Prananda Surya Airlangga
Departemen Anestesiologi Dan Reanimasi; Fakultas Kedokteran; Universitas Airlangga/RSUD Dr. Soetomo; Surabaya

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Percutaneous Dilatational Tracheostomy (PDT) Dini Sebagai Upaya untuk Mencegah Pneumonia dan Mempermudah Perawatan Pasien Stroke di Intensive Care Unit (ICU) I Wayan Suryajaya; Prananda Surya Airlangga; Eddy Rahardjo
JAI (Jurnal Anestesiologi Indonesia) Vol 13, No 1 (2021): 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.v13i1.23456

Abstract

Latar Belakang: Stroke atau cerebrovasuler accident (CVA) merupakan hilangnya fungsi-fungsi otak dengan cepat akibat terganggunya suplai darah ke otak. Tidak jarang pasien stroke dirawat di intensive care unit (ICU) karena mengalami gagal napas sehingga membutuhkan ventilator. Kemampuan menelan dan refleks batuk yang tidak adekuat pada pasien stroke sering menyebabkan komplikasi pneumonia/ stroke associated pneumonia (SAP). Komplikasi pneumonia bisa juga disebabkan oleh penggunaan ventilator yang sering disebut ventilator associated pneumonia (VAP). SAP maupun VAP pada pasien stroke dapat dicegah dengan tindakan trakeostomi dini. Percutaneous dilatational tracheostomy (PDT) merupakan teknik trakeostomi dengan melakukan sayatan minimal untuk memasukkan guide wire sebagai panduan. Kemudian lubang trakeostomi diperlebar dengan menggunakan multipel dilator sampai canule trakeostomi bisa masuk ke trakea. PDT lebih mudah dilakukan dibanding surgical tracheostomi sehingga lebih menguntungkan dikerjakan untuk pasien kritis di ICU.Kasus: Terdapat 3 kasus pasien stroke yang dilaporkan dengan glasgow coma scale (GCS) dibawah 8. Kasus pertama: Pasien stroke dengan subakut infark di basal ganglia dekstra dan oedema cerebri. GCS E1V2M1 Pasien mengalami sumbatan partial jalan napas. Pasien dirawat di ICU dan diakukan intubasi. PDT dikerjakan hari ke 2 dengan tujuan untuk mengamankan jalan napas dan mempermudah bronchial toilet sehingga dapat mencegah terjadinya pneumonia.Kasus kedua: pasien stroke dengan infark luas di hemisphere kanan. Pasien dirawat di ICU dengan ventilator. PDT dilakukan pada hari ke 8 untuk mempermudah melakukan fisioterapi napas, bronkial/trakeal toilet. Setelah 50 hari pasien dipindahkan ke ruangan tanpa ditemukan pneumonia.Kasus ketiga: Pasien dengan kesadaran menurun GCS E2V1M3. Pasien dirawat di ICU dengan sumbatan partial jalan napas. PDT dilakukan pada hari pertama dengan tujuan mempertahankan jalan napas tetap aman dan mempermudah tracheal/ bronchial toilet. Pasien dirawat selama 110 hari dan pindah ke ruangan.Pembahasan: Pada ketiga kasus tersebut dilakukan usaha tracheostomi/ PDT secara dini dengan tujuan mengamankan jalan napas tetap bebas, memudahkan oral hygiene dan melakukan fisioterapi napas berupa tracheal/ bronchial toilet. Trakeostomi juga memudahkan mobilisasi pasien sehingga merupakan upaya untuk mencegah terjadinya pneumonia selama perawatan. Selama perawatan pasien tersebut di ICU tidak terjadi komplikasi pneumonia sampai pasien keluar dari ICU. Kesimpulan: Pasien stroke dengan GCS dibawah 8 akan mengalami perawatan yang lama dan potensial terjadi komplikasi berupa SAP maupun VAP bila memakai ventilator. Trakeostomi dini selain mempermudah perawatan dan mempercepat weaning juga sebagai upaya untuk mencegah terjadinya pneumonia. PDT merupakan teknik trakeostomi yang cocok dilakukan untuk pasien kritis di ICU karena lebih menguntungkan dibanding surgical tracheostomy.
Comparison of Length of Stay and Deep Vein Thrombosis (DVT) Incidents in Dr. Soetomo Hospital Elizeus Hanindito; Prananda Surya Airlangga; Soni Sunarso Sulistiawan; Bambang Pujo Semedi; Lucky Andriyanto; Arie Utariani; Nancy Margarita Rehatta
Folia Medica Indonesiana Vol. 54 No. 4 (2018): December
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (181.835 KB) | DOI: 10.20473/fmi.v54i4.10713

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Vein thrombosis may occur both in deep and superficial vein of all extremities. Ninety percent of vein thrombosis may progress into pulmonary embolism which is lethal. Deep vein thrombosis (DVT) is frequently found in critically ill patients in ICU, especially patients who are treated for a long time. This study aims to analyse the comparison between length of stay and DVT incidents in critically ill patients. A cross-sectional study was employed. We include all patients who were 18 years or older and  were treated in ICU of Dr Soetomo public hospital for at least 7 days. The patients were examined with Sonosite USG to look for any thrombosis in iliac, femoral, popliteal, and tibial veins and Well’s criteria were also taken. This study showed that length of stay is not the only risk factor for DVT in patients treated in ICU. In our data, we found out that the length of treatment did not significantly cause DVT. Other risk factors such as age and comorbidities in patients who are risk factors may support the incidence of DVT events. The diagnosis of DVT is enforced using an ultrasound performed by an expert in the use of ultrasound to locate thrombus in a vein. Length of treatment is not a significant risk factor for DVT. Several other factors still need to be investigated in order for DVT events to be detected early and prevented.
Effectiveness Comparison of Using Macintosh Blade and Mccoy Blade For Endotracheal Intubation In Anesthesia Residents Christya Lorena; Agustina Salinding; Prananda Surya Airlangga
Indonesian Journal of Anesthesiology and Reanimation Vol. 3 No. 2 (2021): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (543.315 KB) | DOI: 10.20473/ijar.V3I22021.46-53

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Introduction: Laryngoscopy is one of the critical points in the intubation process and a mechanical trauma that provides noxious stimulation, affecting cardiovascular, respiratory, and intracranial changes. Practitioner competence is a significant factor that supports laryngoscope intubation procedures. That can influence the intubation duration and amount of mechanical trauma besides caused by laryngoscope type. Objective: To analyze the effectiveness of using Macintosh blade compared to McCoy blade in intubation laryngoscopy by Anesthesia Residents. Materials and Methods: This research is an experimental study in adult patients who underwent elective surgery at GBPT Dr. Soetomo Hospital. Intubation did by Anesthesia Residents at levels 5-9 using Macintosh or McCoy Laryngoscope and chosen randomly.  The data of laryngeal visualization (Cormack Lehane), hemodynamics (blood pressure, pulse), pain scale (qNOX), intubation time length, and pain scale data (VAS) after extubation were taken during intubation laryngoscope. Result and Discussion: The study was conducted on 28 samples that met the criteria. Anesthesia Resident's competence levels based on the semester in both groups laryngoscopes were not different (p 0.868). Based on laryngeal visualization data laryngoscopy, the McCoy's blade had better visualization with CL 1 at 85.7% of the samples and p-value 0.020. This good visualization makes it possible to speed up the laryngoscope-intubation in the McCoy blade group with a significant difference of time compared to the Macintosh blade group. Hemodynamic parameters, there were significant differences for hemodynamics increase. In the Macintosh blade group, the blood pressure and pulse were significantly increased after laryngoscopy intubation. The pain scale during the intubation procedure, which was rated based on the qNOx score, showed a significant increase in the Macintosh blade group with a p-value of 0.003. The postoperative pain scale (VAS) was smaller in the McCoy blade group compared to the Macintosh group (p-value <0.001). Conclusion: The ability to use both laryngoscopes at some levels of Anesthesia residents was equally good, and the use of McCoy Blade is more effective than Macintosh Blade in the intubation laryngoscopy procedure.
EFFECT OF EMPLOYEE LABOR EXPENSES ON THE RESPONSE TIME IN EMERGENCY DEPARTMENT OF SAMPANG HOSPITAL, INDONESIA Miftahul Khoirul Insan; Prananda Surya Airlangga; Lilik Djuari
Majalah Biomorfologi Vol. 31 No. 2 (2021): MAJALAH BIOMORFOLOGI
Publisher : Universitas Airlangga, Surabaya, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mbiom.v31i2.2021.57-65

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Background: The Emergency Department (ED) has the main purpose of receiving, triageing, stabilizing, and providing acute health services to patients, including those who require resuscitation and emergency patients to some degree. An indicator of the success of medical treatment of emergency patients is the speed of providing adequate assistance both in daily routine situations or during disasters. Factors that influence nurses’ motivation to work, especially implementing triage at the Emergency Department include the characteristics of nurses such as age, sex, education, length of work and training. Objective: To analyze the effect of workload of the medical staff of the Emergency Department on the response time in the Emergency Department of Sampang Hospital, Indonesia. Materials and Methods: Observational analytic research with cross-sectional design. Sampling was performed with total sampling method to 24 people who met the criteria. Data collection was done by questionnaire and observation. Data were analyzed using the Chi-square correlation test and Fisher’s exact test. Results: There was a significant influence between workload and response time of triage P1 of Emergency Department staff at Sampang Hospital, Indonesia (p=0.015), whereas in triage P2 and P3 there was no effect of workload of staff on response time (p>0.05). Conclusion: In Emergency Department of Sampang Hospital, Indonesia, the response time in all categories of emergency (P1/red, P2/yellow, and P3/green) is fast. Workload correlates significantly with response time in P1/red category, while in P2/yellow and P3/green categories the workload has no effect on the response time.
Efektivitas Body Surface Area dibanding Predicted Body Weight dalam Menentukan Volume Semenit untuk Mencapai Target PaCO2 pada Operasi Tumor Otak Nanang Nurofik; Prananda Surya Airlangga; Bambang Pujo Semedi; Arie Utariani; Elizeus Hanindito; Hamzah Hamzah
Jurnal Neuroanestesi Indonesia Vol 8, No 1 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (301.979 KB) | DOI: 10.24244/jni.vol8i1.213

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Latar Belakang dan Tujuan: Manajemen neuroanestesi pada operasi tumor otak bertujuan untuk mencegah terjadinya cedera otak sekunder dan memberikan lapangan operasi yang baik. Hal ini dapat dicapai melalui brain relaxation therapy. Penelitian ini bertujuan menganalisis efektifitas Body Surface Area (BSA) dan Predicted Body Weigh (PBW) untuk menentukan volume semenit dalam mencapai target PaCO2 pada pasien yange menjalani operasi tumor otak.Subjek dan Metode: Penelitian analitik observasional dengan desain cross-sectional melibatkan 31 pasien yang menjalani operasi tumor otak di RSUD Dr Soetomo Surabaya. Pasien yang memenuhi kriteria, dilakukan pengukuran tinggi badan dan berat badan, kemudian dibagi dalam 2 kelompok BSA dan PBW. Kelompok BSA mendapat volume semenit 4xBSA (laki-laki) dan 3.5xBSA (perempuan). Kelompok PBW mendapat volume semenit 100mL/kgBB. Tiga puluh menit setelah pengaturan ventilasi mekanik, dilakukan pemeriksaan analisa gas darah untuk menilai PaCO2.Hasil: Penentuan volume semenit menggunakan BSA menghasilkan volume yang lebih besar dibanding PBW pada pasien normal hingga obesitas.Penggunaan BSA dibanding PBW secara signifikan memiliki PaCO2 lebih rendah (33.55±3.43: 39.29±3.32 mmHg) dengan nilai p=0.0001. Simpulan: Penggunaan BSA dalam menentukan volume semenit efektif dalam mencapai target PaCO2 pada pasien yang menjalani operasi tumor otak. Effectiveness of Body Surface Area over Predicted Body Weightto determine Minute Volume to achieve PaCO2 Target in Brain Tumor SurgeryBackground and Objective: Neuroanesthesia management in brain tumor surgery aims to prevent secondary brain injury and provide a good operating field. This goal can be achieved by brain relaxation therapy .This study aims to analyze the effectiveness of Body Surface Area (BSA ) and Predicted Body Weigh (PBW) in determining minute volume to achieve PaCO2 target in brain tumor surgery patient.Subject and Methods: This was an observational analytic study with a cross-sectional approach. Thirty patient with brain tumor surgery were enrolled in this study. Patient who met the inclusions criteria was measured for height and weight then divided into two groups of BSA and PBW. The BSA group gets a minute volume 4xBSA for men and 3.5xBSA for women. The PBW group received minute volume 100mL / kg. Thirty minutes after adjusting mechanical ventilation, a blood gas analysis was examined to measure PaCO2 value.Results: Minute volume which is predicted by BSA had a greater volume than PBW in normal to obese patient. Body surface area is statistically significant compared to PBW in reducing PaCO2 average (33.55±3.43: 39.29±3.32 mmHg) with p value = 0.0001.Conclusion: Body surface areaas more effective to determine minute volume compare to PBW to achievePaCO2 target in brain tumor surgery patient.
Faktor Risiko Pneumonia Komplikata Pada Anak Pratista Oktafia; Prananda Surya Airlangga; Ira Dharmawati; Retno Asih Setyoningrum
Majalah Kedokteran Indonesia Vol 71 No 3 (2021): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.71.3-2021-336

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Introduction: Pneumonia causes morbidity and mortality in children worldwide. Pediatric patients with complicated pneumonia have a poor prognosis and are more at risk of death. Objective To identify risk factors for complications in pediatric patients with pneumonia. Method: This research was a case-control study, involving children with pneumonia aged 1-59 months in Dr. Soetomo in 2016-2020. The sample was divided into two groups. Patients who had complications at first admission were classified as a case group. Whereas patients without complications at first admission were classified as a control group. Samples for the case group were obtained by using total sampling method, while the control group employed random sampling technique. Data were collected from medical records and analyzed by chi-square test. Result: A total of 44 case group samples and 53 control group samples were involved during this study. Among investigated variables, male gender (OR=2,842; 95% CI, 1,24-6,49) and anemia (OR=3,283; 95% CI, 1,26-8,49) might increase the risk of complicated pneumonia. Meanwhile other variables, namely age, comorbidities, birth weight, malnutrition, and immunization status did not have a significant relationship with the incidence of complications in pneumonia patients. Conclusion: Male gender and anemia are risk of complicated pneumonia.
Intracranial Hemorrhage in Patients With Hemophilia A Nugroho Setia Budi; Prananda Surya Airlangga; Bambang Pujo Semedi
Indonesian Journal of Anesthesiology and Reanimation Vol. 2 No. 2 (2020): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (767.662 KB) | DOI: 10.20473/ijar.V2I22020.59-66

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Introduction: Intracranial hemorrhage in inherited bleeding disorders is a medical emergency. The location of bleeding in most children is subdural and the most common cause is hemophilia. Although intracranial bleeding that occurs in people with hemophilia ranges from less than 5% of events, it is a life-threatening medical emergency so appropriate treatment is needed. Case Report: A boy patient 11 years old, 20kg weights have a seizure at home and followed by a decrease in consciousness. It was founded abnormalities in the form of anemia, prolonged FH (PPT 4x and APTT 4x), and hypocalcemia. The patient then was given main therapy; FVIII 100 IU/dL according to the FVIII target level calculated. The therapy continued with 500IU/12 hours according to the daily target of FVIII 50IU/dL. Discussion: The patient's condition was getting better day by day. The patient's consciousness started to improve after 14 days of postoperative. One month after that, the patient received koate treatment as the episodic handler. Diagnosing the exact cause in patients who have intracranial hemorrhage provides appropriate management so that the patients could be helped. Conclusion: Good collaboration between anesthesiologists, neurosurgeons, and pediatrics will increase the probability of successful management of critical bleeding without major sequelae.
Systematic Review Comparison of Endotracheal Intubation Success Rate Using McGrath® Mac Videolaryngoscope with Direct Laryngoscope (Macintosh): A Manikin Studies Dicha Niswansyah Auliyah; Lilik Herawati; Prananda Surya Airlangga
Indonesian Journal of Anesthesiology and Reanimation Vol. 3 No. 1 (2021): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (284.706 KB) | DOI: 10.20473/ijar.V3I12021.22-33

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Introduction: McGrath® MAC videolaryngoscope is a single-handed device designed to facilitate intubation in patients both in patients with normal airway conditions (without any complications) or airway conditions with complications such as cervical spine and/or anatomic abnormalities. Objective: This study aims to compare McGrath® MAC videolaryngoscope and direct laryngoscope using Macintosh blades as learning material or study simulators for medical personnel (including anesthesiologist and paramedics) and novice operator (medical students). Method: this study is a systematic review using the PRISMA method which was carried out systematically. Data was collected through Pubmed, direct science, EBSCOHost, and Proquest using the keywords ‘airway management ', ‘laryngoscopy', and 'manikin'. Journal included based on published publication time between 2008 and 2020, a study using SimMan Laerdal Airway manikin, a journal discussing intubation using McGrath® MAC videolaryngoscope and direct laryngoscope with Macintosh blades here, where it is normal airway (without complications) and difficult airway. Results: 1556 journals were collected through 4 journal search sites and then carried out a screening process for the publication year approved in 2008 to 2020. Four studies use adult manikin SimMan Laerdal Airway including 247 participants were included in this systematic review. Conclusion: Based on journals that have been reviewed, McGrath® MAC videolaryngoscope provides better and superior results compared to Macintosh in terms of the success rate and visualization of glottis. Also, the intubation time using McGrath® MAC videolaryngoscope is shorten compared to Macintosh both on the normal airway (without complication) and difficult airway. The participants (medical personnel and novice operators) in all studies that reviewed prefer to use McGrath® Mac videolaryngoscope instead of using direct laryngoscope with Macintosh blade for Endotracheal Intubation mainly used for learning or study simulators.
FOUR Score sebagai Alternatif dalam Menilai Derajat Keparahan dan Memprediksi Mortalitas pada Pasien Cedera Otak Traumatik yang Diintubasi Airlangga, Prananda Surya; Hamzah, Hamzah; Santosa, Dhania Anindita; Subiantoro, Andri
Jurnal Neuroanestesi Indonesia Vol 9, No 3 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (8674.151 KB) | DOI: 10.24244/jni.v9i3.280

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Skala yang mengukur koma yang ideal seharusnya bersifat linear, reliabel, valid, dan mudah digunakan. Berbagai macam skala telah dikembangkan dan divalidasi untuk mengevaluasi tingkat kesadaran secara cepat, derajat penyakit, dan prognosis terhadap morbiditas maupun mortalitas. Glasgow Coma Scale (GCS) merupakan alat pemeriksaan tingkat kesadaran yang paling sering digunakan dan dijadikan gold standard, namun GCS mempunyai keterbatasan karena pasien yang diintubasi tidak dapat dinilai komponen verbal. Full Outline of UnResponsiveness (FOUR) score dikembangkan untuk mengatasi berbagai keterbatasan GCS. Pemeriksaan FOUR score adalah skala penilaian klinis dalam penilaian pasien dengan gangguan tingkat kesadaran. FOUR score lebih sederhana dan memberikan informasi yang lebih baik, terutama pada pasien cedera otak traumatik yang diintubasi. Hasil penelitian menunjukkan bahwa GCS dan FOUR score memiliki nilai prediksi yang tinggi tidak hanya kematian pada pasien trauma tetapi juga luaran pada pasien yang dipulangkan. Studi multicentre menunjukkan FOUR score dan GCS tidak berbeda dalam memprediksi kematian di rumah sakit. Studi tersebut menyarankan bahwa FOUR score dapat menjadi alat diagnostik yang lebih baik untuk menilai refleks batang otak dan pola pernapasan. Namun penelitian lain didapatkan juga hasil yang bertentangan antara GCS dan FOUR score dalam prediksi luaran pasien. Adanya kontradiksi tersebut menunjukkan perlunya dilakukan lebih banyak studi. Oleh karena itu, telaah literatur ini dilakukan dengan tujuan untuk membandingkan skor GCS dan FOUR dalam memprediksi mortalitas pasien trauma.FOUR Score as an Alternative in Assessing the Degree of Severity and Predicting Mortality in Intubated Traumatic Brain Injury PatientsAbstractThe ideal consciousness scoring scale must be linear, reliable, valid, and user-friendly. There is a need to develop and validate a scale to quickly evaluate the level of consciousness, the severity of the disease, and the prognosis of morbidity and mortality. Glasgow Coma Scale (GCS) is the most commonly used tool to assess the level of consciousness and is considered the gold standard. However, GCS has several limitations, such as inability to evaluate verbal components in intubated patients. To overcome these challenges, researchers developed the Full Outline of UnResponsiveness (FOUR) score. FOUR scores is a clinical grading scale to assess the altered state of consciousness. FOUR scores is simpler and able to provide better information, especially in intubated-traumatic brain injury (TBI) patients. Some studies showed that GCS and FOUR scores have the high predictive value in predicting not only the mortality of trauma patients but also the outcome of discharged patients. A multicentre study showed that FOUR scores and GCS do not differ in predicting inpatient mortality. This study suggested that the FOUR scores could be a better diagnostic tool for assessing brainstem reflexes and breathing patterns. Unfortunately, some studies have found conflicting results between GCS and FOUR scores in predicting patient outcomes. These contradictions suggest the need to conduct more studies. Therefore, this literature review will compare GCS and FOUR scores in predicting mortality of TBI patients.
Development of 3S-Based Nursing Care Instruments (SDKI, SLKI, SIKI) in Patients with Ventilators Ambarwati, Diah Retno; Kurniawati, Ninuk Dian; Airlangga, Prananda Surya; Zamroni, Asroful Hulam
Indonesian Journal of Global Health Research Vol 6 No 1 (2024): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v6i1.2629

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Documentation instrument for quality nursing care according to standards. However, there is no instrument for nursing care for patients installing ventilators according to Indonesian nursing standards. This research aims to develop a 3S-based nursing care instrument (SDKI, SLKI, SIKI) for ventilator patients. The research design is Research and Development carried out in 2 stages. The first phase population is 100 nursing care. The first stage was FGD 1, divided into 3 groups, namely 10 executive nurses, 6 nursing management staff, and 1 expert. The second stage population was 5 nurses. The second stage was carried out FGD 2 with participants from 6 levels of nursing management. The sample used in this research was purposive sampling. The design developed is an instrument for documenting nursing care for ventilator patients. The analysis uses the CVI and KR20 tests. Results: Evaluation of nursing care instruments shows that aspects of nursing outcomes, implementation, and evaluation are not by standards. Instrument development consists of 5 main problems that often arise in ventilator patients. The I-CVI result is ≥ 0.78, which is interpreted as valid. The KR result is > 0.6, which means it is reliable. The recommendation from the research results is that the development of nursing care instruments can be applied in treating patients with ventilators. Conclusion: The development of a nursing care instrument was declared to be valid and reliable in categories in terms of functionality, efficiency, and usability, so it is recommended that nurses use it to improve the quality of hospital services.