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All Journal Jurnal Anestesiologi Indonesia Majalah Kedokteran Bandung Jurnal Anestesi Perioperatif Syifa' MEDIKA: Jurnal Kedokteran dan Kesehatan Majalah Anestesia dan Critical Care Majalah Anestesia & Critical Care (MACC) The Journal of Society Medicine (JSOCMED) Jurnal Komplikasi Anestesi
Erwin Pradian
Departemen Anestesiologi Dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran Rumah Sakit Dr. Hasan Sadikin Bandung
Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Therapeutic Outcome of High Flow Nasal Cannula (HFNC) for Severe COVID-19 Patients in Isolation Intensive Care Unit Baginda Aflah; Erwin Pradian; Nurita Dian Kestriani
Majalah Kedokteran Bandung Vol 55, No 2 (2023)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v55n2.2875

Abstract

This retrospective descriptive study aimed to understand the outcomes of HFNC therapy in severe COVID-19 patients admitted to isolation ICU during the period of January to June 2021 in Dr. Hasan Sadikin General Hospital Bandung, Indonesia. A total of 134 patients with severe COVID-19 were admitted to the isolation ICU and received HFNC. Among them, 44 patients (32.8%, N:134) were successfully weaned from HFNC and 90 patients (67.2%, N:134) failing HFNC with 10 patients (7.5%, N:134) died on HFNC use, 72 patients (53.9%, N:134) died on ventilator use, 4 patients (2.9%, N:134) moved rooms under HFNC use, and 4 patients (2.9%, N:134) moved to non-ICU isolation with ventilator use as the outcome. Patients’ median age was 60 years, most were male (52.3 %, N:134), median BMI was 25.4 kg/m2, with hypertension and diabetes mellitus as the main comorbidities. There was an improvement in the SpO2 on the first day after the use of HFNC. The ROX index had a median value of 3.6 on the first day, with the lowest ROX index of 3.2 and the highest of 4.4 during the treatment time. There was an improvement in the P/F Ratio in successful patients with a median initial P/F Ratio of 86.7 to 200.1 at the end of treatment. Overall, HFNC improves the hypoxemic conditions in early admission but does not correlate with general patient outcomes.
Gambaran Mortalitas Pasien Sepsis Berdsarkan Fluid Accumulation di ICU RSUP DR. Hasan Sadikin Bandung Tahun 2021–2022 Faisal Rachman; Erwin Pradian; Nurita Dian Kestriani
Jurnal Anestesi Perioperatif Vol 12, No 2 (2024)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v12n2.3717

Abstract

Manajemen cairan pasien sakit kritis memiliki risiko terjadinya akumulasi cairan. Resusitasi cairan merupakan bagian penting dalam menstabilkan status hemodinamik dan meningkatkan oksigenasi jaringan. Beberapa penelitian telah menunjukkan bahwa balans cairan kumulatif positif merupakan faktor prognostik yang kuat untuk mortalitas pasien sepsis. Tujuan penelitian ini adalah mengetahui gambaran mortalitas pada pasien sepsis yang mengalami akumulasi cairan selama dirawat di ICU RSUP Dr. Hasan Sadikin Bandung Tahun 2021–2022. Metode pengambilan sampel dilakukan dengan teknik consecutive sampling secara retrospektif melalui rekam medis pasien sepsis yang mengalami akumulasi cairan di ICU RSUP Dr. Hasan Sadikin Bandung selama periode 1 Januari 2021–31 Desember 2022 dengan jumlah sampel adalah 107 orang subjek penelitian. Analisis menunjukkan bahwa karakteristik pasien relatif sama antara kelompok yang mengalami mortalitas dan yang bertahan hidup. Pada kategori akumulasi cairan >10%, semua pasien (100%) mengalami mortalitas, sedangkan pada kategori akumulasi cairan <10%, 27 pasien (51,9%) meninggal dan 25 pasien (48,1%) bertahan hidup. 
Terapi Nutrisi Pasien di Intensive Care Unit (ICU) Santosa, Budi; Suwarman; Pradian, Erwin
Jurnal Komplikasi Anestesi Vol 7 No 3 (2020): Volume 7 Number 3 (2020)
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.v7i3.7480

Abstract

Nutrition is important in critical patient care. Malnutrition may lead to poor outcome of the patient in ICU, including increases morbidity, mortality, and length of stay. Patient in ICU also experienced increased metabolism and catabolism which can lead to malnutrition. Therefore, the provision of nutrition for patients in the ICU needs a special care. The nutritional requirement of critical ill patients depend on the severity of the disease and previous nutritional status. To achieve the demand of nutritional demand can be given enterally, parenterally or both.
KORELASI ANTARA DOPPLER-BASED RENAL RESISTIVE INDEX DAN NILAI KREATININ PADA PASIEN SAKIT KRITIS Tanto, Dedi; Pradian, Erwin; Erlangga, Erias
Jurnal Anestesi Perioperatif Vol 12, No 3 (2024)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v12n3.3779

Abstract

Indeks resistriksi renal/renal resistive index (RRI) merupakan pemeriksaan ultrasonografi non invasif untuk menilai renovascular dan dapat dilakukan dengan prinsip point-of-care testing (POCT) RRI merefleksikan perubahan aliran darah arteri intrarenalis, yang dapat terganggu pada pasien dengan gangguan fungsi ginjal, yang tercermin dalam peningkatan nilai kreatinin serum. Penelitian ini bersifat observasional analitik dengan desain potong lintang, bertujuan untuk mengetahui hubungan antara RRI dan nilai kreatinin serum pada pasien sakit kritis di ICU RSUP Dr. Hasan Sadikin, Bandung, dari Mei hingga Agustus 2023. Sebanyak 51 pasien berusia 18–65 tahun menjalani pemeriksaan RRI dan kreatinin serum pada 24 jam pertama dan kedua setelah masuk ICU. Analisis korelasi menunjukkan nilai R sebesar 0,538, koefisien determinasi (r²) sebesar 0,298, dan nilai p<0,001. Hasil ini menunjukkan korelasi positif moderat antara RRI dan nilai kreatinin serum.
Blokade Peribulbar dengan Adjuvan Fentanil: Efek Hemodinamik dan Analgetik pada Vitrektomi Yadi, Dedi Fitri; Nadya, Siti Fairuz; Halimi, Radian Ahmad; Tavianto, Doddy; Pradian, Erwin; Fuadi, Iwan
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.v13n2.4413

Abstract

Operasi vitrektomi membutuhkan analgesia adekuat dan stabilitas hemodinamik, terutama pada pasien usia lanjut dengan komorbiditas. Ropivakain adalah anestesi lokal yang umum digunakan untuk blokade peribulbar, namun kualitas bloknya dapat ditingkatkan dengan penambahan opioid seperti fentanil. Studi ini merupakan penelitian pertama yang membandingkan efektivitas ropivakain 0,75% dengan kombinasi ropivakain 0,75% dan fentanil 3 μg/mL pada tekanan darah dan kualitas analgesia pada operasi vitrektomi. Desain penelitian ini adalah single blind randomized controlled trial yang melibatkan 54 pasien yang menjalani vitrektomi. Penelitian dibagi menjadi dua kelompok yang masing-masing terdiri 27 pasien: kelompok R yang menerima ropivakain 0,75% dan kelompok RF yang menerima ropivakain 0,75% dan fentanil 3 μg/ml. Tekanan darah sistolik, diastolik, MAP, serta kualitas analgesia (NRS) diukur pada tiga waktu yaitu sebelum, selama dan setelah operasi. Analisis statistik menggunakan uji t tidak berpasangan, Mann Whitney dan Chi-Square. Hasil penelitian menunjukkan bahwa tidak terdapat perbedaan bermakna dalam perubahan tekanan darah sistolik, diastolik, dan MAP antara kedua kelompok (p>0,05). Kualitas analgesia yang dinilai menggunakan NRS juga tidak menunjukkan perbedaan signifikan (p>0,05). Kesimpulan penelitian ini adalah kombinasi ropivakain 0,75 % dan fentanil 3 mcg/ml memberikan hasil yang sebanding dengan ropivakain 0,75 % saja dalam hal stabilitas hemodinamik dan kualitas analgesia pada operasi vitrektomi.
Management of Severe Head Injury Patients with Concurrent Metabolic Disorders, Hyperkalemia, Stage III Acute Kidney Injury, and Suspected Alcohol Intoxication Using Renal Replacement Therapy in ICU Irawati, Dian; Pradian, Erwin
Journal of Society Medicine Vol. 4 No. 11 (2025): November
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i11.239

Abstract

Introduction: Severe head injury (SHI) presents complex challenges, particularly when complicated by metabolic disorders, hyperkalemia, acute kidney injury (AKI), and suspected alcohol intoxication. These conditions necessitate comprehensive management in the Intensive Care Unit (ICU), often incorporating renal replacement therapy (RRT) to address life-threatening complications. This case highlights the multidisciplinary approach required to optimize outcomes in such critical scenarios. Case Description: A 45-year-old male presented to the ICU with SHI following a motor vehicle accident, exhibiting a Glasgow Coma Scale score of 6. Clinical evaluation revealed hyperkalemia (potassium 6.8 mmol/L), stage III AKI (serum creatinine 4.2 mg/dL), and metabolic acidosis. Suspected alcohol intoxication was noted based on clinical history and odor of alcohol. Initial management included neuroprotective measures, mechanical ventilation, and fluid resuscitation. Continuous renal replacement therapy (CRRT) was initiated to manage hyperkalemia and AKI, stabilizing electrolyte imbalances within 48 hours. Neuroimaging confirmed diffuse axonal injury, prompting anticonvulsant therapy and intracranial pressure monitoring. Multidisciplinary care involving neurology, nephrology, and critical care teams facilitated tailored interventions, resulting in gradual improvement in renal function and consciousness over two weeks. Conclusion: Effective management of SHI with concurrent metabolic disorders, hyperkalemia, AKI, and suspected alcohol intoxication requires integrated ICU care and RRT. Early intervention, precise monitoring, and multidisciplinary coordination are critical for improving patient outcomes in such complex cases.
Septic Shock Management Using Continuous Renal Replacement Therapy in a Postpartum Patient with Diabetic Ketoacidosis, Acute Kidney Injury, and Ventilator-Associated Pneumonia Putra, Prana Indra; Pradian, Erwin
Journal of Society Medicine Vol. 4 No. 11 (2025): November
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v4i11.248

Abstract

Introduction: Postpartum sepsis in patients with pregestational diabetes mellitus is a life-threatening condition that may precipitate acute kidney injury (AKI) and diabetic ketoacidosis (DKA). Sepsis frequently leads to multiorgan dysfunction, with the kidneys being particularly vulnerable. Severe AKI in septic shock often requires renal replacement therapy. Continuous Renal Replacement Therapy (CRRT), particularly in hemodynamically unstable patients, is the preferred modality due to its gradual solute and fluid removal, cytokine modulation, and ability to manage complex acid-base disturbances. In this setting, secondary ventilator-associated pneumonia (VAP) further complicates management. Case Description: A 35-year-old woman with pregestational type 2 diabetes mellitus developed septic shock with DKA following spontaneous vaginal delivery. She presented with refractory hypotension, severe metabolic acidosis (pH 6.98), hyperglycemia (301 mg/dL), ketonuria (2+), and oliguria (0.3 mL/kg/h). Serum creatinine rose from 0.85 to 3.61 mg/dL, fulfilling KDIGO stage 3 AKI criteria. During ICU stay, the patient developed VAP, necessitating prolonged mechanical ventilation and targeted antimicrobial therapy. Conclusion: Early initiation of Continuous Veno-Venous Hemodiafiltration (CVVHDF) using bicarbonate-buffered replacement fluid and an oXiris filter effectively corrected severe acidosis (pH 7.255 → 7.359 within 76 hours), removed ketones and inflammatory mediators, stabilized hemodynamics, and facilitated renal recovery while reducing vasopressor requirements. Multidisciplinary management, including strict VAP prevention bundle and culture-directed antibiotics, enabled successful extubation. Timely high-volume CRRT combined with comprehensive critical care is crucial in managing complex postpartum septic shock with DKA and AKI.
The Association Between Changes in Red Cell Distribution Width and Mortality Among Sepsis Patients in the Intensive Care Unit at Hasan Sadikin Hospital, Bandung. Hendro, Rachmad Try; Pradian, Erwin; indriasari, indriasari
Syifa'Medika Vol 16, No 2 (2026): Syifa Medika: Jurnal Kedokteran dan Kesehatan
Publisher : Faculty of Medicine

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32502/sm.v16i2.10672

Abstract

Sepsis is a leading cause of mortality, especially in developing countries. Sepsis biomarkers are needed for diagnostic and prognostic purposes to determine therapeutic effectiveness. Currently, available biomarkers are expensive and not all are available, especially in remote areas. Red Cell Distribution Width (RDW) is a laboratory parameter commonly used to diagnose anemia and can describe the variability of red blood cell shape and size. In sepsis, inflammation and oxidative stress occur, resulting in changes in red blood cell age and maturation, which can affect RDW results. This study aims to examine the relationship between trends in RDW results and mortality in sepsis patients. This retrospective, observational, analytical study was conducted on 71 ICU patients at Dr. Hasan Sadikin General Hospital, Bandung, from 2024 to 2025. In this study, patients were divided into two groups: mortality and survival. RDW was assessed on the first and third days in both groups. The results of this study showed that RDW in the mortality group was higher than in the survival group, 80% and 41.9% (p = 0.001). In the mortality group, 85% of patients experienced a statistically significant increase in RDW on the third day compared to the survival group (p=0.0001) with positive moderat correlation (Contingency Coefficient 0.494). This demonstrates a positive moderate relationship between increased RDW and mortality in sepsis patients. Trend of changes in RDW values can be used to assess mortality risk in sepsis patients in the ICU. 
Co-Authors , Rizki - Irwan - Irwan, - - Suhandoko - Suhandoko A. Muthalib Nawawi A. Muthalib Nawawi Adhitya Pratama Agung Ari Budy Siswanto Agung Hujjatulislam Agung Hujjatulislam, Agung Andie Muhari Barzah Andie Muhari Barzah, Andie Muhari Ardi Zulfariansyah Ardi Zulfariansyah Aris Gunawan Baginda Aflah Bahtiar Susanto Bramantyo Pamugar Budi Fitriyana Budi Fitriyana Budi Santosa Budi Santosa Cindy Elfira Boom Dedi Fitri Yadi Delis, Eddo Alan Destiara, Andy Pawana Dhany Budipratama Dian Irawati Doddy Tavianto Doni Arief Rahmansyah Doni Arief Rahmansyah Eddo Alan Delis Emvina Husni Syam Emvina Husni Syam Eri Surahman Eri Surahman Erlangga, Erias Ezra Oktaliansah Faisal Rachman Faisal Rosady Faisal Rosady Fatima Fatima Ferawati Ferawati Gunawan, Aris Hendro, Rachmad Try Hendro, Rachmad Try Hidayat Hidayat Ida Bagus Krisna Jaya Sutawan Ike Sri Redjeki Ike Sri Redjeki Iman Muhammad Yusup Mansur Iman Muhammad Yusup Mansur Indra Wijaya Indriasari Indriasari Indriasari, Indriasari Irwan Setiadi Iwan Fuadi Jonathan Jonathan Kurnia Ricky Ananta Kurniawan, Muhammad Budi Listiana Dewi Sartika M. Andy Prihartono M. Erias Erlangga Maransdyka Purnamasidi Maransdyka Purnamasidi Marrylin Tio Simamora Mohamad Andy Prihartono Mohamad Andy Prihartono Muhammad Budi Kurniawan Muthalib Nawawi Nadya, Siti Fairuz Nawawi, Muthalib Nurita Dian Nurita Dian Kestriani Nurita Dian Kestriani Nurita Dian Kestriani Pamugar, Bramantyo Permana, Sendy Setiawan Putra, Prana Indra Rachmad Try Hendro Radian Ahmad Halimi Rahmat Rahmat Reza Indra Putra Reza Indra Putra, Reza Indra Reza W Sudjud Ricky Aditya Rudi Kurniadi Kadarsah Ruli Herman Sitanggang Selly Oktarina Rosita Selly Oktarina Rosita Sendy Setiawan Permana Sobaryati Supandji, Mia Susanto, Bahtiar Suwarman Suwarman Suwarman Tanto, Dedi Tatang Bisri Tatang Bisri Tatang Bisri Tinni T. Maskoen Tinni T. Maskoen Tinni T. Maskoen Tinni Trihartini Maskoen Yovita Koswara Yovita Koswara