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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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Predictors of Severity and Management of Severe Leptospirosis Patients in Intensive Care Unit Kusumawardani, Dwi Indriati; Jufan, Akhmad Yun
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 1 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.62735

Abstract

Background: Severe leptospirosis or Weil's syndrome occurs in 10% of leptospirosis cases, with a mortality rate of 5-40%. Misdiagnosis of leptospirosis often occurs due to nonspecific symptoms. Discussion of risk factors, causative agents, pathogenesis, clinical manifestations, diagnostic techniques, and predictors of disease severity are crucial for successful management.Cases: We report 3 cases of leptospirosis with various clinical manifestations and management. In these 3 cases, older age was associated with severe leptospirosis and poor outcomes. The SPiRO score can identify patients with severe leptospirosis requiring intensive care. All three cases of leptospirosis were severe with complications in the kidneys, lungs, and hematological system requiring intensive care in the intensive care unit (ICU).Discussion: Early and appropriate management can reduce patient mortality rates. ICU management of leptospirosis includes antibiotics, fluid balance, and support for affected organs. Patients with respiratory failure are given oxygenation using high-flow nasal cannula (HFNC), non-invasive ventilation (NIV), or invasive mechanical ventilation with endotracheal intubation (ETT). Acute kidney failure in leptospirosis can be managed with hemodialysis as indicated or may improve with conservative therapy. Corticosteroids may be administered for thrombocytopenia associated with leptospirosis.Conclusion: The three cases of leptospirosis were severe with complications in the kidneys, lungs, and hematological system requiring intensive care in the ICU. Early and appropriate management can reduce patient mortality rates. In these 3 cases, older age, mechanical ventilation, acute kidney failure, septic shock, thrombocytopenia, and elevated transaminase enzymes were associated with severe leptospirosis and poor outcomes.
MANAJEMEN ARDS PADA PASIEN SINDROM MEIGS DI ICU hanafia, mochamad fauzi; Jufan, Akhmad Yun; Prasamya, Erlangga
Jurnal Kesehatan Tambusai Vol. 6 No. 2 (2025): JUNI 2025
Publisher : Universitas Pahlawan Tuanku Tambusai

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/jkt.v6i2.45875

Abstract

Sindrom Meigs merupakan tumor jinak ovarium disertai asites dan efusi pleura yang dapat memicu komplikasi sistemik, termasuk Acute Respiratory Distress Syndrome (ARDS). Laporan ini membahas tantangan tatalaksana ARDS pada pasien sindrom Meigs dengan kontraindikasi operasi akibat instabilitas hemodinamik. Pasien dirujuk dengan rencana operasi pengangkatan tumor ovarium, namun mengalami perburukan kondisi akibat efusi pleura masif, hipoalbuminemia (2,53 g/dL), dan syok septik. Kriteria ARDS berat (rasio PaO₂/FiO₂ 85,71) ditegakkan berdasarkan analisis gas darah dan pencitraan toraks. Tatalaksana meliputi ventilasi mekanik mode Synchronized Intermittent Mandatory Ventilation (SIMV) dengan Positive End-Expiratory Pressure (PEEP) 5-8 cmH₂O dan tidal volume 4-6 mL/kgBB ideal (191-287 mL), terapi antibiotik meropenem, koreksi hipoalbuminemia dengan albumin 20%, serta nutrisi enteral dan parenteral. Manajemen ARDS pada sindrom Meigs memerlukan pendekatan multidisiplin dengan fokus pada optimasi ventilasi protektif, koreksi gangguan onkotik, dan kontrol infeksi. Meskipun protokol tatalaksana sesuai pedoman, prognosis tetap ditentukan oleh respons individu terhadap terapi dan komorbiditas penyerta.
MANAJEMEN PASIEN DENGAN SYOK SEPSIS, CONGESTIVE HEART FAILURE, CORONARY ARTERIAL DISEASE, CHRONIC KIDNEY DISEASE POST FISTULEKTOMI DI ICU wijaya, andryadi; Jufan, Akhmad Yun; Prasamya, Erlangga
Jurnal Kesehatan Tambusai Vol. 6 No. 2 (2025): JUNI 2025
Publisher : Universitas Pahlawan Tuanku Tambusai

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/jkt.v6i2.45876

Abstract

Sepsis merupakan kondisi disregulasi sistem imun akibat infeksi dengan angka mortalitas tinggi yang dapat mencapai 26%. Komplikasi seperti Acute Kidney Injury dapat meningkatkan risiko kematian hingga 50%. Masalah utama dalam manajemen sepsis adalah kompleksitas penanganan pasien dengan komorbid multipel seperti gagal jantung kongestif (CHF) dan chronic kidney disease (CKD). Tujuan penelitian ini adalah mengevaluasi manajemen dan luaran klinis pasien dengan syok sepsis disertai komorbid CHF dan CKD post fistelektomi di ruang intensif. Kasus: Pasien menjalani fistelektomi drainase dan dirawat di ICU dengan dukungan ventilasi mekanik, vasopresor (norepinefrin, dobutamin, epinefrin), dan antibiotik spektrum luas (meropenem). Pemeriksaan laboratorium menunjukkan leukositosis signifikan, anemia, hipoalbuminemia, serta gangguan fungsi hati dan ginjal. Setelah empat hari perawatan intensif dengan monitoring hemodinamik ketat, pasien menunjukkan perbaikan klinis, berhasil diekstubasi, dan direncanakan pindah ke ruang perawatan biasa. Simpulan: Manajemen pasien dengan syok sepsis disertai komorbid CHF dan CKD memerlukan pendekatan multidisiplin yang komprehensif. Kontrol sumber infeksi melalui pembedahan, terapi sepsis sistematis, dan pemantauan ketat di ruang intensif berperan penting dalam meningkatkan luaran klinis dan survival pasien.
Multidisciplinary Management of Severe Hemorrhagic Stroke with Triple Challenge: Subarachnoid Hemorrhage, Intracerebral Hemorrhage, and Hydrocephalus-A Case Report Wijaya, Andryadi; Jufan, Akhmad Yun
Journal of Anaesthesia and Pain Vol. 6 No. 3 (2025): In Press
Publisher : Faculty of Medicine, Brawijaya University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jap.2025.006.03.05

Abstract

Background: Hemorrhagic stroke, particularly subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), is a neurological emergency associated with high morbidity and mortality, especially when complicated by increased intracranial pressure (ICP). This report aims to describe the comprehensive management of a patient with severe hemorrhagic stroke complicated by SAH, ICH, and hydrocephalus Case: This case report describes the management of a 69-year-old female with extensive SAH, ICH, ruptured anterior communicating artery aneurysm, and obstructive hydrocephalus. The patient presented with decreased consciousness post-seizure. Initial management included emergency external ventricular drain (EVD) placement and subsequent surgical clipping of the aneurysm. Non-invasive ICP monitoring using optic nerve sheath diameter (ONSD) demonstrated a reduction from 0.68 cm to 0.49 cm over seven days, reflecting successful ICP control. Complications included vasospasm managed with nimodipine, hypernatremia and polyuria suggestive of central diabetes insipidus treated with desmopressin, and nosocomial pneumonia due to serratia marcescens. Antibiotic therapy was escalated from ceftriaxone to meropenem and de-escalated to cefepime based on culture results. Despite optimal intensive care, the patient showed no significant neurological improvement (persistently low Glasgow Coma Scale [GCS]) and failed ventilator weaning. Given a poor prognosis (WFNS grade 4, Hunt & Hess grade 4, ICH score 3), the patient was transitioned to palliative care.  Conclusion: This case highlights the importance of multidisciplinary management, non-invasive ICP monitoring, and timely transition to palliative care in severe hemorrhagic stroke.
Acute Respiratory Distress Syndrome (ARDS) Management Severe COVID-19 Irianto, Helen Yudi; Jufan, Akhmad Yun
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; Widyastuti, Yunita; 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.
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 Indra Wijaya, Adi Irianto, Helen Yudi 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