tri Anantyo Erviani Maulidya Fathy Zuandy Pohan Fauzi, Muhammad Rizki Husnul Asariati I Nyoman Arie Purwana Iin Tri Listiyanti Nugrahani Ika Maya Suryaningtias Irene Ratridewi Jaya Ariheryanto Effendy Jihan Ruhi Said, Astika Khalasha, Takhta Koentartiwi, Dyahris Martinus M. Leman Martinus Martin Leman Melinda Micho, Rahma Muhammad Reva Aditya Muhammad Reza Muharrom, Muhammad Aji Nasution, Badai Buana Nelly Pramita Septiani Niken Wahyu Puspaningtyas Permadi, Prasetya I. Permadi, Prasetya Ismail Piprim Basarah Yanuarso Piprim Basarah Yanuarso, Putra, Galing C. Rahmadany, Aulya Farra Rahmawati Aminingrum Rakhman Tyas Perdana Rizki Dzakiyah Sholikhah, Wanda Saptadi Yuliarto Saptadi Yuliarto Saptadi Yuliarto Savitri Laksmi Winaputri Takhta Khalasha William Prayogo Susanto Wisnu Barlianto Yogi Prawira