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All Journal Jurnal Ilmu Kedokteran (Journal of Medical Science) Jurnal Anestesi Perioperatif Althea Medical Journal E-Journal Widya Kesehatan dan Lingkungan Majalah Anestesia dan Critical Care Jurnal Neuroanestesi Indonesia Majalah Anestesia & Critical Care (MACC) The Journal of Society Medicine (JSOCMED) Jurnal Komplikasi Anestesi
Ezra Oktaliansah
Departemen Anestesiologi Dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung
Biochemistry, Genetics & Molecular Biology Dentistry Education Environmental Science Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Continous Renal Replacement Therapy pada Pasien Sepsis, Respiratory Failure, Acute Kidney Injury, dan Asidosis Metabolik Septian, Dendi; Oktaliansah, Ezra
Jurnal Komplikasi Anestesi Vol 11 No 3 (2023)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v11i3.15136

Abstract

Sepsis is a life-threatening organ dysfunction resulting from dysregulation of the body's response to infection. The hypermetabolic response results in an imbalance between oxygen supply to tissues while oxygen demand in peripheral organs increases. Acute Kidney Injury (AKI) is one of the most common and severe complications of sepsis, and is associated with high mortality and poor outcomes. If pharmacological therapy has been given but there is no clinical improvement, Continuous Renal Replacement Therapy (CRRT) with Continuous Venovenous Hemodiafiltration (CVVHDF) modality can be considered. A 31-year-old male patient came with complaints of shortness of breath, the patient was diagnosed with septic shock accompanied by acute kidney injury and chronic kidney disease. The patient's condition worsened with unstable hemodynamics. CRRT is performed as an option for AKI management in critically ill patients with unstable hemodynamics. There was improvement in renal function, acidosis, and hemodynamics in patients. Renal Replacement Therapy (RRT) is an option for treating AKI in critically ill patients with unstable hemodynamics. CRRT plays an important role in treating septic shock patients with AKI in the intensive care unit.
Management of Autoimmune Encephalitis with Refractory Status Epilepticus Saputra, Rangga; Oktaliansah, Ezra
Journal of Society Medicine Vol. 4 No. 5 (2025): May
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i5.209

Abstract

Introduction: Autoimmune encephalitis (AE) is a leading cause of non-infectious encephalitis. Its diagnosis remains challenging due to the often non-specific clinical presentation and difficulties in confirming antibody-negative cases. Comprehensive evaluation is essential to establish the diagnosis of AE. Case Report: We report a 25-year-old male presenting with decreased consciousness and seizures, accompanied by behavioral changes over the preceding 10 days. Electroencephalography (EEG) showed normal waveforms, and cerebrospinal fluid (CSF) analysis did not suggest infection. Brain CT scans were unremarkable, and serologic tests for herpes simplex virus (HSV) IgG and IgM were non-reactive. Notably, anti-NMDAR antibodies were positive. The patient was managed in the ICU with mechanical ventilation, sedated with propofol, and administered phenytoin for seizure control. Empirical treatment with acyclovir was given for 10 days, with no clinical improvement. First-line immunotherapy with methylprednisolone (1g/day for 5 days) was initiated but failed to produce neurological recovery. On day 14, CSF analysis indicated autoimmune etiology; plasma exchange was performed over three days, resulting in clinical improvement. Conclusion: Diagnosing and managing antibody-negative AE remains challenging. Clinical judgment, supported by the exclusion of differential diagnoses and the absence of characteristic radiological and immunological findings, can justify the initiation of immunosuppressive therapy or plasma exchange, which may lead to significant clinical improvement.
Perubahan Fungsi Kognitif Peserta Program Pendidikan Dokter Spesialis (PPDS) Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran Setelah 24 Jam Kerja Nurchaeni, Ati Nurchaeni; Tavianto, Doddy; Oktaliansah, Ezra
Jurnal Neuroanestesi Indonesia Vol 8, No 3 (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 (2850.464 KB) | DOI: 10.24244/jni.v8i3.3

Abstract

Latar Belakang dan Tujuan: Profesi dokter anestesi merupakan profesi dengan beban kerja tinggi yang dituntut untuk berpikir dan bertindak cepat dan tepat dalam situasi kritis. Kekurangan tidur, kelelahan, dan perubahan irama sirkadian mempengaruhi fungsi kognitif dokter anestesi. Tujuan penelitian ini untuk mengetahui perubahan fungsi kognitif peserta Peserta Program Pendidikan Dokter Spesialis (PPDS) Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran setelah 24 jam kerja yang diperiksa menggunakan Montreal Cognitive Assessment versi Indonesia (MoCA-INA). Subjek dan Metode: Penelitian ini merupakan penelitian deskriptif observasional prospektif dengan pendekatan cross sectional yang dilakukan pada 62 subjek dengan memeriksa MoCA-INA jam ke-0 dan jam ke-24. Hasil: Pada penelitian ini didapatkan penurunan nilai rata-rata MoCA-INA dengan nilai jam ke-0 yaitu 29,84 0,365 dan jam ke-24 yaitu 28,92 1,010. Berdasarkan aspek kognitif yang diperiksa, fungsi atensi merupakan aspek yang mengalami penurunan setelah jam ke-24. Penurunan nilai MoCA-INA paling banyak terdapat pada subjek yang bertugas di kamar operasi. Penurunan nilai rata-rata MoCA-INA setelah 24 jam kerja tersebut masih dalam batas normal karena masih di atas nilai acuan dan secara klinis tidak menunjukkan gangguan. Simpulan: Terdapat penurunan fungsi kognitif peserta PPDS Anestesiologi dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran setelah 24 jam kerja.Cognitive Function Alterations on Residents Anesthesiology and Intensive Care of Medical Faculty Universitas Padjadjaran after 24 Hours ShiftAbstractBackground and Objective: Anesthesiologist is a profession with a heavy workload which is need fast thinking and rapid decision making in a critical and life-threatening situation. Sleep deprivation, extended workshifts, exhaustion and circardian cycle changes can affect anesthesiologists cognitive function. This aim of this study was to evaluate cognitive function changes in Residents of Anesthesiology and Intensive Therapy in Medical Faculty Universitas Padjadjaran after 24 hours shift using Montreal Cognitive Assesment-Indonesia Version (MoCA-INA).Subject and Method: This study was an observational-descriptive-prospective study using crosss sectional approach evaluating MoCA-INA score in 0th hour and 24th hour after shift in 62 subjects. Result: The result of this study shown an average MoCA-INA score at 0th hour was 29.84 0.365 while at 24th hours the average score was 28.92 1.010. According to MoCA-INA, attention is the deprived domain at 24th hour after shift. MoCA-INA score declines mostly in subjects working in the operating room. According to MoCA-INA cut off value, the score of 26 is considered normal after 24 hours shift and not showing any clinical disturbance. Conclusion: The conclusion of this study is decreasing cognitive function among Anesthesiology Medical Faculty Universitas Padjadjaran residents after 24 hours shift.
GAMBARAN POLA KUMAN, RESISTENSI, FAKTOR RISIKO, DAN TINGKAT MORTALITAS PADA PASIEN VENTILATOR ASSOCIATED PNEUMONIA DI GENERAL INTENSIF CARE RSUP HASAN SADIKIN BANDUNG PERIODE JANUARI 2022 - DESEMBER 2022 Oktaliansah, Ezra; Budipratama, Dhany; Putra, Rifki Dwi Anugrah
Jurnal Anestesi Perioperatif Vol 13, No 2 (2025)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851//jap.v13n2.4036

Abstract

Ventilator Associated Pneumonia (VAP) merupakan infeksi paru yang terjadi 48–72 jam setelah tindakan intubasi endotrakeal dan menjadi salah satu infeksi nosokomial paling sering di Intensive Care Unit (ICU), dengan prevalensi mencapai 70-80% dari seluruh kasus pneumonia di rumah sakit. Di Indonesia, insiden VAP tergolong tinggi, terutama disebabkan oleh Acinetobacter baumannii yang bersifat resisten terhadap berbagai antibiotik dan berkontribusi terhadap peningkatan angka mortalitas. Penelitian ini menggunakan metode observasional deskriptif dengan pendekatan retrospektif berdasarkan data rekam medis pasien VAP di ICU RSUP Dr. Hasan Sadikin Bandung periode Januari–Desember 2022. Dari 33 pasien yang diteliti, ditemukan 70 hasil kultur kuman, dengan 55 di antaranya tergolong Multidrug Resistant (MDR). Kuman yang paling dominan adalah Acinetobacter baumannii (85,7% MDR), diikuti Klebsiella pneumoniae (94,4% MDR) dan Pseudomonas aeruginosa (87,5% MDR). Angka mortalitas mencapai 60,6%, dengan tingkat kematian lebih tinggi pada pasien dengan kultur MDR. Faktor risiko yang sering ditemukan ialah hipertensi, penyakit serebrovaskular, dan gagal ginjal kronik. Pola resistensi tinggi teridentifikasi pada Acinetobacter baumannii terhadap cefazolin (95,7%) dan ampicillin-sulbactam (91,3%), Klebsiella pneumoniae terhadap cefazolin (97,0%) dan ceftriaxone (96,8%), serta Pseudomonas aeruginosa terhadap imipenem (94,7%) dan cefazolin (91,7%). Hasil ini menunjukkan perlunya peningkatan program penanganan VAP di RSUP Dr. Hasan Sadikin.
Red Cell Distribution Width to Albumin Ratio versus Red Cell Distribution Width to Platelet Ratio as Predictors of 28-Day Mortality in Sepsis Patients Admitted to the Intensive Care Unit Ningsih, Diana Fitria; Pison, Osmond Muftilov; Suwarman, Suwarman; Maskoen, Tinni T.; Oktaliansah, Ezra; Aditya, Ricky
Jurnal Anestesi Perioperatif Vol 13, No 3 (2025)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v13n3.4638

Abstract

Background: Sepsis is a leading cause of mortality in the Intensive Care Unit (ICU). Early identification of high-risk patients requires simple and accessible prognostic biomarkers. The Red Cell Distribution Width to Albumin Ratio (RAR) and Red Cell Distribution Width to Platelet Ratio (RPR) have been proposed as potential biomarkers.Methods: This prospective cohort study was conducted in the ICU of Dr. Hasan Sadikin General Hospital, Bandung, from July to September 2025, involving 71 subjects who met the Sepsis-3 criteria. RAR and RPR values were calculated from blood tests within the first 24 hours of ICU admission. The primary outcome was 28-day mortality. Statistical analysis used the Receiver Operating Characteristic (ROC) curve to determine the cut-off value, sensitivity, specificity, and Area Under the Curve (AUC). The AUC comparison between RAR and RPR was analyzed using the DeLong test.Results: A total of 41 patients (57.7%) experienced 28-day mortality. The optimal cut-off value for RAR was 5.7404 (Sensitivity 85.4%; Specificity 73.3%) with an AUC of 89.3% (95% CI: 79.8–95.4%). The optimal cut-off value for RPR was 0.0627 (Sensitivity 75.6%; Specificity 76.7%) with an AUC of 74.7% (95% CI: 63.0–84.3%). RAR had a significantly better discriminatory value than RPR (p=0.026).Discussion: The RAR value is a better predictor of 28-day mortality than the RPR value in septic patients treated in the ICU.Conclusion: RAR can be considered a simple and effective prognostic tool for the early risk stratification of septic patients.
Comprehensive Intensive Care Management of Sepsis Secondary to Submandibular Abscess Complicated by Ventilator-Associated Pneumonia Vonny, Vonny; Oktaliansah, Ezra; Erlangga , M. Erias
Journal of Society Medicine Vol. 5 No. 1 (2026): January
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v5i1.262

Abstract

Introduction: Phlegmon is an acute, rapidly spreading, suppurative inflammation of the connective tissue characterized by diffuse involvement without clear anatomical boundaries. When it affects the floor of the mouth, particularly the submandibular and sublingual spaces, it is referred to as Ludwig’s angina, a severe deep neck infection most commonly originating from odontogenic infections of the second or third mandibular molars. Ludwig’s angina is potentially life-threatening because of the risk of sudden airway obstruction and rapid progression to serious complications, including mediastinitis, pulmonary infection, sepsis, multiorgan failure, and death. Despite advances in antimicrobial therapy and surgical source control, airway compromise and infectious complications remain major challenges. Case Description: A 35-year-old man with bilateral submandibular abscesses who underwent incision, drainage, and tracheostomy at a referring hospital. Three days postoperatively, the patient developed pneumonia with purulent discharge from the tracheostomy site. Imaging revealed the extension of the infection into the parapharyngeal and retropharyngeal spaces, requiring repeat surgical debridement. Following surgery, the patient was admitted to the intensive care unit (ICU) and required mechanical ventilation. The ICU course was complicated by right-sided pleural empyema necessitating thoracotomy with decortication and chest tube placement, as well as ventilator-associated pneumonia caused by multidrug-resistant organisms. Management involved aggressive source control, advanced airway management, broad-spectrum antimicrobial therapy, optimized nutritional support and intensive respiratory physiotherapy. Conclusion: This case underscores the complexity of managing severe Ludwig’s angina complicated by sepsis and ventilator-associated pneumonia. Early recognition, prompt surgical intervention, meticulous airway management, and comprehensive multidisciplinary intensive care are crucial for improving outcomes in patients with extensive deep neck infections and critical respiratory complications.
Co-Authors A. Himendra Wargahadibrata A. Himendra Wargahadibrata Achmad Noerkhaerin Putra Afifuddin Afifuddin Afifuddin Afifuddin, Afifuddin Agus Fitri Atmoko Ahmado Okatria Anggita Marissa Harahap Anggita Marissa Harahap Anna Christanti Anthon Vermana Ritonga Anthon Vermana Ritonga Ardi Janardika Ardi Zulfariansyah Arvianto Arvianto Arvianto Arvianto, Arvianto Asep Deden Komara Atmoko, Agus Fitri Bernadeth Bernadeth Budiana Rismawan Cindy Elfira Boom Cindy Elfira Boom Dedi Fitri Yadi Dendi Karmena Dendi Karmena, Dendi Dhany Budipratama Doddy Tavianto Eri Surahman Eri Surahman Eri Surahman Erlangga , M. Erias Erwin Pradian Ferianto Ferianto Ferianto Gavrila Diva Amelis Heru Wishnu Manunggal Heru Wishnu Manunggal Ibnu, Muhamad Ihrul Prianza Prajitno Ihrul Prianza Prajitno Ike Sri Redjeki Ike Sri Redjeki Immanuel Wiraatmaja Immanuel Wiraatmaja Indra Wijaya Indriasari Indriasari Indriasari Indriasari Indriasari Irvan Setiawan Irvan Setiawan Iwan Fuadi Jauharul Alam Jauharul Alam Keshina Amalia Mivina Mudia Keshina Amalia Mivina Mudia, Keshina Amalia Mivina Komara, Asep Deden Linggih Panji Nugraha M. Andy Prihartono M. Erias Erlangga Maria Agnes Berlian Yulriyanita Meilani Patrianingrum Meilani Patrianingrum Melliana Somalinggi Mira Rellytania Sabirin Mira Rellytania Sabirin Mohamad Andy Prihartono Mohamad Andy Prihartono Muhamad Adli Boesoirie Muhamad Adli Boesoirie, Muhamad Adli Muhamad Ibnu Muhammad Ibnu Muhari, Andie Naftalena Naftalena Nelly Margaret Simanjuntak Ningsih, Diana Fitria Nobelia Carnationi Novie Salsabila Nurchaeni, Ati Nurchaeni Okatria, Ahmado Pison, Osmond Muftilov Putra, Rifki Dwi Anugrah Radian Ahmad Halimi Radian Ahmad Halimi Rakhman Adiwinata Rakhman Adiwinata, Rakhman Rangga Saputra Reza Widianto Sudjud Ricky Aditya Ricky Aditya, Ricky Rudi K. Kadarsah Rudi K. Kadarsah Ruli Herman Sitanggang Said Badrul Falah Said Badrul Falah, Said Badrul SATRIYAS ILYAS Septian, Dendi Simanjuntak, Nelly Margaret Sitanggang, Ruli H Somalinggi, Melliana Stefi Berlian Soefviana Suryaningrat, IGB Suwarman Suwarman Suwarman, Suwarman Tatang Bisri Tatang Bisri Thayeb, Srilina Tinni T. Maskoen Tinni T. Maskoen Tirto Hartono Vick Elmore Simanjuntak Vick Elmore Simanjuntak Vonny Vonny, Vonny Wirawan Anggorotomo Wirawan Anggorotomo, Wirawan