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Antonius H. Pudjiadi
Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia
Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health Veterinary

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Prevalens dan Faktor Risiko Infeksi Luka Operasi Pasca-bedah Lina Haryanti; Antonius H. Pudjiadi; Evita Kariani B. Ifran; Amir Thayeb; Idham Amir; Badriul Hegar
Sari Pediatri Vol 15, No 4 (2013)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (209.063 KB) | DOI: 10.14238/sp15.4.2013.207-12

Abstract

Latar belakang. Infeksi luka operasi (ILO) merupakan salah satu komplikasi pasca-bedah abdomen yang dapat meningkatkan morbiditas, mortalitas, dan biaya pengobatan. Diperlukan data prevalens ILO pasca-bedah abdomen pada anak di RSCM dan faktor risiko yang memengaruhinya.Tujuan. Mengetahui prevalens dan karakteristik ILO serta hubungan antara usia, jenis kelamin, status nutrisi, skor PELOD, skor ASA, jenis operasi, kategori luka operasi, dan lama operasi dengan ILO pasca-bedah abdomen pada anak.Metode. Data penelitian dari rekam medis tahun 2009-2011 pada anak pasca-bedah abdomen dengan besar sampel 180 subjek. Analisis statistik dengan uji Chi-square/Fisher dan regresi logistik.Hasil. Prevalens ILO pasca-bedah abdomen pada anak di RSCM selama tiga tahun 7,2%. Infeksi luka operasi merupakan 23,6% dari total infeksi nosokomial pasca-bedah abdomen di RSCM. Enam dari 13 subjek dengan ILO mengalami sepsis dan 2 di antaranya meninggal karena sepsis. Tiga jenis ILO, yaitu ILO insisional superfisial (9 subjek), ILO insisional dalam (2 subjek), dan ILO organ (2 subjek). Terdapat hubungan bermakna antara jenis operasi cito dengan ILO (p=0,007, RO 4,72;95%IK 1,54-14,42). Sedangkan variabel lainnya tidak berhubungan bermakna.Kesimpulan. Jenis operasi cito merupakan faktor risiko ILO pasca-bedah abdomen pada anak di RSCM Jakarta. Perlu penelitian prospektif dengan sampel yang lebih besar.
Faktor Risiko yang Berperan pada Mortalitas Sepsis Desy Dewi Saraswati; Antonius H. Pudjiadi; Mulyadi M. Djer; Bambang Supriyatno; Damayanti R. Syarif; Nia Kurniati
Sari Pediatri Vol 15, No 5 (2014)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (267.655 KB) | DOI: 10.14238/sp15.5.2014.281-8

Abstract

Latar belakang. Sepsis merupakan penyebab utama kematian bayi dan anak. Status imun pejamu dan malnutrisi merupakan faktor penting yang menentukan luaran pada sepsis. Skor pediatric logistic organ dysfunction (PELOD) adalah sistem skoring disfungsi organ pada sakit kritis, untuk memprediksi mortalitas pasien sepsis.Tujuan. Mengetahui faktor risiko usia, status gizi, dan skor PELOD terhadap mortalitas sepsis.Metode. Retrospektif analitik berupa data rekam medis pasien berusia 1 bulan – 18 tahun di PICU RSCM bulan Apri1- Agustus 2011 dengan diagnosis sepsis menurut kriteria konsensus sepsis internasional.Hasil. Sembilanpuluh dua dari 209 pasien mengalami sepsis, 22 (23,9%) di antaranya meninggal. Median usia subjek 15 (rentang 2-192) bulan dengan sebaran terbanyak pada kelompok usia 1 bulan – 1 tahun (62%). Sebagian besar subjek (57,61%) memiliki status gizi kurang. Fokus infeksi tersering adalah infeksi saraf pusat dan gastrointestinal, masing-masing 32 (34,77%) subjek. Gizi buruk (p<0,001; OR 26,88;IK95% 4,74-152,61) dan skor PELOD ≥20 (p<0,001; OR 78,8;IK95%14,23-436,36) merupakan faktor risiko yang secara independen berperan terhadap mortalitas sepsis pada anak.Kesimpulan. Gizi buruk dan skor PELOD ≥20 berperan terhadap mortalitas sepsis pada anak. Usia <5 tahun tidak terbukti sebagai faktor risiko mortalitas sepsis pada anak.
Resusitasi Cairan: dari Dasar Fisiologis hingga Aplikasi Klinis Antonius H Pudjiadi
Sari Pediatri Vol 18, No 5 (2017)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/sp18.5.2017.409-16

Abstract

Resusitasi cairan merupakan langkah penting tatalaksana renjatan pada anak. Kebutuhan resusitasi cairan sangat individual. Pemberian cairan yang tidak tepat dapat membahayakan  pasien. Tinjauan pustaka ini akan membahas fisiologi dasar sistem hemodinamik, khususnya dalam kaitannya dengan resusitasi cairan. Berbagai protokol pemberian resusitasi cairan akan dibahas secara teknik, serta masalahnya pada penggunaannya dalam klinis.
Hubungan antara Kadar High Density Lipoprotein dengan Derajat Sepsis Berdasarkan Skor Pediatric Logistic Organ Dysfunction Emi Yulianti; Antonius H. Pudjiadi; Mardjanis Said; E.M. Dady Suyoko; Hindra Irawan Satari; Pramita Gayatri
Sari Pediatri Vol 15, No 2 (2013)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (217.041 KB) | DOI: 10.14238/sp15.2.2013.116-21

Abstract

Latar belakang. Sepsis masih merupakan penyebab kematian terbesar di Pediatric Intensive Care Unit (PICU). Peran high density lipoprotein(HDL) pada keadaan sepsis mengikat dan menetralisir lipopolisakarida (LPS), menghambat adhesi molekul dalam kaskade inflamasi, dan sebagai antioksidan.Tujuan. Mengetahui profil HDL pada anak sepsis serta mengetahui hubungan kadar HDL dengan derajat sepsis berdasarkan skor pediatric logistic organ dysfunction (PELOD). Metode.Studi potong lintang pada anak sepsis di PICU Rumah Sakit Cipto Mangunkusumo (RSCM) usia 1 bulan- 18 tahun antara April-Agustus 2011.Hasil. Didapatkan 34 subjek, dengan sebaran terbanyak pada kelompok usia <2 tahun (19/34). Terdapat hubungan antara kematian dengan skor PELOD >20 (p=0,000). Lima dari 7 pasien dengan skor PELOD >20 ditemukan mempunyai kadar HDL rendah (p=1). Tidak didapatkan hubungan yang bermakna antara kematian dengan kadar HDL (p=0,248). Terdapat korelasi lemah berbanding terbalik antara kadar HDL dengan skoring PELOD tetapi tidak bermakna secara statistik (r =-0,304, p = 0,080)Kesimpulan. Pasien sepsis dengan skor PELOD tinggi cenderung memiliki kadar HDL rendah.
Fungsi Adrenal pada Sepsis di Unit Perawatan Intensif Pediatrik R. Irma Rachmawati; Dwi Putro Widodo; Bambang Tridjaja AAP; Antonius H. Pudjiadi
Sari Pediatri Vol 12, No 6 (2011)
Publisher : Badan Penerbit Ikatan Dokter Anak Indonesia (BP-IDAI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (90.821 KB) | DOI: 10.14238/sp12.6.2011.426-32

Abstract

Latar belakang. Insufisiensi adrenal sering dijumpai pada pasien syok septik dan berhubungan dengankejadian syok refrakter katekolamin dan peningkatan mortalitas.Tujuan. Mengetahui profil fungsi adrenal pada anak yang menderita sepsis di Unit Perawatan IntensifPediatrik RSCM.Metode. Penelitian deskriptif dengan desain potong lintang. Semua subjek menjalani uji stimulasikortikotropin dosis standar. Insufisiensi adrenal (IA) ditegakkan jika respons peningkatan kortisol terhadapuji (􀀧 maks) 􀁤9 μg/dl dan dikelompokkan menjadi absolut (IAA) jika kortisol pra-uji t0 <20 μg/dl danrelatif (IAR) jika t0 􀁴20 μg/dl.Hasil. Tiga puluh anak sepsis (18 laki-laki) diikutsertakan dalam penelitian. usia median adalah 29 (1-153)bulan dan median skor PELOD 12,5 (0-33). Insufisiensi adrenal dijumpai pada 8 (26,7%) pasien (2 IAA and6 IAR), lebih sering pada perempuan (p=0,003), serta cenderung lebih sering pada syok septik (p=0,682).Median t0 32,75 (4,23-378) μg/dl, t30-60 48,20 (16,70-387) μg/dl, dan 􀀧 maks 15,40 (0,90-60,80) μg/dl. Kadar t0 dan t30-60 lebih tinggi pada kelompok syok septik (p=0,03 dan p=0,01) namun tidak berbedaantara subjek dengan dan tanpa IA. Terdapat kecenderungan korelasi positif antara skor PELOD dengant0 dan t30-60 (r=0,7; dan r=0,6; p􀁤0,001). Hipotensi sistolik dijumpai pada seluruh subjek dengan IA dansyok refrakter katekolamin cenderung lebih sering pada kelompok IA (p=0,67). Mortalitas 36,7%, tidakberbeda antara subjek dengan dan tanpa IA.Kesimpulan. Insufisiensi adrenal sering dijumpai pada yang menderita anak sepsis dan harus dipertimbangkanpada kondisi syok septik. Penelitian lanjutan diperlukan untuk menentukan efektivitas terapi steroid.
Hyperlactacemia in critically ill children: comparison of traditional and Fencl-Stewart methods Hari Kushartono; Antonius H. Pudjiadi; Susetyo Harry Purwanto; Imral Chair; Darlan Darwis; Abdul Latief
Paediatrica Indonesiana Vol 47 No 1 (2007): January 2007
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (563.506 KB) | DOI: 10.14238/pi47.1.2007.35-41

Abstract

Background Base excess is a single variable used to quantifymetabolic component of acid base status. Several researches havecombined the traditional base excess method with the Stewartmethod for acid base physiology called as Fencl-Stewart method.Objective The purpose of the study was to compare two differentmethods in identifying hyperlactacemia in pediatric patients withcritical illness.Methods The study was performed on 43 patients admitted tothe pediatric intensive care unit of Cipto MangunkusumoHospital, Jakarta. Sodium, potassium, chloride, albumin, lactateand arterial blood gases were measured. All samples were takenfrom artery of all patients. Lactate level of >2 mEq/L was definedas abnormal. Standard base excess (SBE) was calculated fromthe standard bicarbonate derived from Henderson-Hasselbalchequation and reported on the blood gas analyzer. Base excessunmeasured anions (BE UA ) was calculated using the Fencl-Stewartmethod simplified by Story (2003). Correlation between lactatelevels in traditional and Fencl-Stewart methods were measuredby Pearson’s correlation coefficient .Results Elevated lactate levels were found in 24 (55.8%) patients.Lactate levels was more strongly correlated with BE UA (r = - 0.742,P<0.01) than with SBE (r = - 0.516, P<0.01).Conclusion Fencl-Stewart method is better than traditionalmethod in identifying patients with elevated lactate levels, so theFencl-Stewart method is suggested to use in clinical practice.
Thyroid hormone profile and PELOD score in children with sepsis Agung G. Tanurahardja; Antonius H. Pudjiadi; Pramita G. Dwipoerwantoro; Aman Pulungan
Paediatrica Indonesiana Vol 54 No 4 (2014): July 2014
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (100.884 KB) | DOI: 10.14238/pi54.4.2014.245-50

Abstract

Background Thyroid hormonal dysfunction, also known aseuthyroid sick syndrome or nonthyroidal illness, can be seenin sepsis. There have been few studies on thyroid hormonedysfunction in septic children, as well as on a relationshipbetween their thyroid hormone profiles and pediatric logisticorgan dysfunction (PELOD) scores. Procakitonin (PCT) is oneof the sepsis biomarker.Objective To evaluate the thyroid hormone profile in childrenwith sepsis as well as to assess for a correlation between the thyroidlevels and PELOD scores, PCT levels, and patient outcomes.Methods This cross-sectional study included children aged 1- 18years admitted to the pediatric intensive care unit (PICU) with aprimary diagnosis of sepsis. PELOD scores and thyroid hormonallevels were assessed once during the first 24 hours after PICUadmission.Results Thirty subjects were included in the study. The medianvalues ofT3, free T4, and TSH were 45 (range 17 -133) ng/dL,0.81 (range 0.3-1.57) ng/dL, and 1.36 (range 0.05-7.78) μIU/L,respectively. The T3, free T4, and TSH levels were decreased in97%, 50% and 40% of the subjects. There were no significantdifferences between low and normal to high TSH with regards tothe PELOD score (P=0.218), PCT level (P=0.694), or patientoutcomes (P=0.55). The risk of death increased by 15 timesamong the subjects with PELOD score ~20 compared to thosewith PELOD score <20 (OR 15; 95%CI: 1.535 to 146.545;P=0.012).Conclusion Thyroid hormones are decreased in septic childrenwith the majority having low T3. A high PELOD score is stronglycorrelated with mortality and can be used as a prognostic parameterfor septic children in the PICU, but there is no correlation withdecreased TSH.
Pulse pressure variation and systolic pressure variation in mechanically ventilated children Johnny Nurman; Antonius H. Pudjiadi; Arwin A. P. Akib
Paediatrica Indonesiana Vol 51 No 1 (2011): January 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi51.1.2011.34-40

Abstract

Background In mechanically ventilated patients, changes in breathing patterns may affect the preload, causing stroke volume fluctuation. Pulse pressure variation (PPV) and systolic pressure variation (SPV) are dynamic means of the hemodynamic monitoring in ventilated patients. No study on PPV and SPY in children has been reported to date.Objective To study changes in PPV and SPY values in mechanically ventilated children.Method A descriptive cross􀁏sectional study was done at the Pediatric Critical Care Unit (PICU), Cipto Mangunkusumo Hospital, Jakarta. Subjects were mechanically ventilated children aged > 12 months. Echocardiography was performed in all patients to determine the cardiac index. Arterial pressure was measured by connecting an arterial line to a vital signs monitor. PPV and SPV were calculated using the standard formulas. Bivariate correlation tests were performed between cardiac index and PPV and between cardiac index and SPV. Receiver operator characteristic (ROC) curve analysis was done to determine the optimum PPV and SPV cut-off points to predict normal cardiac index (2:3.5 L/minute/m2).Results Eighteen patients were enrolled in the study, yielding 48 measurements. Mean cardiac index was 2.9 (SD 1-2.6) L/minute/m2. Median PPV was 18.9 (range 4.1-45.5)% and SPV was 12.1 (range 3.8- 18.9)%. We found strong negative correlations between PPY and cardiac index (r= ; p = ) and SPY and cardiac index (r= ; p = ). To predict nonnal cardiac index, the optimum cut-off point was 11.4% for PPV (100% sensitivity, 100% specificity) and 9.45% for SPV (91.7% sensitivity, 100% specificity).Conclusion In mechanically ventilated children, cardiac index is negatively correlated with PPV and SPV.
Prognostic factors of death in children admitted to pediatric intensive care unit, Cipto Mangunkusumo Hospital, Jakarta, Indonesia Antonius Hocky Pudjiadi; Meri Yanti; Aland Roland Tumbelaka
Paediatrica Indonesiana Vol 42 No 11-12 (2002): November 2002
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (407.275 KB) | DOI: 10.14238/pi42.6.2002.254-60

Abstract

Background The primary goal of intensive care is to prevent mortality in patients with reversible critical illness, while preserving or improving functional outcome. It follows that the capability to estimate patient's risk of death is extremely important.Objective To identify the prognostic factors of death, evaluate the probability of death by using Pediatric Index of Mortality (PIM) model, and develop the new model for predicting probability of death in children admitted to PICU in accordance with characteristic of patients in the study unit.Methods Design Retrospective study. Setting Pediatric intensive care unit of Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Patient Two hundreds and sixty five consecutive admissions, <18 years old, during one year period.Results Logistic regression of 18 variables identified 6 prognostic factors of death (P<0.05): age, consciousness level, heart rate, platelet count, PaO2/FiO2, and use of mechanical ventilation at the first hour in PICU. PIM model predicted 17.9 deaths and this study model predicted 113.2 deaths from 200 subjects (56 died) in this study, with the area under ROC curve was 0.82 for PIM model and 0.83 for this study model.Conclusion Both PIM model and this study model cannot predict mortality in this study unit accurately. It may due to the different characteristics between sample in this study and sample from which the PIM model was derived, or the lack of sample and variable in this study
Correlation of Interleukin-8, Pediatric Logistic Organ Dysfunction score and factors associated with systemic inflammatory response after cardiopulmonary bypass in children who have undergone open-heart surgery Ririe F Malisie; Antonius H Pudjiadi; Fathema D Rachmat; Jusuf Rachmat
Paediatrica Indonesiana Vol 50 No 4 (2010): July 2010
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi50.4.2010.245-51

Abstract

Background Cardiopulmonary bypass (CPB) provides a complex set of non-physiologic circumstances, induces systemic release of pro-inflammatory cytokines and initiates systemic inflammatory response. IL-8 is an important activator of neutrophil with chemotactic effect and are proposed to be major mediator of inflammation. The majority of general intensive care unit scoring system does not adequately address the specific characteristics of cardiac surgery patients. None of the study had been published the validation of PELOD score setting in pediatric cardiac intensive care unit (CICU).Objectives To evaluate the correlation between interleukin-8 (IL-8), Pediatric Logistic Organ Dysfunction (PELOD) score and factors associated with systemic inflammatory response after bypass (SIRAB) in children undergone cardiopulmonary bypass surgery.Methods A quasi-experimental study was conducted on children who have undergone cardiac surgery requiring CPB. There were 21 eligible children, two were excluded. Blood samples from mixed vein and coronary sinus were taken before, during and after surgery. The plasma level of IL-8 analyzed at 3 time points: baseline (before) CPB, at reperfusion period and 3 hours after aortic cross clamp-off. Cumulative organ dysfunctions were analyzed by PELOD score.Results The plasma level of IL-8 highly increase at the reperfusion period. IL-8 plasma level correlated with bypass-time (r > 0.49, p=0.003) and aortic cross clamp-time (r > 0.55, P=.014). Moderate association between age and PELOD score (r > 0.47, P=0.041). The correlations were significant between age and mechanical ventilation time support (r > 0.47, P=0.03), age and length of stay in CICU (r > 0.44, P=0.05). No correlation between IL-8 plasma level and PELOD score.Conclusion There was no correlation between IL-8 plasma level and PELOD score. IL-8 plasma level correlated with aortic cross clamp-time in children who undergo cardiopulmonary bypass surgery.
Co-Authors Abdul Latief Abdul Latief Abdul Latief Abdul Latief Latief Agung G. Tanurahardja Ahmad Arif Amin Aland Roland Tumbelaka Aman Pulungan Amir Thayeb Angelina Arifin Aria Kekalih Arwin A. P. Akib Aryono Hendarto Badriul Hegar Bambang Supriyatno Bambang Tridjaja AAP, Bambang Tridjaja Damayanti R. Syarif Darlan Darwis Desy Dewi Saraswati Diana Aulia Dilawar, Ismail Doddy Kurnia Indrawan Dwi Putro Widodo E.M. Dady Suyoko Emi Yulianti Evita B. Ifran Evita Kariani B. Ifran Fathema D Rachmat Galih Satria Kusumanto Gunanti . Gunanti Gunanti Hari Kushartono Heri Wibowo Hindra I. Satari, Hindra I. Hindra Irawan Satari Hotber Pasaribu I Nyoman Budi Hartawan Idham Amir Idham Amir Imral Chair Irawan Mangunatmadja Irene Yuniar, Irene Johnny Nurman Jusuf Rachmat Lina Haryanti Lisnawati Rachmadi Mardjanis Said Melpa Susanti Purba Meri Yanti Mulya R. Karyanti Mulyadi M. Djer Mulyadi M. Djer Munar Lubis Murni, Indah K. Najib Advani Najma Hayati Ni Made Rini Suari Nia Kurniati Nina Dwi Putri Nindya Permata Piprim B. Yanuarso, Piprim B. Pramita G. Dwipoerwantoro Pramita Gayatri R. Irma Rachmawati Raden Roro Soesatyoratih Rina A.C. Saragih, Rina A.C. Ririe F Malisie Rismala Dewi Ronald Chandra Rubiana Sukardi, Rubiana Saptawati Bardosono Setyo Handryastuti Supriatna, Novianti Susanti, Dhama S. Susetyo Harry Purwanto Taralan Tambunan Tartila Fathan Tatang M. Puspandjono Vimaladewi Lukito Yosilia Nursakina Zakiudin Munasir