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All Journal SAINS MEDIKA : JURNAL KEDOKTERAN DAN KESEHATAN Jurnal Anestesiologi Indonesia Jurnal Anestesi Perioperatif Indonesian Journal of Anesthesiology and Reanimation (IJAR) Journal of Anaesthesia and Pain Jurnal Kesehatan Tambusai Solo Journal of Anesthesi, Pain and Critical Care Ahmad Dahlan Medical Journal The International Journal of Medical Science and Health Research Jurnal Komplikasi Anestesi
Akhmad Yun Jufan
Department Of Anesthesiology And Intensive Therapy, Faculty Of Medicine, Public Health, And Nursing, Universitas Gadjah Mada, Yogyakarta
Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Dentistry Education Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health Veterinary

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Penggunaan Delta C-Reactive Protein dan SOFA Score Sebagai Prediktor Kematian Pasien Sepsis Nova Maryani; Akhmad Yun Jufan; Yusmein Uyun; Calcarina Fitriani Retno Wisudarti; Untung Widodo
Jurnal Anestesi Perioperatif Vol 11, No 1 (2023)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15851/jap.v11n1.2955

Abstract

Penelitian ini berfokus pada penggunaan skor DELTA CRP dan SOFA dalam memprediksi prognosis pada pasien ICU. Penelitian observasional kohort digunakan sebagai desain. Penelitian dilakukan di RSUP Dr. Sardjito periode Februari–Juli 2019. Sampel dipilih menggunakan teknik pengambilan sampel berturut-turut. Para peneliti mengumpulkan 32 responden dengan sepsis dan syok sepsis yang dirawat di ICU berdasarkan kondisi ini. Skor area under curve (AUC) delta CRP menunjukkan >0,7 (0,780;CI 95%: 0,58–0,97) dengan cut-off 3 (sensitivitas=53,8%, spesifisitas=91%), menyiratkan bahwa CRP delta dapat menunjukkan keadaan pasien sepsis dan syok septik yang memburuk, tetapi kurang sensitif untuk memprediksi kematian. Sementara itu, skor AUC of SOFA >0,7 (0,787; 95% CI: 0,58–0,98) pada hari ke-0 dengan cut-off 8,5 (sensitivitas=76,9%, spesifisitas=81,8%), dan 0,836 (CI 95%: 0,67–0,99) pada hari ke-2 dengan cut-off 6 (sensitivitas=84,6%, spesifisitas=72,7%). Hal ini menunjukkan bahwa skor SOFA dapat memprediksi tingkat kematian prognostik pada pasien yang didiagnosis sepsis dan syok septik di ICU. Baik skor delta CRP dan SOFA memiliki nilai AUC lebih besar dari 0,7, tetapi hanya delta CRP yang memiliki sensitivitas rendah sebagai prognostik kematian.
Relationship Between Simple Oxygen Extraction Ratio to Cardiac Index and Mean Arterial Pressure in Septic Shock Patient Treated in ICU Dr. Sardjito Hospital Yogyakarta helen yudi irianto; Akhmad Yun Jufan; Untung Widodo
Solo Journal of Anesthesi, Pain and Critical Care (SOJA) Vol 3, No 2 (2023): October 2023
Publisher : Fakultas Kedokteran Universitas Sebelas Maret Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/soja.v3i2.76067

Abstract

Background : Oxygen extraction ratio (O2ER)  having any relationship with  cardiac index and mean arterial pressure in septic shock patient.Objective: Discover any relation between simplified oxygen extraction ratio with cardiac index and mean arterial pressure in shock septic condition at ICU of RSUP Dr Sardjito YogyakartaMethod : 32 subject with crossectional study was performed by inclution criteria such as : patient in ICU diagnosed as shock septic, more than 18 years old, inerted cvc in right atrium, inserted arterial line in  arterial radialis or brachialis which connected mostcare. BGA (arterial and venous ) sampel was taken by I-STAT® together with recording mean arterial pressure (MAP) and cardiac index value.Result :  Correlation between O2ER and cardiac index p=0,009 (p<0,05) with r -0,456. Correlation between O2ER and MAP p=0,006 (p<0,05) with r-0,474.Conclusion :Anesthesia management of TGA TGA cases is to avoid reducing cardiac output and SVR and keep the PVR lower than the SVR.
Acute Respiratory Distress Syndrome (ARDS) Management Severe COVID-19 Helen Yudi Irianto; Akhmad Yun Jufan
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 2 (2023): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V5I22023.96-101

Abstract

Introduction: The Coronavirus disease 2019 (COVID-19) caused a global pandemic and many management challenges. Acute Respiratory Distress Syndrome (ARDS) is one of the most common pneumonia complications in COVID-19 cases. ARDS in COVID-19 have worse outcomes and increased risk of intensive care unit (ICU) admission. Objective: This case report aims to recognize and understand ARDS management in a severe COVID-19 case. Case Report: A 68-year-old man with diabetes mellitus and hypertension arrived at the Emergency Room (ER) after experiencing five days of fever, cough, diarrhea with frequency of four times a day, weakness, and a positive antigen result for COVID-19 at admission. Anosmia was absent. The patient had been vaccinated for COVID-19 twice. The main problem was his desaturation of 88%, blood pressure of 156/73 mmHg, heart rate of 80x/minute, and respiratory rate of 20x/minute. However, the patient was alert and admitted to the isolation ward. After 21 days of hospitalization, the patient's condition worsened. The patient developed ARDS and was referred to the COVID ICU for 25 days and 20 days to the non-COVID ICU, where he was intubated, and a tracheostomy was performed. After 45 days of admission to the ICU, the patient's condition improved. Discussion: COVID-19 patients with ARDS should be immediately intubated when conditions such as dyspnea, RR>30x/min, SpO2<92% (for patients with no comorbidities) or <95% (for patients with comorbidities), unconsciousness, or shock appears. Furthermore, other conditions, such as an HR> of 120x/min and a ROX index of <3.851, should be considered an indication for intubation. Conclusion: Timely intubation improves the outcome of COVID-19 patients with ARDS.
Validation of the APACHE IV Score for ICU Mortality Prediction in Dr. Sardjito Hospital During the Pandemic Era Rayhandika; Akhmad Yun Jufan; Yunita Widyastuti; Juni Kurniawaty
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 2 (2023): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V5I22023.72-80

Abstract

Introduction: ICU service quality must continuously improve to provide better patient service. One of these improvement efforts is the use of a risk prediction system to predict mortality rates in the ICU by utilizing risk factors. This system helps healthcare services perform evaluations and comparative audits of intensive services, which can also aid with more targeted planning. APACHE IV is considered to have good validity. However, its predictive capabilities may change over time due to various factors, such as the pandemic, where changes in the case mix may affect its predictive abilities. Therefore, this research tests the validity of APACHE IV on the Indonesian population through Dr. Sardjito Hospital patients. The findings can be utilized for future use and risk stratification, and ICU quality benchmarking. Objective: This study aims to assess the validity of the APACHE IV score in ICU Mortality prediction in Dr. Sardjito Hospital for medical patients, surgical patients, and patients with both cases during the pandemic. Methods: This study used retrospective data from 336 patients at Dr. Sardjito Hospital Yogyakarta from the 1st of January 2020 to the 31st of December 2021. All data required for calculating the APACHE IV score was collected, and the patient's observed ICU Mortality was used. The model's predictive validity is measured by finding the discrimination and calibration of the APACHE IV score and comparing it to the observed ICU mortality. Validation was also conducted separately for medical and surgical cases. Results: APACHE IV shows good discrimination ability in all cases (AUC-ROC 95% CI: 0.819 [0.772-0.866]) but poor calibration (p = 0.023) for mortality prediction in the ICU. For medical cases, the discrimination ability is poor but still acceptable (AUC-ROC 95% CI: 0.698 [0.614-0.782]), and in surgical cases, the discrimination ability is good (AUC-ROC 95% CI: 0.848 [0.776-0.921]). Both cases showed good calibration (p: medical = 0.569, surgical = 0.579) in predicting mortality during the pandemic. Conclusion: APACHE IV showed good discrimination but poor calibration ability for predicting mortality for all ICU patients during the pandemic era. Mortality prediction for surgical cases showed good discrimination and calibration. However, medical cases showed poor discrimination but good calibration.
Lymphocyte Count as Predictor of Covid-19 Patients Mortality and Length of Stay in the Covid ICU of Dr Sardjito Hospital Indra Wijaya, Adi; Jufan, Akhmad Yun; Widodo, Untung
Ahmad Dahlan Medical Journal Vol. 5 No. 1 (2024): May 2024
Publisher : Universitas Ahmad Dahlan

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

Abstract

Covid-19 is an acute infection of the respiratory tract with a variety of clinical manifestations and severity. Lymphocyte count correlates to the severity of Covid-19. This study aims to find the relationship between lymphocyte count, mortality, and length of stay in COVID-19 patients. A retrospective cohort observational studies were conducted using medical records of confirmed COVID-19 patients in RSUP Dr. Sardjito Hospital between 1st January 2021 to 31st December 2021. The lymphocyte count cut-off point as a mortality factor was determined with the ROC curve and Youden’s index. Survival analysis was done using Kaplan Meier to investigate the relation of lymphocyte count to mortality and length of stay. The correlation between lymphocyte count and other factors affecting mortality and length of stay was analyzed with Cox regression. There were 217 subjects who fulfilled the inclusion and exclusion criteria. The cut-off point of lymphocyte count was set at 1.06,103 cells/μL. A total of 121 subjects have a lymphocyte count of <1.06,103 cells/μl. Higher lymphocyte counts (≥1.06,103 cells/μl) showed a reduced risk of mortality (HR 0.570; 95% CI 0.403 – 0.807, p=0.002). The duration of hospitalization was shorter in the group of patients with lymphocyte count <1.06,103 cells/μL OR 0.802, 95% CI 1.032-2.646; p=0.110) with a median of 128.77 hours (12.84 – 983.99 hours), which might be explained by higher mortality (p = 0.000) in the low lymphocyte patients’ group (64.8%). Low lymphocytes <1.06,103 cells/μL in COVID-19 patients is independently and significantly associated with increased risk of mortality and insignificantly associated with shorter length of stay.
Management of restrictive and obstructive lung disease in intensive care unit: a review Listiarini, Dian Ayu; Jufan, Akhmad Yun; Wisudarti, Calcarina Fitriani Retno
Sains Medika: Jurnal Kedokteran dan Kesehatan Vol 15, No 1 (2024): June 2024
Publisher : Faculty of Medicine, Universitas Islam Sultan Agung (UNISSULA), Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30659/sainsmed.v15i1.35660

Abstract

Lung disease is broadly divided into obstructive lung disease (OLD) and restrictive lung disease (RLD). The latter is a disorder of the parenchyma, pleura, thorax, or neuromuscular walls of the lungs, characterized by decreased total lung capacity due to reduced lung distensibility. Meanwhile, OLD causes increased resistance to flow due to the blockage of part or all of the respiratory tract from the trachea to the terminal bronchioles. These two diseases' initial symptoms and signs are common, such as shortness of breath, coughing, cyanosis, respiratory muscle retractions, snoring, and fever. Early detection is needed to recognize differences in symptoms and signs, establish a diagnosis, and carry out appropriate treatment. It is essential to differentiate between RLD and OLD because they have different therapeutic management. This review aims to discuss the management of restrictive and obstructive lung disease in intensive care unit It is drawn upon various sources, including case reports, literature reviews, systematic reviews, and meta-analyses, to provide an overview of the difference between RLD and OLD to help clinicians differentiate between RLD and OLD and provide appropriate therapeutic management. Although RLD and OLD have similar signs and symptoms, they have different pathologic processes. The leading cause of RLD is a pathological condition that causes a decrease in lung compliance. Meanwhile, the primary pathological process of OLD is an increase in airway resistance, which causes typical obstructive symptoms. Addressing this area of interest can help clinicians to provide appropriate management of both pharmacotherapy and mechanical ventilation and monitoring of respiratory mechanisms
Modern Intensive Care Unit Design : A Literature Review Wijaya, Andryadi; Jufan, Akhmad Yun; Adiyanto, Bowo
The International Journal of Medical Science and Health Research Vol. 4 No. 4 (2024): The International Journal of Medical Science and Health Research
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/h3b92933

Abstract

The need for Intensive Care Units (ICUs) continues to increase over time. In Canada, 11% of hospitalized patients are referred to the ICU, while in the United States, up to half of the population receives ICU care in their last year of life. Standardization of ICU design and operations is considered essential for efficiency and high-quality patient care. The ICU is a clinical care unit to monitor and support the vital functions of potentially life-threatening critical patients. The organization and management of critical care services are key components that contribute to ICU performance and can impact patient outcomes and healthcare costs. Modern ICU design should consider various elements such as layout, isolation rooms, staff areas, and family rooms. Technological developments such as Smart ICU and the ICU Without Walls concept demonstrate innovation in efficiency improvement and patient safety. The continuity of care activities in the ICU requires skilled human resources, adequate facilities, effective management, and a deep understanding of good ICU design. Technology integration and multidisciplinary approaches are essential to optimize critical patient care and improve clinical outcomes.
Peran Ultrasonografi dalam Kegawatdaruratan Al-Munawar, Nira Muniroh; FRW, Calcarina; Jufan, Akhmad Yun
Jurnal Komplikasi Anestesi Vol 2 No 2 (2015): Volume 2 Number 2 (2015)
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.v2i2.7212

Abstract

Ultrasonografi (USG) merupakan piranti diagnostik yang memiliki banyak keunggulan, di antaranya menyajikan hasil “real time”, non-invasif, memiliki sensitivitas yang cukup tinggi, dan didukung dengan perlengkapan yang portable. Dengan segala keunggulan itu, USG kini banyak digunakan dalam bidang kegawatdaruratan untuk memberikan diagnostik yang cepat dan akurat sehingga penanganan dini yang sesuai dapat dilakukan. Protokol Rapid Ultrasound in Shock (RUSH) dan Bedside Lung Ultasound inEmergency (BLUE) merupakan protokol yang cukup sederhana dan dapat dilakukan pada situasi gawat darurat, memberikan hasil yang cepat dan sensitif. Dengan cepat dan akuratnya hasil diagnosis yang diperoleh, diharapkan akan memperbaiki outcome pasien instalasi gawat darurat (IGD).
Manajemen Anestesi Bedah Sesar pada Pasien dengan Infeksi HIV Anwar, Yusuf ‘Alim Musthofa; Jufan, Akhmad Yun; Pratomo, Bhirowo Yudo Pratomo
Jurnal Komplikasi Anestesi Vol 3 No 1 (2015): Volume 3 Number 1 (2015)
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.v3i1.7230

Abstract

Telah dilakukan penatalaksanaan anestesi operasi bedah sesar elektif pada pasien wanita berusia 28 tahun primigravida hamil aterm 38 minggu belum dalam persalinan dengan infeksi HIV dalam terapi antiretroviral. Pasien diklasifi kasikan ASA II dan dilakukan anestesi regional teknik blok subarakhnoid dengan obat bupivakin 0,5% hiperbarik 10 mg dengan standar keamanan universal precaution. Dilahirkan bayi perempuan berat lahir 2300 gram, dengan skor Apgar 7/9. Operasi berlangsung selama 1 jamdengan hemodinamik TD 90-130/65-80 mmHg, HR 85-100 x/mnt, SpO2 99-100%, perdarahan 400 cc, produksi urin 100 cc. Paska operasi pasien diobservasi di ruang pemulihan hingga skor Bromage 0 sebelum dikembalikan ke bangsal. (Keterangan: HIV human immunodefi ciency virus; TD tekanan darah; HR heartrate; SpO2 saturasi oksigen).
Duchenne Musculer Dystrophy Jufan, Akhmad Yun; Sari, Djayanti; Mahardieni, Karlina
Jurnal Komplikasi Anestesi Vol 3 No 2 (2016): Volume 3 Number 2 (2016)
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.v3i2.7242

Abstract

Duchenne muscular dystrophy merupakan suatu kelainan otot yang sering ditemui. Penyakit ini terpaut pada kromosom X yang disebabkan oleh mutasi gen dystrophin. Gejalanya berupa kelemahan otot proksimal yang berat, bersifat degenerasi progresif dan infi ltrasi lemak ke otot. Efek duchenne muscular dystrophy terhadap otot respirasi dan berhubungan dengan kardio-miopati yang dapat mengarah ke kematian.Dilaporkan anak laki-laki usia 12 tahun dengan diagnosa duchenne muscular dystrophy dd/ Baker’s muscular dystrophy dilakukan prosedur biopsi. Pasien dinilai sebagai status fi sik ASA 2 yang dilakukan general anesthesia dengan teknik TIVA. Setelah persiapan preoperasi, pasien diberikan ko induksi dengan midazolam 1,5mg, induksi dengan ketamine 20mg. Pemeliharaan anestesi dengan O2 melalui nasal kanul. Hemodinamik durante operasi stabil dengan jalan nafas terjaga dengan kepala ekstensi. Operasiberlangsung selama 20menit. Perdarahan minimal dan urine output 25cc. Kondisi pasien setelah operasi stabil dan kembali ke bangsal.
Co-Authors Adi Wibowo Adiyatma, Krisna Hario Adrin, Olga Elenska Al-Munawar, Nira Muniroh Anwar, Yusuf ‘Alim Musthofa Apriyanto Arifin, Achmad Reza Atmanagara, Dikho Bahrun, Nugraha Septian Bhaktiyar, Agung Bhirowo Yudo Pratomo Bowo Adiyanto Calcarina Fitriani Retno Wisudarti Dewi, Baiq Dessy Resmana Dian Ayu Listiarini Djayanti Sari Fauzi, Rizqi Ahmad Febrianti, Skolastika Rani Firman Ardiansyah FRW, Calcarina Hanafi, Irham Hanafia, Mochamad Fauzi Hartono, Pinter helen yudi irianto Helen Yudi Irianto Indra Wijaya, Adi Juni Kurniawaty Muhdar Abubakar Djayanti Sari Kuncoro, Kusuma Edhi Kusuma, Danur Adi Kusumawardani, Dwi Indriati Mahardieni, Karlina Maryani, Nova Nova Maryani Pradana, Gilar Rizki Aji Prasamya, Erlangga Pratama, Andhika Marthsyal Ratih Kumala Fajar Apsari Rayhandika Sari, Dhanty Dwita Sarosa, Pandit Sudadi Sulistiyantoro, Antonius Catur Sunantara, I Gusti Ngurah Putu Mandela Teguh Setiadi Trijayanti, Christiana Untung Widodo Untung Widodo Untung Widodo, Untung Utami, Vengky Wibowo, Catur Prasetyo Wibowo, Erry Alamsyah Asjhuri Wijaya, Andryadi Yuliani, Irma Yunita Widyastuti Yusmein Uyun Zulfakhri, Zulfakhri