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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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Hubungan Nilai “Lung Ultrasound Score (LUS)” dengan P/F Ratio pada Pasien Pneumonia yang Dirawat di ICU RSUP Dr Sardjito Wibowo, Catur Prasetyo; Wisudarti, Calcarina Fitriani Retno; Jufan, Akhmad Yun
Jurnal Komplikasi Anestesi Vol 7 No 2 (2020): Volume 7 Number 2 (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.v7i2.7448

Abstract

Background: Respiratory tract disease (about 22.4%) is the frequent reason of admitting patients to the Intensive Care Unit (ICU), with 72.6% of it is caused by infection, such as pneumonia. On patient with pneumonia, there will be impairment in oxygen diffusion from alveoli to the blood flow that can affect the P/F ratio. Lung ultrasonography is directly proportional to the degree of pulmonary aeration or the ratio of air to liquid composition in the lung. Changes in pulmonary aeration can be detected accurately using pulmonary ultrasonography. Objectives: Knowing the relationship of “Lung Ultrasound Score (LUS)” with P/F ratio as a parameter to assess the degree of oxygenation in pneumonia patients treated at ICU Dr. Sardjito General Hospital. Methods: The design of this study was cross sectional study. In this study, every single sample will be examined only one time to obtain Lung Ultrasound Score (LUS) and arterial blood gas analysis (BGA) sampling to get the P/F ratio. LUS measurement was done by performing pulmonary ultrasonography at 12 predetermined examination points (6 in the left hemithorax and 6 in the right hemithorax) then scoring (0-3) per examination point, the total scoring from the 12 examination points is the result of the LUS sample. Inclusion criteria in the subjects of this study were >18 years of age, diagnosed pneumonia (score ≥6 from CPIS score), intubated with mechanical ventilation, and the candidate could be mobilized slightly right and left incline. While exclusion criteria were, patients with unstable hemodynamics (HR <60x / min or>130x / min and MAP <70mmHg or>120mmHg), pulmonary trauma, patients undergoing hemodialysis, there are contraindications to the oblique position (spinal cord injury), patients with wound dressing on the chest, and patients with morbid obese (BMI> 40). Results: There were 60 subjects in this study. Patient observation pointed that have high P/F ratio values tend to have lower Lung Ultrasound Score (LUS) values. Based on the correlation results, the value of p = 0.010 (p <0.05) with the correlation coefficient (r) = -0.332 had a negative sign which means there is a significant negative correlation between the value of Lung Ultrasound Score (LUS) with the P / F ratio with the closer relationship of the category weak (0.2 - 0.399). Conclusion: The higher the P/F ratio, the lower the LUS value in patients with pneumonia who were getting mechanical ventilation in ICU Dr. Sardjito.
Perbandingan Antara Nilai Indeks Variasi Gelombang Plethysmography dengan Nilai Variasi Tekanan Pulsasi Arteri pada Pasien dengan Ventilasi Tekanan Positif di ICU RSUP Dr. Sardjito Bhaktiyar, Agung; Widodo, Untung; Jufan, Akhmad Yun
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.v7i3.7470

Abstract

Background: Pulse pressure variations (PPV) provide a good assessment of fluid status but require the installation of arterial line with high cost, difficult installation, and the risk of complications in the form of tissue death as well as infection. Meanwhile, the plethysmography variation index which has similarities to the pulse pressure variation that arises due to arteriolar pulses and is influenced by the breathing cycle, but is non-invasive, easy to apply, cheaper material, and without the risk of tissue death or infection. Methods: This study uses a prospective observational study design. We measured pulse pressure variation and plethysmography variability index (PVi) in 22 patients mechanically ventilated with preexisting radial artery catheter in intensive care unit (ICU). PPV was obtained by installing radial arterial line connected to Mostcare®. PVi was obtained by installing an oximetry probe on fourth finger and connected to the Masimo® monitor. We compared PPV and PVi using Mann-whitney test and looked for correlations with the spearman coefficient. Result: Twenty-two patients (SAPS II = 1.74 (0.4-75) had PPV values of 11.7 (7.03) and PVi 13.29 (7.76) different but were not statistically significant p = 0.405 (p> 0.05). There was a moderate correlation between PPV and PVi (r = 0.55). Four of the 22 patients receiving noreepinephiren (dose = 0.125 mcg / kg / min (0.1- 0.15)) showed no correlation between PPV and PVi (r = 0.40 p = 0.60). Conclusion: There was no significant difference between the value of the pulse pressure variation and the plethysmography variability index (PVi). There was a moderate correlation between the pulse pressure variation with the plethysmography variability index. There was no correlation between PVi and PPV in patients receiving norepinephrine.
Manajemen dan Stabilisasi Pasien dengan Edema Paru Akut Jufan, Akhmad Yun; Adiyanto, Bowo; Arifin, Achmad Reza
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.v7i3.7475

Abstract

Acute pulmonary edema is a condition when there is accumulation of fluid in the lungs (insterstitial space and alveoli). This fluid fills the alveoli in the lungs which makes it difficult for someone to breathe. The most common cause of pulmonary edema is caused by heart problems. However, the accumulation of fluid in the lungs can be caused by several reasons including pneumonia, some poisons, or drugs. The number of deaths for one year for patients hospitalized with acute pulmonary edema reaches 40%. The most common causes of acute pulmonary edema include myocardial ischemia, cardiac arrhythmias (eg atrial fibrillation), cardiac valve dysfunction and excess fluid volume. It can also be caused by other causes including pulmonary embolism, renal artery stenosis, non-compliance with previous disease treatments and side effects from medications can also trigger pulmonary edema. Management in patients with pulmonary edema we first look for diseases that underlie the occurrence of edema. Because it is a very important factor in treatment, so it needs to know the cause immediately. Because specific therapy cannot always be given until the cause is known, supportive therapy is very important. The general goal is to maintain basic physiological and cellular functions. Namely by improving the airway, adequate ventilation, and oxygenation
Manajemen Pasien Leptospirosis di ICU Jufan, Akhmad Yun; Widodo, Untung; Bahrun, Nugraha Septian
Jurnal Komplikasi Anestesi Vol 8 No 1 (2021): Volume 8 Number 1 (2021)
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.v8i1.7490

Abstract

We reported a 54-year-old male patient with leptospirosis, septic shock, and MODS. Patient is referred from RSUD Prambanan with chief complaint of high fever accompanied by yellow eyes and body, headache, calf pain, body aches rheumatic pain, nausea, vomiting, shortness of breath, and tea colored urine. From history taking, it was found that there was a possibility of a history of contact with animals that were the source of transmission of leptospirosis, namely rats. The patient was treated in the ICU for several days. During treatment, hemodialysis was performed several times due to an increase in blood urea. After being treated for several days, the patient’s condition improved and treatment was carried out on the ward by internist.
Manajemen Nutrisi pada Pasien ICU yang Menjalani Prosedur Esofagektomi Widodo, Untung; Jufan, Akhmad Yun; Adrin, Olga Elenska
Jurnal Komplikasi Anestesi Vol 10 No 2 (2023): Volume 10 Number 2 (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.v10i2.8297

Abstract

Patients in intensive care are generally exposed to catabolic stress with complications that increase morbidity and mortality, and affect the length of stay in the intensive care unit. Optimal nutritional management can help enhance the metabolic response to stress, prevent oxidative cellular injury, and modulate the immune response. We reported a 30 years old male underwent an esophagectomy procedure due to esophageal tumor. After the third day of surgery the patient was given enteral nutrition, there was a brownish residue in the nasogastric tube, in exchange of this condition, parenteral nutrition was given until the tenth day of intensive care. Enteral nutrition was continued on the tenth day of care until the patient transferred to the ward on the thirteenth day in the intensive care unit.
Manajemen Pasien dengan Hoarseness Paskatiroidektomi Total Dipacu Kusuma, Danur Adi; Pratomo, Bhirowo Yudo; Jufan, Akhmad Yun
Jurnal Komplikasi Anestesi Vol 10 No 1 (2022): Volume 10 Number 1 (2022)
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.v10i1.8324

Abstract

look at the clinical appearance of the patient who appears hoarse after extubation, thevoice becomes softer, the ability to cough is not strong but the respiration rate is stillnormal 18 times/minute with a saturation of 98% then The probability of injury isunilateral. Pathophysiologically hoarseness can mean there is a possibility of injury toeither the bilateral superior laryngeal nerve or unilateral recurrent laryngeal nerve (RLN).Then the possibility of injury is unilateral RLN unilateral in this patient. Ideally thedifferential diagnosis of postoperative hoarseness requires examination such as simplelaryngoscopy, stroboscopy or intra and extralaryngeal electromyography. In practice it isdifficult to distinguish between damage caused by thyroid surgery and anaestheticfactors. There are a number of anesthetic-related factors that may predispose to hoarseness in these patients such as the risk of doubling in patients who are intubated for3-6 hours (in patients 3.5 hours). This could be ruled out if we could measure the ET cuffpressure during surgery. While from the surgical factor there are several risk factors suchas surgery on the neck area (thyroid surgery), excessive neck extension during surgery,pulling the RLN causing injury. In the last operation the position of the neck extended, forRLN in the operation report has been identified. It is better to assess vocal cord functionprior to extubation, such as a cuff leak test or insertion of a flexible intubation scopethrough the lumen of the ET tube.
Diagnosis dan Tata Laksana Sepsis Maternal Jufan, Akhmad Yun; Wisudarti, Calcarina Fitriani Retno; Atmanagara, Dikho
Jurnal Komplikasi Anestesi Vol 10 No 1 (2022): Volume 10 Number 1 (2022)
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.v10i1.8328

Abstract

Maternal sepsis is a common and potentially preventable cause of direct maternal death globally. A barrierto further progress has been the lack of consensus on the definition of maternal sepsis. Recognition and treatment of maternal sepsis are often delayed due to the physiological adaptations of pregnancy and vague or absent signs and symptoms during its initial presentation. Over the past decade, our understanding of sepsis has evolved and maternal early warning systems have been developed in an effort to help providers promptly identify and stratify parturients who are at risk. In addition, new consensus definitions and care bundles have recently been published by the World Health Organization and the Surviving Sepsis Campaign to facilitate earlier recognition and timely management of sepsis. Standardizing the criteria for maternal sepsis optimizes clinical finding. It may facilitate the evaluation of the role of different clinical parameters and biomarkers in the diagnosis, earlier recognition and management of maternal infection and sepsis. Further work is required to develop an international consensus on the criteria for diagnosing maternal sepsis and any associated organ dysfunction. In this narrative review, we summarize the available evidence about sepsis and provide an overview of the research efforts focused on maternal sepsis to date.
Manajemen Ekstubasi pada Pasien dengan Jalan Nafas Sulit Perioperatif Adiyanto, Bowo; Jufan, Akhmad Yun; Adiyatma, Krisna Hario
Jurnal Komplikasi Anestesi Vol 9 No 2 (2022): Volume 9 Number 2 (2022)
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.v9i2.8341

Abstract

Tracheal extubation is a critical step during emergence from general anesthesia. Good management of extubation is needed to prevent undesired complication including laryngospasm, hypoxia, airway injury. Patient with difficult airway is at risk during intubation and extubation period, so the knowledge about it is necessary.
Identifikasi Faktor Risiko Kematian di ICU RSUP Dr. Sardjito Ardiansyah, Firman; Widyastuti, Yunita; Jufan, Akhmad Yun
Jurnal Komplikasi Anestesi Vol 9 No 2 (2022): Volume 9 Number 2 (2022)
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.v9i2.8345

Abstract

Background: ICU is one of patients care unit that is costly and have limited capacity. Thus, time spending, man resources and tools should be allocated wisely based on the needs of the patients that would be admitted to ICU. One of the means that can be used to increase care quality of the ICU is creating a risk prediction system to assess and analyze risk factors that associated with mortality in ICU. This system makes comparative assessment and intensive care evaluation can be done. For the first step, we need to identify risk factors that affect mortality in ICU, that can be used as a new scoring models. Methods: This study based on 356 patients that admitted to ICU RSUP dr. Sardjito from 1 January to 31 December 2019. In this cohort retrospective study, variables will be tested with regression logistics test, with univariable and multivariable approach. From this test, we achieved variables that identified as risk factors of mortality in ICU. Those identified variable undergo assessment of strength as a predictor with Area Under The Curve (AUC) method. If we find that, the discrimination strength is quite strong, we continue the test with calibration test using Hosmer-Lemeshow to achieve compoarative value within observed and expected mortality. The whole statistic process use SPSS application version 26.0. Results: Factors that identified as risk factors for mortality in the ICU Dr.Sardjito Hospital were intraoperative use of vasopressor/inotropic drugs drugs, respiratory failure, GCS (Glasgow Coma Scale) decrease, kidney failure and intraoperative PRC transfusion with p < 0.005 in both univariable and multivariable tests. The AUC for mortality prediction in this study was 0.896 (95% CI; 85,3-94%). This value is classified as strong as a predictor factors, so it is continued to the calibration test with Hosmer-Lemeshow test and showed a p value of 0.53 (p > 0.05) which means that this risk prediction factors has a good fit between the observed and the expected. Conclusion: The intraoperative use of vasopressor/inotropic drugs, respiratory failure, GCS decrease, kidney failure and intraoperative PRC transfusion are predictive factors for mortality in the ICU Dr.Sardjito Hospital. The discrimination ability of these factors is strong and also have a good fit in predicting the incidence of mortality in the ICU Dr.Sardjito Hospital.
Pengaruh Fisioterapi Terhadap Parameter Hemodinamik pada Pasien Kritis Di ICU RSUP Dr. Sardjito Hanafi, Irham; Sari, Djayanti; Jufan, Akhmad Yun
Jurnal Komplikasi Anestesi Vol 9 No 2 (2022): Volume 9 Number 2 (2022)
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.v9i2.8346

Abstract

Background: Critically ill patients undergoing treatment in the ICU experience long-term immobilization. Giving physiotherapy to patients is a recommendation to mobilize critically ill patients early to prevent complications. Monitoring vital signs is important to ensure that physiotherapy is safe and that the patient is protected from the adverse effects of physiotherapy. The recording of hemodynamic changes has never been done in Dr. Sardjito General Hospital. Objective: To determine the effect of passive motion physiotherapy on hemodynamic parameters in critically ill patients admitted to the ICU. Method: This study used a quasi-experimental interventional design. Patients who entered the inclusion criteria were patients who were treated in the ICU and aged over 18 years in June and July 2021. Hemodynamic data were taken from bedside monitors and ICON devices. Results: The number of research subjects was 32 patients. Passive motion physiotherapy resulted in a lower SVV value (10.84 ± 6.19; p = 0.014) than at baseline (12.91 ± 6.19) and after rest (12.25 ± 5.21). Other parameters, HR, RR, SBP, DBP, MAP, SV, SI, CO, CI, SVR, and DO2 did not produce statistically significant changes. Conclusion: Passive motion physiotherapy has no effect on hemodynamic parameters in critically ill patients admitted to the ICU Dr. Sardjito General Hospital. Passive motion physiotherapy resulted in lower SVV compared to baseline and resting conditions.
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